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Brain procedure generating wave of support: Los Altos psychiatrist embraces TMS to treat depression

Published: 17 May 2005  Written by Bruce Barton - Town Crier Staff Writer

Bob Claypool and Dr. Janusz Smolenski discuss transcranial magnetic stimulation.

Dr. Janusz Smolenski of Los Altos is using cutting-edge technology to treat depression - except that this technology has nothing to do with cutting or invasive surgery.

Smolenski, an engineer turned psychiatrist, uses transcranial magnetic stimulation (TMS) as one of his treatment modalities for depression. The technology, first developed in the mid-1980s, involves a special electromagnet delivering short bursts of energy to stimulate nerve cells in the brain. Smolenski uses rapid-rate TMS (rTMS), considered even more effective in treating depression. The frequencies used range from 1 to 20 pulses per second.

TMS is not to be confused with anything approaching electroconvulsive or electroshock therapy, proponents said.

"Some patients report a slight knocking or tapping sensation on the head," Smolenski said. "This may be a result of the tapping sound produced by the TMS device." Although the patient's head has to be held firmly in place during a procedure, TMS is painless and requires no anesthesia.

Smolenski is among a growing number of physicians who contend TMS can be as effective in relieving depression symptoms as antidepressant medications.

The outpatient procedure usually takes a half-hour. Smolenski said current research suggests TMS treatments five or six days a week for three to five weeks for best possible effectiveness. Treatment could continue once every two weeks to a month thereafter.

Its origins

TMS was discovered through the use of magnetic resonance imaging, or MRIs, used to produce high-quality images inside the human body. "Patients (who were depressed) were saying we feel better after the MRI," Smolenski noted.

Smolenski had been reading TMS literature and "thinking about it" for several years but was hesitant to pursue his medical career in that direction. However, a recent wave of TMS acceptance, shown in approval of grants for studies and publication in prestigious psychiatric journals, prompted Smolenski's move to using TMS. He cited two big studies currently under way - by the National Institute of Mental Health and Neuronetics Capital Venture - on the procedure, which has already been approved for use in Canada and Israel.

"There has been enough evidence that it works," Smolenski said. "I said, OK, looks like this plane is taking off."

The Food and Drug Administration is considering approval of the procedure but has already signed off on the equipment needed to perform it, Smolenski said. He expects the FDA to give its blessing to TMS by the fall of 2006.

Smolenski said that based on current data, "If you have someone who didn't respond to antidepressants and you go to TMS, you have almost a 50 percent chance you would be helped."

What Smolenski sees in TMS is the potential for successful treatment of depression as an alternative to or in conjunction with drugs, with a minimum of possible side effects.

He said these might include slight muscle contractions on the scalp, a mild headache or lightheadedness. The greatest risk is the potential, however small, for a seizure. He noted eight out of the first 1,000 tested had seizures but none since the introduction of guidelines in 1998 to increase safety. He said approximately 2,000 patients have undergone TMS thus far.

Buzz over TMS

The buzz, if you will, on TMS is currently at a high point. The respected publication Psychiatric Annals devoted its entire February issue to TMS, with the editor, Dr. Jan Fawcett, noting the publication rarely publishes information on a treatment "that has not been studied fully enough to be approved for use in the treatment of our patients." But the magazine made an exception here, Fawcett noting, "TMS could become a very helpful treatment for patients with absent or inadequate response to the medications we have available ... I have hope that TMS will fill an important treatment need of our patients in the relatively near future."

Time magazine followed in March with a TMS feature, touting, "A flaky-sounding treatment seems to work on depression, but scientists still can't explain precisely why."

Smolenski said he plans on attending an American Psychiatry Association convention at the end of the month that will feature TMS as a main topic of discussion.

Some experts contend that in addition to depression, TMS could also be used to successfully treat anxiety and improve cognitive abilities, among other improvements, although none of this is close to being proven.

"I'm very excited about the possibilities," said Los Altos resident Bob Claypool, a retired engineer and longtime friend of Smolenski's who has volunteered to be his first TMS patient even though he is not suffering from depression.

Potential TMS patients would go through a routine psychiatric examination with Smolenski, reviewing all options of treatment, including medications. The TMS procedure, currently not covered by health insurance, is $500 per treatment. A 20-treatment plan would run a patient approximately $6,000. Smolenski uses equipment manufactured by Cadwell Laboratories.

His credentials

Smolenski, who attended Stanford University for his premedical education and received his medical degree from the University of California at Davis, completed his residency training in psychiatry in the early 1990s at the University of California at San Francisco. He has been trained in the TMS procedure in Dr. Mark George's clinic at the Medical University of South Carolina. Smolenski, who has private practices in Mountain View and Hawaii, said he is currently the only psychiatrist practicing TMS west of the Rockies.

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