Treatment Resistant Depression.

Despite trial of multiple oral antidepressants, augmentation strategies and psychotheray approximately 1 in 3 patients do not achieve remission in depression.

FDA has approved 3 advanced treatment options.  They are 

1) ECT (elctroconvulsive therapy)

2) Repetitive Transcranial Magnetic Stimulation ( rTMS) and

3) Esketamine (marketed as Spravato)

ECT is very effective, but can only be provided in a hospital setting. It requires food and water abstinence for approximately 12 hrs. A lot of patients also complain of memory problems. 

Transcranial Magnetic Stimulation was approved by FDA in 2008 for Unipolar Major Depressive Disorder. It is safe, effective, has minimum side effects and is covered by almost all insurances. We recently treated an individual who was referred by his PCP for dysphoric mood and a long list of medical problems. He couldn't tolerate any medication they had given him.

He was skeptical about TMS when this idea was presented to him. After consulting with his health care team --Neurologist, Endocrinologist, GI doctor and of course his PCP regarding TMS, he finally agreed to proceed with it. At the end of 36 treatments this patient's PHQ-9 score was down to 7 which is one of the lowest that I have ever seen. 

Here at Suburban Behavioral Health. we have been treating patients with TMS since mid 2020. We have more success stories to share. 

In the next blog I will write about our success stories with ESKETAMINE. 

Author
Mazhar Golewale MD Board Certified Psychiatrist and Medical Director of Suburban Behavioral Health Services

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