TMS Shows Promise in Treating Depression

July 14, 2023

Amber Crawford had lost hope that she’d ever find a treatment for depression that worked for her.

Diagnosed at age 22, Crawford said her depression has impacted many aspects of her life, including her relationship with family members. The mother of twins (and grandmother of one) said when she first came to Dr. Vijay Dalai, psychiatrist at Mercy Clinic Behavioral Health – Fort Smith, she was “at the bottom of a very black hole.”

“I had given up, basically, on ever feeling better. I had resigned myself to the fact that this was my life – I would feel bad until I die,” said Crawford, 45, a Fort Smith resident. “I went through a really dark time in December and January. I felt so bad that I didn’t want to see people; I didn’t want to talk to anybody. I was failing at my job, and my marriage was failing. I had lost the close relationship I always had with my children, my sister and my mom. I sat in the dark and just ignored life.”

Mercy doctor's coat Dr. Vijay Dalai visits with patient Amber Crawford at Mercy Clinic Behavioral Health - Fort Smith.

By her own estimate, Crawford had tried “probably 20” different types of medication to help treat her depression since her diagnosis. She eventually had genetic testing done and found out she has defects that caused her not to respond to the medication she was taking.

It was time to take a different approach.

Dr. Dalai suggested Crawford consider transcranial magnetic stimulation (TMS) treatments, a new option for patients at the Mercy Fort Smith clinic. TMS treatments use magnetic fields to stimulate specific nerve cells in the brain. The noninvasive procedure is done at the clinic during a series of appointments.

For Crawford, the treatment has made a huge difference in her life.

“From the very first time I came to Dr. Dalai’s office, I could tell that he’s a fighter and that he actually wanted me to feel better,” she said. “I was hopeful he could help me, but I didn’t have a lot of faith. I had tried so many other things in the past. It just seemed like nothing worked.” After TMS treatments, Crawford said, “I got to the point I felt like I was annoyingly happy, which was a new feeling for me.

“I remember the first day that I actually felt good,” she said. “I told my husband, ‘I feel good, and I don’t really know what to do with this.’ It had been years since I had a single day when I felt good.”

For most patients, the positive results are the accumulative effect from a series of TMS treatments. Dr. Dalai said each of his 20 patients who have undergone TMS treatments has shown positive results. Mercy Fort Smith began offering TMS in early 2023 and is the only location in Sebastian County, Arkansas, to do so, although there are other locations in northwest and central Arkansas offering the treatments. Additionally, other Mercy locations including Springfield, Missouri, will begin offering the treatments. Purchase of the equipment in Fort Smith was funded by Mercy Health Foundation.

“Depression is a chronic problem, and we have seen several patients try multiple medications who are still having a lot of symptoms,” he said. Any patient who has tried more than two adequate types of medication along with psychotherapy is considered a treatment-resistant depression patient, he said. 

Mercy doctor's coat Dr. Dalai adjusts the TMS machine for patient Amber Crawford.

How it works

TMS is a non-invasive neurostimulation technique that has gained significant attention in the field of neuroscience and psychiatry. It involves the application of focused magnetic fields to specific regions of the brain, with the aim of modulating neural activity and promoting therapeutic effects.

TMS treatments were first approved by the FDA in 2008 and work by stimulating the left dorsolateral prefrontal cortex. Dr. Dalai said MRI studies have shown this particular part of the brain can be more or less active depending on each individual.

During a typical TMS session, a coil containing a wire carrying an electric current is placed on the scalp of the individual undergoing the procedure. The coil generates a rapidly changing magnetic field, which penetrates the scalp and skull, reaching the targeted brain region. This magnetic field induces small electrical currents in the neural tissue, thereby influencing the firing patterns of neurons in the targeted area.

One of the key advantages of TMS is its ability to selectively stimulate specific brain regions while leaving surrounding areas unaffected. This precision allows researchers and clinicians to target regions implicated in various neurological and psychiatric disorders, such as depression, anxiety, schizophrenia, and chronic pain.

As a non-invasive and relatively painless technique, TMS offers several advantages over more invasive brain stimulation methods. It does not require anesthesia or surgery and can be performed in an outpatient setting, allowing for convenience and flexibility in treatment.

The treatments can be time-consuming, with a patient like Crawford spending about 30 minutes a day at the clinic over the course of several weeks. However, Dr. Dalai said there are many advantages to the treatments, as they are completely painless and noninvasive and no hospitalization is required. Most patients tolerate TMS well with few side effects, which may include a mild headache.

“I did treatments every day, Monday through Friday, for six weeks, then three weeks of tapering,” Crawford said. “With every treatment, I continued to feel better and better and better. I wasn’t sure what was happening in my brain, but I knew I liked it.”

Dr. Dalai reiterated that before any treatments begin, he must get to know the patient.

“The first thing I do is spend a lot of time with my patients. That’s the most important thing,” he said. “This is a patient population that has tried so many medications with multiple providers and tried psychotherapy. They are frustrated with their depression treatment and recovering from their problem. So I do spend a lot of time with them and get the complete history with the patient and look at how many medications they’ve tried and how adequate the medication trials are. I try to rule out everything and be as thorough as possible. That creates a lot of hope for the patient.”

Dr. Dalai also explains TMS thoroughly before scheduling a patient to begin the treatment, emphasizing the significance of personalized care in the TMS treatment process. Spending ample time with each patient, he thoroughly evaluates their medical history, medication trials, and previous treatment experiences. This comprehensive approach fosters a sense of hope and empowers patients to explore new possibilities for recovery.

mercy-fs-dalai-tms Amber Crawford and Dr. Dalai demonstrate TMS therapy.

“This is the patient population that has tried and tried so many medications, seen multiple providers and may be hospitalized in the past due to this chronic major depressive disorder," he explained. "They are frustrated with their depression treatment and recovering from their problem. So, I do spend a lot of time with them and get the complete history with the patient and look at how many medications they’ve tried and how adequate the medication trials were.”

Not all patients will benefit from TMS. Dr. Dalai said between 65 and 70% of patients are expected to show positive results. However, each patient Dr. Dalai has seen in Fort Smith has made progress with their depression through TMS. Studies are underway to see if patients suffering from PTSD, OCD or other conditions could benefit. Most insurance companies have covered the treatments or a portion of them, but prior authorization is required. Recommended treatment can be different for each patient.

The therapy's effectiveness can vary between individuals, and further research is still being conducted to optimize treatment protocols and understand its long-term effects fully. Additionally, TMS is not suitable for everyone, and proper assessment and guidance from healthcare professionals are necessary to determine if an individual is an appropriate candidate for the procedure.

For Crawford, the best part of overcoming depression is having her family notice the positive changes.

“Dr. Dalai has completely changed my life,” she said. “I feel good now, my marriage is good, my relationship with my kids is good. My friends and family tell me I look different and how nice it is to see me happy and to be able to hear in my voice that I’m happy.”

Crawford continued, “When there is a treatment available that has the possibility of helping a person feel better, especially a person like me who had given up on ever feeling better, I hope they reach out to Dr. Dalai. This treatment has saved me. This treatment is a miracle. I feel like God sent me here. He knew there was better for me in the future. I feel so blessed to have received this.”