RAMSAY MENTAL HEALTH New milestone in treatment of depression In any given year, more than one million Australians will suffer a crippling episode of depression. And approximately one third will be have a severe depressive illness that is “treatment resistant” because their illness does not improve with a trial of at least one anti-depressant medication. New hope is on the horizon however, with an innovative treatment option called Repetitive Transcranial Magnetic Stimulation (rTMS). rTMS uses magnetic pulses to stimulate nerve cells in the cerebral hemisphere (frontal lobe). Ramsay’s mental health Ambassador and Queensland Origin player Darius Boyd visited New Farm Clinic recently. 8 The Ramsay Way 2017 | 02 This in turn causes brain plasticity over time resulting in 37 percent of treatment-resistant patients recovering from their depression, the American Psychiatric Association Conference in San Diego was told last month. New Farm Clinic was one of first private hospitals to introduce rTMS to Queensland, and three years down track are performing more than 900 procedures per month. “Transcranial Magnetic Stimulation is a safe treatment that uses high powered magnetic pulses to stimulate the areas of the brain that we know are underactive in patients who are suffering from depressive illness that has previously not responded to antidepressant medications,” says Dr Jon Steinberg, Consultant Psychiatrist from New Farm Clinic. "It’s a very exciting space to be working in because it means that patients who previously had no choice but to undergo Electroconvulsive Therapy (ECT) can now have these high-powered pulses delivered to the brain without seizures.” He said ECT is still the gold standard treatment for the most severe resistant depression but rTMS offers a safe effective choice for treatment resistant patients who either don’t need to have ECT or can’t have ECT due the possible risks of ECT such as possible anaesthetic side effects or transient memory disturbance. Dr Steinberg said the rTMS treatments also triggered growth in the brain; restoring normal activity in the frontal lobe that governs mood. “It’s like any muscle really, if you force it to fire it gets bigger.” He said rTMS has been around for years but only recently had its efficacy been definitively proven in patients “where everything has failed”. In one study released in 2016 from the Monash Alfred Psychiatry Research Centre in Melbourne, about 500 out of 1100 depressed patients went into remission after undergoing rTMS according to data pooled over 10 years. “rTMS has emerged as a safe and effective treatment option for patients and is an important adjunct therapy for a state-of-the-art mental health clinic like New Farm.” He said no anaesthetic is involved; the treatment courses typically include 4-6 weeks of once daily sessions, five times per week. “For many patients rTMS means there is a good possibility of successfully “finetuning” the brain in a safe, non-invasive environment while they are awake and conscious.” He said rTMS response rates in treatment-resistant patients were between 45% and 60% and remission rates between 30% and 40% in various studies. “While most patients who respond maintain clinical improvement 12 months later, there is variability in the duration of response. The best strategies to sustain the antidepressant effect of rTMS remain undefined but long term psychiatric treatment with medication and psychological therapy is advised to prevent relapses after rTMS. “Some patients might have repeat courses of rTMS over time to prevent relapses especially if they cannot take medications due to side effects or if their other psychiatric treatment is ineffective.” But given the enormous burden of treatment-resistant depression to both patients and society, establishing effective, long term treatment strategies like this are of the upmost importance.” Depression treatment success rates According to Dr Jon Steinberg at New Farm Clinic the following relates to treatments for depression: ECT – Electroconvulsive Therapy has 80 to 90% success rates in treatment-resistant patients. ECT of the past was depicted in 1950s movies like One Flew Over The Cuckoo’s Nest as a painful and torturous process which led to misconceptions about ECT. However in reality ECT in modern times is a safe and painless treatment with main side effects temporary such as short term mild memory loss ; jaw pain and extremely rarely, cardiovascular issues from ECT. Other extremely rare risks include those typically associated with having an anaesthesia – ie stroke, death. TMS – 30 to 40% of the general population who suffer with depressive illness will be treated successfully with TMS which is virtually side-effect free; but they may need to supplement with medication down track. A good option for people who cannot tolerate medications or ECT; but follow up rTMS sessions may be required if they cannot take medication. MEDICATION – Around 40 to 60% of people notice improvement in symptoms within two months; however side effects such as nausea, dizziness and headaches can make medicine difficult to tolerate for one third of people. EXERCISE – Has anti-depressant properties for mild depression in the general population; also a good adjunct treatment for severe depression. However exercise alone is not a successful treatment for severe depression. NO TREATMENT – The lifetime risk of suicide from untreated depression is 2.2 to 15% and people with depression generally are 25 times more likely to commit suicide than the general population. Mr Ken Craig CEO New Farm Clinic, Dr Michael Theodoros, and Dr Jon Steinberg at the conference.
The Ramsay Way - Winter 2017
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