LITTLETON — Laura Zenga settled
into the big chair, reminiscent of one found in a dentist’s office, in a room at the New England Center for Healthy Minds for Mental Health last week.
The treatment coordinator, Victoria Cruz-Howsare, accessed her brain map and moved the arm of the NeuroStar machine, placing the portion housing the magnetic coil on Zenga’s head. As the 37-minute timer began to tick down, a tapping noise emerged as the machine delivered bursts of magnetic pulses to Zenga’s neurons, activating the neurotransmitters she has been lacking as a result of depression.
“The best way that I can describe it is that it’s kind of like a small woodpecker in one spot, but it doesn’t hurt that much,” Zenga said. “You get used to it.”
Transcranial magnetic stimulation, or TMS, is a relatively new treatment for depression. It produces magnetic pulses similar to those found in magnetic resonance imaging, or MRI machines, but precisely targeted to certain areas of the brain to produce a therapeutic response.
TMS was approved for adults by the U.S. Food and Drug Administration in 2008, but only in the last couple years have insurance companies begun to cover the treatment, said New England Center for Healthy Minds Medical Director Dr. Madhavi Kamireddi.
Some still do not. Without coverage, the entire course of treatment carries a price tag of $9,500 for the patient, Cruz-Howsare said.
Of the New England Center for Healthy Minds patients treated with TMS, 71 percent have responded so positively that they have mild to no symptoms of depression, she said.
Of these patients, 42 percent have been affected so greatly they have entered remission for their depression.
Those who respond well to TMS may experience the positive side effects for years afterward, Kamireddi said, while others may have to return for maintenance treatments.
For long-term sufferers of depression like Zenga, TMS is a godsend after years spent trying one pharmaceutical after another and finding little relief from often debilitating symptoms.
Zenga, a 28-year-old medical assistant from Tewksbury, has suffered from depression since high school. She said her family was great, but she was consistently socially rejected by her peers from childhood.
“So it just kind of became this all-encompassing loneliness and I just kind of didn’t feel like I was necessary, if that makes sense, to be here,” Zenga said.
She didn’t know what the hopelessness was until she sought help during college, and entered regular therapy that continued afterwards.
Zenga has tried several medications, including Prozac, Lexapro and Wellbutrin, but said each only raised her up a bit before leveling off. She is now on Zoloft, which she has continued taking since starting the TMS treatment about three weeks ago.
Zenga said she began to notice differences in herself after about the seventh treatment. She began to feel more stable throughout the day, less irritable and better able to handle everyday stresses. Zenga’s outlook on life has been bleak for a long time, but she is beginning to feel more hopeful about the future and her prospects to find a partner and have children.
While it’s still difficult for her to see the things she wants, “I’m at least putting myself in a position where it’s a possibility,” she said.
Littleton resident Libby Dagostino, 24, said her life has been changed by TMS.
She was one of the first patients to begin the treatment at New England Center for Healthy Minds in August 2014, shortly after the facility obtained its NeuroStar.
Dagostino said she was always very emotionally sensitive and anxious as a child. It was between sixth and eighth grade that her depression, resulting from both biological predisposition and witnessing traumatic events, became debilitating.
“From what I saw as a kid, being an adult looked miserable,” Dagostino said. “I saw nothing good out of growing up and continuing to live.”
She began seeing a counselor around that time, and was soon introduced to Kamireddi, who was then working at another practice in Chelmsford.
The differences that came with the first medication Dagostino was prescribed, Prozac, were immediate. There were a flood of emotions, from joy to frustration, she hadn’t realized she had become numb to.
“I didn’t realize I was literally walking around in a fog all the time,” Dagostino said. “I had gotten so used to it, I didn’t even notice.”
But the cloud of depression came back a year later. The same thing would happen with each of the 12 different medications she would subsequently try.
While attending Salem State University, Dagostino, who aspires to be a counselor, took a biological psychology course that introduced her to TMS. She knew immediately that if she ever had the opportunity, she would jump at having the treatment.
When that moment came last year, she did. Where most would be nervous to try the treatment, Dagostino was excited.
Unfortunately for her, the first pulse at full strength was very painful, likely due to her small size. The pulse had to be dialed down for the beginning of her treatment, until she became used to the sensation. For others, like Zenga, the pain is minimal, producing headaches that are cured with over-the-counter remedies.
Dagostino knew the treatment was working during the second week. She had a strong flashback of her father, who had died earlier in 2014 of pancreatic cancer. The memory played in her head, and then it was over. Before TMS treatment, such an experience would have debilitated her for a whole day.
She began to notice more and more situations like this occurring, and realized how much TMS was changing her depression. Dagostino had started a new job at the time she began treatment, and she was easily able to manage a demanding schedule. The negative automatic thoughts would still come, but she was able to stand up to the bully in her brain and break through those thoughts.
A year after she started her treatment, Dagostino stopped taking Lamictal, a mood-stabilizing drug. Now, she’s slowly weaning herself off of the antidepressant Cymbalta, which is particularly difficult to stop due to withdrawal symptoms.
Dagostino is enjoying getting to know herself without depression and redefining her identity. She’s finally seeing the value in traits she had previously perceived as negative, such as introspectiveness and empathy.
“I’m seeing as much beauty in the world as I saw negativity before, and I love that,” Dagostino said. “I’m still emotionally sensitive, but to joy as well. I feel like I’m laughing all the time.”
She said learning the science of the brain gave her hope, and she wants people of all ages to see it’s not too late to change.
“When you learn that all the brain is pathways of neurons, you realize it’s so easy to change the way you think,” Dagostino said. “It’s very possible to change at any age. The brain is always able to establish new connections. Nothing is set in stone.”
Zenga hopes TMS will become for her the long-term solution it has so far proven to be for Dagostino.
“I have not been the best friend that I could be, the best anything that I could be,” Zenga said. “I’m really hoping that now I can actually live my life, participate in it and make it something that’s going to be worthwhile, and that’s going to be something I can look back on and say yeah, I had a good life.”
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TMS and depression
* Transcranial magnetic stimulation is a non-invasive treatment for depression that uses magnetic pulses to stimulate neurons and activate neurotransmitters that are often out of balance in people with depression.
* Treatment is typically done in 36 sessions that are each 37 minutes long. Sessions generally occur five days in a row (on weekdays) with two days off between each set (weekends).
* No matter a patient’s previous diagnoses, a full psychological evaluation is conducted prior to treatment.
* For treatment to be covered by insurance, most patients will need a diagnosis of major depressive disorder and evidence they have had at least four medication failures from two different classes of antidepressants.
* Depression usually does not exist alone. Patients will often have other accompanying illnesses, such as anxiety, bipolar disorder, post-traumatic stress disorder or substance abuse. TMS treats only the depression, but symptoms of other such illnesses may lessen or become easier to deal with as a result of effective TMS.
* New England Center for Healthy Minds is the only facility in the immediate area to offer TMS through NeuroStar. Facilities in Worcester and in and around the Boston area also offer it, but because it is a near-daily treatment, traveling a distance each day may not be practical. Other facilities in Concord and Nashua also offer Brainsway, a deep TMS treatment.