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Out of the Darkness: A Different Approach to Depression Treatment.

Depression (also called Major Depressive Disorder or MDD) is a common but severe mood disorder that affects approximately 14 million people in the United States. It is a pervasive disorder that not only involves those who suffer from the condition, but impacts families and communities, as well. Historically, depression has been overlooked, under-diagnosed and. sadly, under-treated. Current research suggests that depression is caused by a complex combination of factors.

Many of the factors that can lead to depression are also associated with substance use disorder. Imbalances in brain chemistry, family history and past trauma, for instance, are frequently involved in both depression and addiction. Substance abuse is all too common among people who are battling depression. Many depressed individuals, if not properly treated, reach for drugs and/or alcohol as a way to lift their mood. As a result, depression and substance abuse feed into each other, and one condition will often make the other worse. As depressive episodes become more severe, the frequency and intensity of negative thoughts and self-destructive behavior may increase. The Journal of Clinical Psychiatry estimates that a third of adults who struggle with alcohol or drug abuse also have clinical depression. Depression is often an entry into substance use, and without qualified treatment, substance use can transition into full-blown addiction.

Without treating the depression that drives addiction, or vice versa, the individual is likely to return to substance use or experience a return of depressive symptoms. Sadly, conventional treatment centers that do not provide adequate therapeutic support for both mood and addiction may see limited success among participants. Research shows that persons with addiction and depression have poorer treatment adherence, higher relapse rates with either disorder, higher rehospitalization rates, and are at a higher risk for suicidal and homicidal behaviors.

TMS Therapy in Residential Treatment

Sierra Tucson, a residential treatment facility in Tucson, Arizona, has long been renowned for its integrative approach to mental health, including co-occurring disorders. Treatment for depression is provided through its Mood & Anxiety Program, the foundation of which is medication management and individual and group therapy, combined with innovative modalities such as biofeedback, mindfulness meditation and EMDR (eye movement desensitization and reprocessing). In this tradition of innovation and clinical excellence. Sierra Tucson has added NeuroStar TMS Therapy[R] to the Mood & Anxiety Program's comprehensive list of services.

TMS, or transcranial magnetic stimulation, provides a different approach to treatment for depression. This safe, well-tolerated, non-invasive and non-pharmacological treatment is offered in physicians' offices across the country. While TMS is innovative, it isn't novel. It was cleared by the Food and Drug Administration (FDA) in 2008 for the treatment of MDD, and more than 25,000 patients have benefitted.

How TMS Works

TMS uses magnet technology similar to that of an MRI, but the therapy is precisely targeted toward the brain. For each treatment, a magnetic coil is placed gently against the scalp, whereby a pulsed magnetic field is generated, thus stimulating nerve cells in the brain that are involved with mood regulation. The procedure can normalize and restore balance in areas of abnormal or decreased activity, resulting in a significant reduction of symptoms or complete remission from depressionall without the systemic side effects caused by antidepressant medication. Each session takes less than an hour; treatment is administered five days a week for approximately 4-6 weeks, with no sedation or anesthesia needed.

What sets transcranial magnetic stimulation at Sierra Tucson apart from outpatient TMS Therapy is the therapeutic environment. Patients are engaged daily in process groups, therapeutic recreational activities, and integrative services, in addition to having the benefit of 24-hour staff care. Typically, an individual who undergoes TMS treatment for depression will have to drive to his or her psychiatrist's office, five days per week, for 4-6 weeks. In some instances, it may be difficult for someone with Major Depressive Disorder to take that kind of time out of his or her daily life and negotiate 20 to 30 psychiatry appointments around work, school or family obligations. For individuals who have already taken the time out of their lives for residential treatment, TMS sessions can be completed during their stay. Sierra Tucson is pioneering the concept of transcranial magnetic stimulation in the residential treatment setting. Because TMS involves a time commitment, Sierra Tucson simply streamlines the process by utilizing a person's commitment to participate in residential treatment.

From a Clinician's Perspective

For patients receiving transcranial magnetic stimulation for depression, safety is a priority. TMS is performed under the supervision of Sierra Tucson psychiatrists, and as the primary clinical operator, I am a registered nurse who is TMS-certified. Treatment takes place in a calming and comfortable suite. I assist each patient with continuing care during treatment by providing the individual with locations of NeuroStar TMS providers in his or her area to contact once they leave Since many individuals stay at Sierra Tucson for approximately four weeks, we may begin TMS treatment in the residential setting and assist with transition to a local outpatient practitioner to complete the last few treatments. When we started offering TMS over a year ago, I treated a patient who was from North Dakota, and I located the nearest TMS provider to his hometown. Because it was 300 miles away, he wanted to undergo as many sessions as possible during his time at Sierra Tucson. (I even came to Sierra Tucson on Saturdays to administer treatments in order to achieve this goal.) Upon discharge he said, "I never imagined this would work, but I feel like there isn't even a trace of depression left."

As patients return for TMS treatment sessions on a daily basis. I gradually see the light return to their eyes. They become more active, conversation with others becomes easier, and there is a renewed interest in what's going on around them They experience a desire to re-engage with a life that they had given up on--to reconnect with people and loved ones from whom they once retreated during their depressive episode.

One patient's experience stands out in my memory and I often share this story with individuals who are through 10 treatments and stated that she did not feel any different than before. When I came back to work on a Monday following a weekend off, Beth smiled at me. "Do you notice anything different?" she asked. "I made an appointment at the salon over the weekend. This is the first time in two years that I've colored my hair. My husband is coming for Family Week." That subtle shift was the beginning of a major change in her depression symptoms. She completed four weeks of TMS--20 treatments total--and was thrilled with the results.

Into the Light

Depression has no known cure, but is treatable; and today, there are more options than ever to manage symptoms. Fortunately, treatments exist that allow patients to lead normal, symptom-free lives. Depression is often initially treated with psychotherapy and antidepressant medication administered together. Antidepressants can be effective for some patients, but they do not work for everyone. Furthermore, antidepressants frequently result in unwanted side effects due to their systemic nature. Many patients do not experience symptom relief from antidepressant medication and/or cannot tolerate the side effects caused by them. With transcranial magnetic stimulation, individuals suffering from depression now have a solution beyond traditional medication. Sierra Tucson is pleased to add this non-invasive treatment to its already comprehensive list of integrative services that addresses and treats MDD.

The reality of depression is that it's so much more than mere sorrow or unhappiness; it is a debilitating condition that prevents the sufferer from functioning normally. At its worst depression can be fatal, resulting in thousands of deaths each year from suicide. The World Health Organization (WHO) estimates that over 800,000 people die by suicide each year--one person every 40 seconds. What's more, depression is the leading cause of disability the world over. If you are having thoughts about harming yourself or attempting suicide, reach out for help immediately. Call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255). To reach the Veterans Crisis Line, call the same number and press "1." If a loved one or friend is in danger of attempting suicide or has made a previous attempt, make sure someone stays with him or her. call 911 or your local emergency number immediately or, if you can do so safely, take the person to the nearest hospital emergency room.

For more information on Sierra Tucson's Mood & Anxiety Program, as well as transcranial magnetic stimulation, call 844-202-7373 or visit

* Name has been changed for privacy purposes.

By Michelle Chacon, RN, Certified TMS Clinical Operator, Sierra Tucson

Caption: TMS Therapy A Breakthrough for Depression
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Author:Chacon, Michelle
Publication:Addiction Professional
Date:Jun 22, 2017
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