Treating the Toughest Cases of Depression and Brain Illness

Combination Therapy with Transcranial Magnetic Stimulation and Ketamine for Treatment Resistant Depression

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 with little results and no relief.  When traditional combinations of medication, psychotherapy, and/or lifestyle changes (sleep, nutrition, exercise, etc.) aren’t enough, it may be time to consider alternative options.

One of those options is Combination Therapy with Transcranial Magnetic Stimulation (TMS or rTMS) and Ketamine, a novel patented therapy pioneered by Dr. Steve 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.

(Read the study on the clinical benefits of combining two established depression treatments, TMS and ketamine infusion, for patients suffering from treatment-resistant depression.) 

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. Or, as the Mayo Clinic describes it, “the electromagnet painlessly delivers a magnetic pulse that stimulates nerve cells in the region of your brain involved in mood control and depression…to activate regions of the brain that have decreased activity in depression.”

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. 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.

The combined approach yields the rapid onset of relief commonly experienced with ketamine infusions, with the longer-term benefits observed with TMS treatments.

How it Works

The mechanisms of action in the brain in response to both rTMS and ketamine are still being understood. Neuroimaging data from patients treated with rTMS have shown neural changes in the frontal and limbic regions associated with MDD (Teneback et al., 1999). And, rTMS may improve synaptic functioning (Roger et al., 2012). Ketamine works predominantly on the NMDA receptor site, impacting the neurotransmission of glutamate which may be aberrant in depression (Zarate & Niciu, 2015).

While some patients may respond to each therapy alone, ketamine harnesses the healing power of both treatments. The combined approach may yield more rapid onset of relief commonly experienced with ketamine infusions, coupled with the longer-term benefits observed with TMS treatments. And, with fewer TMS sessions needed, patients are more likely to adhere to the ketamine protocol leading to the more effective recovery from treatment-resistant depression.

Learn More about Combined TMS and Ketamine Therapy for Treatment of Depression and Chronic Pain

With the combined TMS and ketamine therapy, patients are finding extended relief from treatment resistant illness. Many have gotten to a place where they would be considered “recovered,” in that they are back to work, engaged with family and may have reduced substance use.

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.

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