Akos Antwi recalled the day when one of her clients who had been suffering with depression for more than 30 years came to her with a piece of good news.
The client told Antwi that she woke up on a recent morning and finally felt like doing something she loved but hadn’t done in 20 years: dance.
“Just to see a client do something they haven’t been able to enjoy or want to do in more than 20 years, it definitely is the reason why we continue to advocate for the services that we do provide,” said Antwi, who started Revive Therapeutic Services in Providence with her sister Abby more than two years ago.
Akos Antwi said the client’s breakthrough happened three weeks into her transcranial magnetic stimulation, or TMS, therapy sessions. The therapy is meant to help those with treatment-resistant depression, or a patient’s depression that has not improved after trying at least one antidepressant.
Revive started offering TMS around a year and a half ago. Prior to that, Antwi said they offered individual therapy and medication management services, but some patients were still struggling with their depression.
So, after learning more about TMS and how patients have benefited throughout the country, Antwi knew Revive needed to add it to the practice. So far, Revive has treated 65 patients with TMS, all of whom have shown a positive response to the therapy, Antwi said.
Antwi said the success of TMS therapy is subjective and based on the patient’s response. To measure this, she said patients at Revive complete a patient health questionnaire to get a baseline of how they are feeling. The patient then takes the survey again each week they are receiving TMS therapy and for up to three months after they’ve completed the treatment sessions, and again every six months to track their progress.
Dr. Noah Philip, lead for mental health research at the Providence VA Medical Center, described the treatment as using high school physics to help restore a patient’s normal brain function.
Philip said the treatment works by quickly switching the magnetic field off and on to help activate certain nerves in the brain related to depression, anxiety and post-traumatic stress disorder. If this is done gently enough and for long enough, Philip said TMS can change the way the brain works.
“When we target that part of the brain that’s involved in depression and anxiety and PTSD, we can change how it functions and help people get back to their lives,” said Philip, who is also professor of psychiatry and human behavior Brown University’s Warren Alpert Medical School.
TMS has been around for several years. The Food and Drug Administration first approved marketing for TMS as a treatment for major depression in 2008. Since then, the FDA has also approved TMS to treat obsessive compulsive disorder and aid with smoking cessation.
VA Providence has been offering TMS therapy since 2012 and in that time, Philip says he has been able to help around two-thirds of the people with the treatment to varying degrees. Also, approximately 2,000 people have been treated with TMS therapy at U.S. Department of Veterans Affairs hospitals across the country since 2018, Philip said.
Along with this, there have been studies into how TMS could help people stop smoking and Philip said VA Providence is currently researching the use of TMS to treat substance use disorders. Philip said recruitment for the study has been completed and he expects results will be ready in the near future.
Dr. Linda Carpenter, director of Butler Hospital’s TMS Clinic and professor of psychiatry at the Warren Alpert Medical School, says she has published many research papers on a variety of TMS-related subjects, including using it to treat PTSD, and she recently received a grant from the National Institutes of Health to figure out the best frequencies for TMS treatment.
Carpenter said Butler has been offering TMS since 2009 and while she’s noticed there are thousands of centers offering it worldwide and across the country, it’s still challenging for some patients to access.
The FDA recommends a patient receive a one-hour TMS treatment five days a week throughout six weeks for a total of 30 sessions. This is no small-time commitment, especially for patients who live far away from a treatment center.
But Carpenter said there has been some research into making TMS more accessible and a version was recently approved in which patients receive several treatments in one day and can finish the process in around five days.
Though technology-based treatments such as TMS require a lot of work and managing several different devices, Philip said TMS is a promising option because it is free of side effects that come with medications.
“There is a lot of hope and a lot of promise using transcranial magnetic stimulation for a whole variety of psychiatric illnesses that people are suffering from,” Philip said.
