Intermittent Theta Burst Stimulation Treatment for Depression as an Alternative to ECT

Electroconvulsive therapy, or ECT, is a medical treatment most commonly used for patients who are experiencing severe major depression or bipolar disorders and have not responded to other treatments like psychotherapy and medications. ECT involves a brief and direct electric stimulation to the brain while the patient is under anesthesia. Research has found that ECT is a highly effective, however, there are risks associated with it. Some of the risks include short term memory loss and diffficulty learning as well as permanent gaps in memory. In addition, this treatment requires the patient to be put under general anesthesia, which has similar risks of those who undergo minor surgeries. What complicates things even more is that during the COVID pandemic, social distancing measures have led to an interruption to the treatments. Moreover, the use of general anesthesia and bag mask ventilation further increases the risk of infection by aerosolized virus. Patients who are left isolated and undergoing stress further implicates the symptoms that the patients are experiencing which is why it is crucial that patients get the care they need. 

Accelerated intermittent theta burst stimulation (iTBS) is a suitable alternative to ECT during the pandemic especially for those who are unable to continue ECT treatments. This procedure is effective and research has shown to improve the symtoms of those who are majorly depressed. To read more about the studies done regarding TMS and iTBS treatmets, click here for the TMS study, or here for the iTBS paper. This treatment is noninvasive and does not require the patient to be placed under general anesthesia and the patient can go about their day normally after their treatments. The side effects for TMS treatments include mild headaches at the point of stimulation. Click the links below to be redirected to our other blogs explaining the safety and efficacy of TMS treatment using the iTBS ptotocol. Link. 

A case study was conducted with a 66 year old woman who experienced a relapse during the COVID pandemic for her treatment resistant depression. After completing the iTBS treatment, she was able to achieve remission using the PHQ-9 and BDI-II questionaire to evaluate the levels of her depression. At the end of the study the authors were able to conclude that, "[Accelerated iTBS] represents an important advancement in neurostimulation, and older adults should be thoughtfully included in future clinical trials that examine the efficacy of this intervention. Our case not only illustrates the potential for this approach to be effective in older adults with moderate to severe depression but also highlights that a methodological modification to current aiTBS protocols that deliver 1800 pulses per session (i.e., reducing the number of pulses to 600) may not sacrifice effectiveness.” To read the whole paper, click here. 

Take the quiz by clicking this link to see if you are a good candidate for the TMS treatments. If you have any questions about switching over from ECT to TMS give us a call today, at (714) 867-7037, to schedule an appointment to meet with our chief psychiatrist, Dr. Suzuki.