According to the National Institute of Mental Health, an estimated 17.3 million adults in the United States, or 7.1%, had at least one major depressive episode in 2017. And, it’s estimated that between 15% and 33% of patients who seek help for major depressive disorder will not respond to multiple interventions. That’s classed as suffering from “treatment-resistant depression” (Little, 2009).
To patients and their families, “treatment resistant” usually means they are at their wits end. They’ve tried everything they know of to find sustainable relief from depression, chronic pain, drug abuse or misuse. When traditional combinations of medication, psychotherapy, and/or lifestyle changes (sleep, nutrition, exercise, etc.) aren’t enough, it may be time to consider other options.
One of those options is Combination Therapy with Transcranial Magnetic Stimulation (TMS or rTMS) and Ketamine, a novel patented therapy pioneered by Dr. Steven Best, Founder and Director of The Neuroscience Center in Deerfield, IL. Both TMS and infused ketamine are individually recognized treatments for patients suffering from depression. The Neuroscience Center is helping patients achieve sustained relief with a research informed combination of the two.
“Over 90% of patients we’ve treated with this approach in our clinic were able to reach some form of remission, whether that be returning to work, not being on disability or repairing broken relationships,” says Dr. Best, a Board Certified psychiatrist with additional training in psychopharmacology, brain imaging and TMS.
About Transcranial Magnetic Stimulation (TMS or rTMS)
TMS is approved by the US Food and Drug Administration (FDA) for the treatment of treatment resistant depression (Perera et al., 2016). It is considered a well-tolerated, non-invasive therapy with relatively mild side-effects. TMS uses a specifically designed coil placed in contact with the head that eventually induces an electrical current in the cortex that alters local and remote electrophysiological activity.
Patients treated with TMS have shown neural changes in the frontal and limbic regions associated with major depressive disorder, without inducing changes in the normal healthy parts of the brain (Rodger et al., 2012).
About Ketamine for Depression
Ketamine was approved by the FDA as an anesthetic for anesthesia in the 1960’s. Studies, including from the National Institutes of Health, also affirm its effect as an analgesic to treat pain. Research also has shown that ketamine, when administered intravenously, can be used safely and easily for acutely dangerous depressive illness. It offers antidepressant relief within four hours post-infusion (Zarate et al., 2006).
Although studies of ketamine have shown the treatment to be rapid, the relief may be briefer in nature, with relapse typically occurring within one week. And, most studies do not test for remission beyond seven days following treatment (McGirr et al., 2014; Newport et al., 2015).
The Benefits of Combined Therapy with TMS and Ketamine
Individually, both TMS and ketamine treatments have been shown to offer some patients relief from treatment resistant depression symptoms.
Our goal at The Neuroscience Center is to find the most sustainable or semi-permanent relief over the shortest length of time. For many, coming into a clinic seven days a week for three to four hours a day to get appropriate, patient tolerable levels of TMS treatment is not feasible. That’s where the combination of therapies has a substantial benefit: The coincident administration of ketamine allows for higher TMS intensities than otherwise would be tolerated by patients.
How It Works
The treatment is administered by a neuropsychiatrist experienced in administering TMS, along with an anesthesiologist or certified registered nurse anesthetist to administer the ketamine. Five minutes after the commencement of TMS, the ketamine infusions begin. The IV ketamine infusion is delivered in a standard commercial formulation over a period of 20 minutes. Following the completion of the ketamine infusion, the TMS would continue for a further 5 minutes, after which the full procedure is complete.
“The analgesic effect of ketamine appeared to increase the tolerability of TMS, which allowed the output power to the head coil to be raised to unusually high intensity,” said Dr. Best about this successful approach in his recently published two-year study (read the full article here).
The combined approach yields the rapid onset of relief commonly experienced with ketamine infusions, with the longer-term benefits observed with TMS treatments. And, with fewer treatment sessions overall, patients are more likely to adhere to the ketamine protocol leading to the effective treatment of treatment-resistant depression with lasting remission.
Learn More about Combined TMS and Ketamine Therapy for Treatment of Depression and Chronic Pain
Typical temporary relief of symptoms from ketamine is two to seven days. However, with the combined TMS and ketamine therapy, patients are finding over two years of relief. Many have gotten to a place where they would be considered “recovered,” in that they are back to work, engaged with family and not using large doses of drugs or alcohol.
Do you know someone who is suffering from treatment resistant depression or pain? Please share this news with those who might need it, whether it’s a professional medical referral or a friend or loved one you know is struggling.
Here Are Three Ways to Learn More
- Read the full article here: “Combination therapy with transcranial magnetic stimulation and ketamine for treatment-resistant depression: A long-term retrospective review of clinical use” By Steven R.D. Best, Dr. Dan G. Pavel, and Natalie Haustrup, PhD
- Visit neuroscience.md
- Click here to schedule an intake evaluation or to arrange treatment.