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TMS Therapy: Alternative Treatment for Depression, Anxiety


By Megan Garcia

WRNMMC Command Communications

Dr. Navneet K. Atwal and her team of TransCranial Magnetic Stimulation Treatment Service at Adult Outpatient Behavioral Health Clinic at Walter Reed National Military Medical Center are hoping to help patients who are looking for an alternative treatment for depression and anxiety.
TMS Therapy uses precise, targeted magnetic pulses via a magnetic field generator called a coil that is placed on a person’s scalp, emitting a small, electric current to the region of a person’s brain involved in mood control and depression.
Atwal said TMS has been shown to be a safe and well-tolerated procedure that can be an effective treatment for patients with depression who have not benefitted from certain antidepressant medications or cannot tolerate antidepressant medications due to side-effects; patients like Jane Doe and John Doe (whose names have been omitted to protect the patients’ privacy).
Jane, who spent seven years in the Navy and deployed twice to Guantanamo Bay Naval Base, said that about six months after coming back from her deployment in 2008, she started having issues with sleeping, and it progressively got worse, resulting in a later diagnosis of Post-Traumatic Stress Disorder, Anxiety and Depression.
She added that she tried various medications for the next three years, but nothing seemed to be working, compelling her to look at other options.
“In 2011, I tried [an alternative procedure], and it kind of was like someone hit the reset button. It was like all of a sudden I slept through the night. The depression seemed to lift a lot, and even the anxiety was better,” Jane said.
Although she saw progress from the procedure and it was effective, the side effects were dramatic, and “it takes a lot out of you to do it,” Jane said.
After two to three years when she needed to repeat the treatment, Jane said she didn’t know if she could put herself through that again, so she discussed various alternative options with her provider, who recommended Jane try TMS Therapy.
The TMS Treatment takes place for five days a week, for four to six weeks, with each session lasting about 40 minutes.
“I was reluctant to do it, but my spouse told me I had to try whatever I could,” Jane said. “She said, ‘Try it once, and if I don’t like it, so be it.’”
Jane explained with her depression and anxiety, leaving her house was a struggle. Additionally, the constant fatigue she felt from not getting any rest had gotten so bad that even driving had become difficult for her. However, she pushed forward and began her treatment in March and saw instant results.
“I noticed immediately after sitting in the chair for 40 minutes I was more tired, and I was leaving here a little sleepy, and I was like, ‘Wow!’, this is kind of weird because I am usually so edgy that I’m not sleepy at all. So I’d go home in the afternoon, and I haven’t slept during the day in I don’t know how many years, and every once in a while I would fall asleep and take a nap,” she said.
Jane laughed as she recalled calling her TMS Therapy nurse to tell her how she was finally able to get some rest.
“I felt so much better, and now when I sleep, I’m like a rock. When I’m out, I’m out,” Jane added.
Although she is still taking some medication from time to time to help her sleep, her dosage has been decreased from 200 mg to 50 mg. 
“If I have trouble calming down at night, I’ll take them, but it’s not nearly what I had to take before,” she said.
She has also seen improvements in her mood.
“I’m totally ok with taking the dogs outside now,” said Jane, who has three dogs and a litter of puppies. “They love to go for walks. Before, there were sometimes when I just didn’t want to go outdoors. Now we go on three walks a day. There’s not a lot keeping me from going out now.”
She also finds she doesn’t need her anxiety medication as much and only takes it once a week versus every day.
Jan said she is glad she made the decision to try the treatment.
 “It seems like a lot at first, but its way worth it, and it becomes way easier after the first couple of weeks,” she said. “Then it’s no longer ‘Oh my God, I have to go every day.’ It’s ‘I’m going to feel so much better after I get out of that chair.’”
John Doe, who still serves on active duty, said he has also seen a change since starting the therapy.
In 2014, six months after he joined the Navy, John said he started to feel detached from everything, and he also noticed he didn’t enjoy doing certain things like he did before. After finally reaching out for help in early 2016, he was diagnosed with depression and anxiety and was placed on medication.
He decided to start the TMS Treatment in May after talking with his provider about his growing frustrations with medications he felt weren’t working.
He started to see changes going into his third week of treatment.
“The biggest thing that I noticed was the impact on my anxiety,” he said. “I had deadlines coming up, and instead of freaking out and not doing anything about it, I just did it. Things seemed more doable, and I didn’t get overwhelmed as quickly.”
Although John still has some time before he is finished with the treatment, he said he is very pleased with the results so far. The detachment he once felt has gotten better, and he’s more willing to engage with people than he was before.
“I’m starting to talk to people a lot more and reconnect with my family,” John said. “My psychiatrist said when she first saw me I would smile with my mouth, but not with my eyes, but now she said she’s notices a difference.”
Atwal said that due to its noninvasive nature and minimal risk of lasting side effects, TMS Therapy has been studied as a possible treatment for a wide range of psychiatric conditions, though the data is strongest for use in treatment of Major Depressive Disorder. 
 “We have a wonderful team for our TMS therapy service at our clinic, including another psychiatrist, Dr. Joanna Galati and two TMS therapy nurses, Annette Davis and Yogeswari Nathan, who are very attentive to the patients’ needs and are competent in rendering the TMS Treatment.”  Atwal said that TMS Treatment is being offered at Psychiatry Continuity Service as well.