Increased remission rate for depression with new method of TMS, now offered at MUSC

MUSC Health is the first hospital system in the country to use SAINT TMS, which has a dramatically higher remission rate for depression than previous treatment options

by Celia Spell

Treatment for depression has largely focused on medication and psychotherapy over the last several decades. With research centering on targeting chemicals in the brain like serotonin, norepinephrine and dopamine, a large group of patients have been left without other options.

Depression, also known as major depressive disorder or clinical depression, is the highest cause of disability worldwide, but as many as half of those diagnosed are resistant to treatment, which can lead to frustration and further feelings of hopelessness.

Edward Baron Short, M.D., is a MUSC Health physician specializing in brain stimulation, which can offer relief to patients who have not found it in medication. “The brain itself is an electrochemical organ,” Short said. “So we can do things to change the chemistry, like we do with medication, but we could also change the electrical pattern in the brain.”

Much of the work for transcranial magnetic stimulation, or TMS, began at MUSC with Mark George, M.D., who is the director of the Brain Stimulation Lab at MUSC. With its FDA approval in 2008, it has only grown and improved. Short refers to the first iteration as TMS 1.0. The latest update, which is only available at a couple of locations in the country, is TMS 2.0.

Stanford Neuromodulation Therapy, or SAINT, is a new method of TMS that allows patients to complete their treatment more effectively and more efficiently. Almost 80% of patients reported remission of their depression episodes 4 weeks after treatment, and many felt relief almost immediately.

 

Prior to SAINT, patients would need to undergo treatment sessions five days a week for seven weeks, which could be cumbersome for patients’ schedules and challenging for those who needed to travel for treatment. Treatment success was between 30 and 60%.

By incorporating functional MRI scans and a new machine, patients can expect to do 10 treatments each day for 5 days.

With depression, the dorsolateral prefrontal cortex is not active enough according to Short. By taking “a video of the brain,” or an fMRI scan, physicians can pinpoint the exact location in the dorsolateral prefrontal cortex that needs help and then send the electrochemical signals to that exact location. With treatment for 10 minutes each hour, patients feel a tapping sensation on the head and then rest for the remaining 50 minutes before the next round.

“Think of it like an exercise,” said Short. “If you were going to build your biceps, you wouldn’t do 50 curls at once. You would do a set of 10 and then rest. The SNT treatment is like that but very targeted.”

Nolan Williams and Brandon Bentzley developed this method while at Stanford, but they trained at MUSC under Short and George during their residency (Williams) and medical student training (Bentzley). MUSC Health was the second hospital in the country to receive the device but was then the first hospital system in the country to actually perform the SAINT method for patients in May. It is still one of only a couple of hospitals nationwide that can offer it.

Anyone interested in SAINT TMS should call the MUSC clinic to discuss potential insurance coverage and self-pay options. To refer a patient or learn more about SAINT treatment opportunities, call 843-792-5716.

Short says this method has the potential to treat other mood disorders in the future, as many of them also find their roots in underactive or overactive areas of the brain. And an fMRI scan can pinpoint precisely where to target the treatment.

“SAINT TMS offers intelligent, individualized treatment with unparalleled, fast recovery for patients,” he said. “I think this will change the trajectory of how we treat the depression epidemic.”