Comparison to Other Depression Therapies

COMPARISON TABLE OF DEPRESSION THERAPIES
PHARMACOTHERAPY
ELECTROCONSULSIVE THERAPY(ECT)
VAGUS NERVE STIMULATOR(VNS)

Comparison Table of Depression Therapies

The following table provides a generalized comparison of rTMS therapy with pharmacotherapy (i.e. drugs or medication) and ECT therapy.

*of compliant patients; 20% cannot tolerate a complete course of medication

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Pharmacotherapy:

• The treatment of diseases through the use of medication, such as antidepressants
  
• Medication for depression, or pharmacotherapy, usually requires a 5 to 6 week timeframe. This allows for observation in order to find out if the antidepressant medication is appropriate, i.e. if it is working and does not have unwanted side effects on a patient. After this, it usually takes another 6 months or more of continued use of the medication to ensure that it remains effective.
• Up to two-thirds of depressed patients receiving pharmacotherapy experience some form of improvement.
• Many patients also experience undesired side effects from these medications which may include headaches, light-headedness, weakness, and sexual dysfunction.

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Electroconvulsive Therapy (ECT):

• ECT, or "shock-treatment”, is used to relieve severe depression.
• ECT involves 8 to 10 treatment sessions over a 3 to 4 week period. A patient can consider ongoing treatment once every 2 weeks to once every 4 weeks over a several month period, if the initial treatment was successful.
• ECT has been shown to be up to 80% effective, but resulting side effects can be high.
• With ECT, the skull acts as a resistor; this requires more energy and results in the scattering of energy throughout the brain. This scattering may produce undesired side effects, such as memory loss, and results in a loss of focal precision of the electrical stimulation to the targeted areas. In contrast, rTMS therapy avoids these drawbacks.

Ilyin et al. in Russia, and Rosa et al. in Brazil, suggest that rTMS is slightly more effective than ECT in treating depression:



Illyin et al (Abstract, CINP, 2004) N=40, Randomized to either ECT or TMS
Rosa et al (Abstract, ACT Meeting, 2004) N=35, Randomized to either ECT or TMS

Schulze-Rauschenbach et. al, 2005, state that unlike ECT, rTMS therapy for severe depression has no adverse effect on memory one week after the end of treatment. Treatment response was comparable between the ECT group and the rTMS group in terms of reduction in Hamilton Depression scores:

"In patients treated with rTMS, cognitive performance remained constant or improved and memory complaints alleviated, whereas in the ECT group memory reclal deficits emerged and memory complaints remained."

- Schulze-Rauschenbach et. al, 2005

Click here to view medical journal articles comparing ECT and rTMS

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Vagus Nerve Stimulator (VNS):

Vagus Nerve Stimulator, or VNS, stimulates the limbic system, a group of related brain structures that affect mood, motivation, sleep, appetite, alertness and other factors commonly altered by depression. VNS is delivered to the left cervical vagus nerve by a stopwatch-sized generator, implanted just under the skin in the left chest area. VNS delivers pre-programmed, mild, intermittent electrical pulses to the left vagus nerve 24 hours a day. The implantation procedure takes approximately one hour and usually requires no overnight hospitalization.

rTMS vs. VNS

rTMS - Pros:

• Non-invasive and safe.
• Excellent ability to target specific neuron circuits.
• Our data at MindCare Centres show that ~65% of patients respond to treatment.
• Rapid onset of therapeutic benefit – effectiveness only requires 2 to 4 weeks of treatment.
• rTMS can provide therapeutic benefit for treatment-resistant individuals.
• Patients who are currently on medication, do NOT have to stop taking them in order to receive rTMS.

rTMS - Cons:

• Potential side effect: 1 out of 10 patients experience a mild headache post treatment, but can be alleviated with 1 Tylenol.
• Contraindications: a person who has a history of seizures, has a pacemaker, has metal fragments in their skull, or has been a metal worker, may not be able to receive rTMS.
• Not yet FDA approved in the US.

VNS - Pros:

• Has been approved for epilepsy.
• FDA approved in the US.
• Does not cause the side effects normally associated with depression medications, such as weight gain, loss of sexual function, cognitive impairment and insomnia.

VNS - Cons:

• Invasive.
• Effects are modest and it is unclear how to tune pulses to alter brain function.
• Potential side effects:
  
  
• Lack of coordination in the voluntary muscles (ataxia)
• Difficulty breathing, shortness of breath (dyspnea)
• Hoarseness (voice alteration)
• Impaired sense of touch (hypesthesia)
• Inability to sleep (insomnia)
• Increased coughing
• Indigestion (dyspepsia)
• Infection inflammation of the pharynx, throat (pharyngitis)
• Muscle movement of twitching generally associated with stimulation
• Nausea
• Pain
• Prickling of the skin (paresthesia)
• Throat, larynx spasm (laryngismus)
• Vomiting
• Additional side effects of VNS:
  
  
  • Aspiration (fluid in the lungs)
  • Blood clotting
  • Choking sensation
  • Damage to nerve or blood vessels in the surgical area, including the carotid artery and jugular vein

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Note: The information above does not replace personal medical advice from your doctor or a qualified health care professional. Please read our disclaimer.

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