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Using TMS to Treat Patients with PTSD

Symptoms
Causes
How TMS Helps PTSD
How TMS is Done

 

Post-Traumatic Stress Disorder commonly known as PTSD is a mental health disorder that can be triggered by a frightening event either experiencing it or witnessing it. Most people who experience traumatic events may have difficulty adjusting at first, but with good self-care, they usually get better over time.  

Symptoms of PTSD may include nightmares, flashbacks, severe anxiety, and uncontrollable thought about the traumatic event. Without proper care, these symptoms worsen over time, interfering with the normal daily routine and taking away the quality of enjoyable living. Seeking proper medical care and effective treatment after PTSD symptoms become apparent is crucial in recovering from the disorder.

 

PTSD Symptoms

PTSD symptoms may become apparent as early as one month after the traumatic event, but on some occasions, it may surface several years after the event. Medical professionals group PTSD symptoms into four categories, namely: avoidance, intrusive memories, negative changes in thinking and mood, and changes in physical and emotional reactions. As any other mental health problems, PTSD symptoms vary in severity and from one person to another.

 

Avoidance

Symptoms of avoidance may include avoiding certain places, activities, and people that remind patients of the traumatic event. Usually, patients do not want to talk about the traumatic event.

 

Intrusive memories

The most common symptoms of intrusive memories include flashbacks or reliving the traumatic event as if it were happening again, recurring unwanted memories, or severe emotional distress or physical reactions towards which reminds them of the traumatic event.

 

Causes

Because PTSD varies greatly, medical professionals find it difficult to know the exact cause of the mental disorder. Although a generalized diagnosis of a stressful experience, inherited mental risks like having family members with anxiety and depression, and the way the brain regulates chemicals in the body can trigger PTSD.

It’s hard for anyone to live with PTSD as symptoms can intensify over time leading to more serious health problems including drug addiction and suicidal thoughts. People with PTSD can suddenly change their behavior when they hear loud clattering or a car backfire thinking about their combat experiences. This often interferes with their daily lives, in severe cases, they can no longer function properly.

 

How TMS Helps PTSD

Transcranial Magnetic Stimulation or TMS emits rapid but short pulses of the magnetic field into an area of the brain. It can simultaneously stimulate the inactive or disruptive region while suppressing the overactive area of the brain. The procedure can reduce symptoms of anxiety and depression associated with PTSD.

 

How does it work?

TMS uses repeated strong electromagnetic pulses to change the activities within the brain circuitry. This gives out a direct influence on the brain activity in a very precise manner, enabling an unprecedented method of control over how the brain works.

Since 2008, after receiving approval from the US Food and Drug Administration, TMS had been used as an alternative treatment for major depressive disorder. People suffering from treatment-resistant medications can benefit well using TMS.

During TMS session, the electromagnetic pulses passed through the skull going to the different areas of the prefrontal cortex of the brain can have significant effects on mood regulation. Depending on what areas are targeted and the depth into the brain, TMS can lessen symptoms of some mental disorders and improve overall mood behavior. This new innovation procedure can change activity in the brain area and affects the overall function of the brain.

According to several studies, introducing the brain to these electromagnetic pulses triggers the electrical charge within the cells, thus brain activity can be shifted from one state to another. This makes the brain shift from a depressed state of mind to a healthy pattern of neurons. TMS can alter the disordered cognitive and emotional processing of the brain in PTSD, restoring its proper function. In several occasions, TMS can slow down brain activity in motor its region to interfere with hyperactive circuits in obsessive-compulsive disorder. Furthermore, TMS is known to also reduce activity in the auditory cortex to hinder hallucinations and ringing sensations in Tinnitus.

TMS therapy can offer great help with its magnetic stimulation of the brain structures and networks associated with PTSD. This can significantly change the lives of many people suffering from this mental health disorder.

Experts believe that understanding more of how the brain works and its region can provide information on how TMS can be utilized more in treating various mental health problems. With a better design protocol and threshold, it can build more accurate models and targeted areas to treat more mental disorders.

 

How it is Done

TMS therapy treatment is administered for a period of weeks inside the doctor’s office as an outpatient. It usually takes less than an hour depending on the patient’s condition. Patients remain awake and fully alert to their environment. Since TMS does not produce any major side effects, patients can immediately go back to their normal routine following the treatment.

 

It’s perfectly normal  to feel anxious, especially during times of stress or tension, such as the brief moment when your boss contemplates just after you asked for a raise. Anxiety is our brain’s way of preparing itself for danger. Not exactly to combat it, but to ensure that if we ever fight, or flee, our body is ready to act as best as it can.

 

When a person starts to feel anxiety outside where they should, problems start to arise. When anxiety occurs outside normal circumstances, and happens for days, over a course of more than 6 months, it’s classified as a disorder. The medical disorder is known as Generalized Anxiety Disorder, GAD for short.

 

It’s generalized because it has a number of causes, some of them unique to the person. It causes restlessness, fatigue, irritability, sleeping issues, and concentration problems, all of which make a significant dent in a person’s quality of life. What’s worse is that GAD is often accompanied, or causes other mental complications like depression.

Treatment via drug therapy is the most common solution, with counseling or Cognitive-Behavioral Therapy being the go-to for long-term treatment and recession prevention.

One downside to the otherwise effective ways to treat GAD is the high costs and the possible adverse effects due to the medication. If a person has good health insurance, that can be mitigated somehow, but not everyone has it.

Transcranial Magnetic Stimulation: A New Hope

As the procedure is called, Transcranial Magnetic Stimulation (TMS for short) is a relatively novel way to treat anxiety disorders. TMS was already in use decades ago in order to map out brain function in stroke patients. They figured that since our brain cells respond to weak pulses of electromagnetism, it could be used to stimulate brain cells to restore their function.

The idea is simple. An electromagnet is placed on top of your head and a machine regulates the electricity flowing to the magnet, creating minute pulses of electromagnetism. The targeted area of the brain is affected by the waves and they activate or at least react to the stimulation. Like physical therapy on a newly recovered leg or arm, the procedure will “train” and “massage” the target area of the brain to work back to normal. These procedures normally last about an hour and are done daily for 4-6 weeks.

 

Magnetic Pulses

The magnetic pulses are set to a low frequency of 1 Hz. Think of this as music. Lower Hz is slow, calm music while higher ones are the intense, fast beats. The low “hum” causes an inhibitory effect on the brain, calming activity as if listening to calming soul music. The pulsing is then aimed at the area of the brain where the cause of GAD is identified, such as the left prefrontal cortex. (The area above your left eye.)

The inhibitory effects showed remarkable results in reducing anxiety. Clinical trials with different experiments show consistent positive results, especially with continued TMS therapy. Currently, the only way to get TMS treatment for GAD is participating in clinical trials, but with solid evidence of improvement on patients, it’s only a matter of time before it’s approved as a treatment method.

 

Anxiety is a condition that has many forms, including being aggravated by various types of depression. Thus, anxiety is a complex condition that may debilitate a person who has it. It is also important to remember that anxiety varies in levels from hour to hour. It also varies in degrees from day to day. And as far as being responsive to environmental influences is concerned, anxiety can also lead to panic attacks and improper social behavior.

One treatment used for anxiety is prescription medications. Your doctor might prescribe a particular medication to treat anxiety. Other medications may also be prescribed to combat the side effects of the main drug used to treat anxiety. Because of the side effects experienced by people taking anti-anxiety medications, a variety of treatments have been developed as an alternative to or additional support for medication.

One such treatment is Transcranial Magnetic Stimulation (TMS) therapy. TMS can be given to patients who don’t respond to counselling and prescription medications. They can also be given if patients experience extreme side effects with prescribed drugs. TMS has many forms and the responses from patients with anxiety vary. It actually is dependent on various factors:

 

1. Type Of Magnetic Coil

Each TMS machine type has a different magnetic coil. For example, Neurostar’s coil is a figure-8 coil. This type of coil stimulates a relatively focused area of the brain. On the other hand, the Brainsway device has a coil that stimulates a wider area because of its H-shape form.

 

2. Stimulation Location

Certain locations of the brain are stimulated based on the illness being treated. For example, clinical trials stimulate the right dorsolateral prefrontal cortex for anxiety. On the other hand, the orbitofrontal cortex is stimulated for obsessive compulsive disorder.

 

3. Stimulation Frequency

Clinical trials of TMS usually deliver a rapid stimulation of cortex at the frequency level of 10Hz. However, with anxiety, 1 Hz is used. This is because 1 Hz is known to induce inhibitory reactions on cortical activity. On the other hand, 10 Hz is known to have excitatory effects.

Studies have also been conducted on the use of TMS for PTSD, Panic Disorder, and Generalized Anxiety Disorder. For example, one controlled trial showed results that the stimulation of the left dorsolateral prefrontal cortex at 10 Hz is very efficient for core PTSD.

In another study, they have found symptom reduction for those who have panic disorders. In this study, a 1 Hz treatment was used to stimulate the right dorsolateral prefrontal cortex. Remission of patients was also present in another study. This used stimulation of the right dorsolateral prefrontal cortex at 1 Hz. Note: The patients who underwent this study have generalized anxiety disorder.    

   

In Conclusion:

Anxiety can be a difficult condition to deal with, especially since it so often comes side by side with depression. People with extreme anxiety disorders can have an incredibly difficult time trying to live an “everyday” life. The good thing is studies have shown promising results regarding TMS for anxiety. If you have a loved one who has this condition, you can talk to your doctor about undergoing TMS.

It can be an alternative or a supplement to your loved ones’ current therapy sessions and could potentially lead to longer periods without anxiety attacks. To learn more about TMS treatment for anxiety, give us a call Monday through Friday from 9am to 5pm.

 

What is Anxiety?

Anxiety, or Generalized Anxiety Disorder (GAD), is a severe mental illness characterized by excessive and uncontrollable worry. The condition occurs on most days of the week and lasts for at least 6 months. GAD affects about 6.8 million adult Americans or 3.1% of the US population.  The exact cause for GAD is not fully identified but genetics, brain chemistry, and environmental factors seem to trigger the disorder.

The Anxiety and Depression Association of America describe anxiety in adults when they experience at least three of the following symptoms:

  • Restlessness
  • Muscle tension
  • Fatigue
  • Irritability
  • Difficulty in sleeping or staying asleep
  • Problems concentrating

Other symptoms may include stomach upsets, nausea, or diarrhea. In most cases, GAD can overlap other mental disorders with depression being the most common of all. This makes it even harder in detecting and treating anxiety.

Today, treatments like medications and therapy are often prescribed to people suffering from anxiety. Even with these treatments, though, as many as 50% of patients fail to improve.

 

The Neurobiology Behind GAD

GAD affects the frontal and limbic structures of the brain. It can also disturb some of the connectivity between these regions. The frontal region of the brain is commonly associated with anxiety and has become the basis for using TMS therapy in treating anxiety.

TMS therapy can give hope to patients who can’t tolerate antidepressant medications or who’ve tried therapy several times but failed to see improvement.

 

Treating Anxiety with rTMS Therapy

TMS therapy sends out electromagnetic pulses near the frontal region of the head to stimulate nerve cells in the patient’s brain. This region of the brain controls mood behavior. When magnetically pulsed in quick succession, it’s called rTMS or repetitive TMS. rTMS is quite simple and can be administered in a doctor’s office. As a non-invasive method, it does not require traumatic procedures like sedation or anesthesia. It is also non-systemic which means there are no fears of anxiolytic medication side effects.

Various types of research show TMS therapy can help people suffering from anxiety disorder. The US Food and Drug Administration first approved TMS therapy in 2008 for treating major depressive disorder. Two years after its approval, researchers at the University of California conducted a small-open label study of 10 patients. The UCLA discovered that TMS therapy may also be used as an effective treatment for at least some anxiety disorders. The results from that study shows a favorable 60% response rate for people suffering from GAD. This makes TMS therapy at least twice as effective as conventional anxiety treatments.

 

TMS therapy benefits

TMS therapy can still benefit people who have already tried several other anxiety treatments to no benefit. Even for patients who haven’t responded well to their previous treatments can improve through TMS therapy. Some of the benefits include:

  • Greater control of anxiety problems
  • Decrease in the emotional aspects of depression
  • No major bodily changes
  • Fewer muscle pains
  • Fatigue prevention

Most studies shows that TMS therapy will often result in the overall mood improvement of patients.  People diagnosed with an anxiety disorder can now live in worry-free and productive lives with this treatment method and are recommended to look further into their options.

 

Defining Anxiety

Anxiety or Generalized Anxiety Disorder (GAD) in medical terms is a chronic mental illness associated with excessive and uncontrollable worry. The condition occurs on most days of the week lasting for at least 6 months.

Some of the symptoms of GAD include:

  •    restlessness
  •    muscle tension
  •    fatigue
  •    irritability
  •    difficulty sleeping
  •    problems concentration

 

In most cases GAD coexists with other mental disorders with depression being the most common of all. This makes it even harder to detect and treat the anxiety.

People suffering from anxiety spend an inordinate amount of time worrying. Patients often describe the feeling of having considerable worry right after they wake up in the morning. The feeling of uneasiness will continue throughout the day, even without anything in particular to be worried about.

GAD affects the person in a numerous substantial ways, which includes:

  •    anxiety is often associated with a poor health condition like obesity
  •    it prevents the person in enjoying simple pleasures in life
  •    at its peak, anxiety can directly lead to expensive health care services

 

Conventional Anxiety Treatment

Some of the existing treatments for anxiety include:

  •    medications – usually consisting of anxiolytics
  •    medication combined with psychotherapy
  •    counseling and potentially  cognitive-behavioral therapy

 

However, even with these available treatments, as many as 50% of patients fail to improve their mental health conditions. These patients continue to suffer from the devastating symptoms of anxiety.

 

The Neurobiology of GAD

GAD affects the frontal and limbic structures of the brain. It can also disturb some connectivity between these regions. Even though several studies show different findings, the front of the brain is commonly associated with anxiety. Experts consider these findings as the basis for using TMS therapy in treating this condition. According to recent studies, repetitive Transcranial Magnetic Stimulation (rTMS) is believed to be a promising treatment for anxiety disorder.

 

Treating Anxiety with rTMS therapy

TMS therapy sends out electromagnetic pulses near the front of the head to stimulate the nerve cells. This region of the brain controls mood behavior. When the pulses are sent out in quick succession, it then called rTMS or repetitive TMS.   rTMS is a fairly simple procedure and can be administered in a doctor’s office. As a non-invasive method, it does not require traumatic procedures like sedation or anesthesia.

The full extent of rTMS effects are not yet known but it has been shown to effectively decrease depression symptoms. TMS often resulted in the overall mood improvement of patients.

Even though considered an effective alternative treatment, it also has its limitations. These include:

  •    Mental disorders that show signs of detachment from reality
  •    Patients with several years of depression
  •    Patient had any Electroconvulsive therapy (ECT) in the past and failed to show improvement

 

Findings of the study

The US Food and Drug Administration first approved TMS therapy in 2008 for treating major depressive disorder. Two years after its approval, researchers at the University of California conducted a small-open label study of 10 patients. The UCLA lab discovered that TMS therapy may also be used as an effective treatment for anxiety disorder. The results from the study show a favorable outcome of 60% response rate for people suffering from GAD.

For more information about TMS therapy to treat anxiety, please feel free to contact us anytime.

 

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