After suffering miserably with depression symptoms, who wouldn’t be excited and full of hope when they leave their doctor’s office with a prescription for antidepressants in hand? Finally, there is hope of returning to your normal self. Yippee. Your days of misery are over, you think while whistling through the parking lot to go fill the Rx.
Not so fast. It can come as a rude awakening to find yourself packing on unwanted pounds as a side effect of taking these selective serotonin reuptake inhibitors, or SSRIs. Antidepressants and weight gain seem to be attached at the hip, so to speak. In fact, for nearly every antidepressant on the market, the risk of weight gain is included in the long list of potential side effects. Worse yet, in 1 out of 3 patients, these drugs do not even alleviate the symptoms of depression.
When antidepressants and weight gain lead to ever more suffering, it may be appropriate to investigate an alternative treatment for depression that does not involve any drug at all. Transcranial magnetic stimulation (TMS) can offer new hope for treatment-resistant major depressive disorder (MDD).
Antidepressants and Weight Gain—What Causes it?
The jury is still out on the reason why antidepressants can cause weight gain. Some research indicates that the drugs cause a metabolic change that can lead to an increase in weight. Others theorize that a result of feeling better individuals may then regain their appetite and simply consume more calories. Another theory centers on the medication’s effect on the neurotransmitter serotonin, which can impact its role in regulating weight.
The antidepressants most prone to causing weight include:
There are some tips for managing the weight gain. The doctor can switch the patient to another type of antidepressant or adjust the dosage. Each trial takes about 4-6 weeks to see if it has made a positive difference. Also, patients can ramp up their exercise routine to try to control their weight. Diet is also important in controlling weight while on an antidepressant. Avoiding starchy, salty processed foods, sugary beverages, and alcohol will all help in this effort.
Antidepressants Didn’t Help the Depression—Now What?
After trialing several different antidepressants and weight gain, unfortunately, was a stubborn common denominator, it may be time to take a different path for treating the depression. Exploring alternative methods makes sense, especially if the medications didn’t offer any tangible reduction of symptoms.
TMS therapy has established a solid clinical track record for helping individuals who have been determined to be “treatment-resistant.” TMS is in the neuromodulation family of treatment options, providing the only option that is noninvasive. Because TMS requires no surgery, it can be applied without the use of any medication. There is no incision, no general anesthesia, and no recovery period. For individuals who were not responsive to antidepressant drug therapy, or antidepressants and weight gain caused the individual to suspend treatment, TMS offers renewed hope.
More About TMS Therapy
TMS therapy has been shown to help patients struggling with depression by going at the treatment process from a different angle. Antidepressants work systemically to alter the brain’s structure by increasing levels of the neurotransmitter serotonin. TMS also impacts the neurotransmitters, but does so by directly stimulating the brain cells that are underactive. Over the course of treatment, brain chemistry becomes rebalanced while depression symptoms gradually improve. Where antidepressant drug therapy may last for a year, five years, or a lifetime, TMS is a short-term, drug-free solution.
TMS therapy uses powerful magnetic fields to help make alterations in the neurons located in the limbic system. During a TMS therapy treatment session, the patient is seated comfortably for about 40 minutes. A coil is placed over the scalp, allowing the magnetic pulses to be delivered to the targeted brain tissue. This is the brain’s “mood center.” The magnetic energy then becomes converted into electrical currents within the brain tissue where it acts to stimulate underactive brain cells.
As the therapy sessions proceed, the patient will begin to notice subtle positive changes. As early as the 10th session, a patient may notice they are getting better sleep. As the TMS sessions continue, other improvements begin to surface, such as feeling more energetic, being better able to concentrate, and experiencing improved mood.
For best results, TMS therapy is prescribed for a period of 4-6 weeks, with 5 sessions per week. This treatment period allows the therapy to make subtle changes over time, eventually resulting in a rebalancing of brain chemistry. TMS is safe, with very few adverse effects reported by patients or study participants. Generally, any side effect that does surface, such as headaches or scalp irritation, will subside spontaneously with no intervention needed.
Research Backs Up TMS
For the past two decades ongoing clinical trials have been conducted on TMS, both in the U.S. and worldwide. TMS continues to be found to be both safe and effective in providing real results for individuals with treatment resistant MDD. Consider these studies:
- A large multi-site study with 325 MDD patients was conducted to evaluate TMS safety after acute exposure to the TMS therapy, extended exposure, and follow-up exposure. Adverse treatment effects were recorded at each benchmark with the resulting data showing that TMS had a low incidence of adverse effects, all which were mild to moderate in nature. These mild effects were scalp irritation and headaches that were transitory, resolving as treatment continued. The study concluded that TMS is well tolerated and safe for the treatment of major depressive disorder.
- For example, one recent clinical trial, conducted at Brown University, collected data on 257 study participants during the TMS treatment study period and then one year later. The results showing the long-term effects of TMS were compelling, showing a 68% response rate and a 48% remission rate at one year post-treatment.
- A large-scale multi-center study involved 42 clinical sites and 307 patients who had treatment-resistant MDD. Clinical assessment tools recorded changes in depression symptoms at three points: baseline, week two, and week six of TMS treatment sessions. The results demonstrated statistically significant response and remission rates, with the final data indicating TMS is safe and effective for treatment-resistant patients with MDD.
What is TMS Maintenance?
To help prevent a relapse back into depression, it is often recommended that patients follow up the initial TMS course of treatment with periodic maintenance sessions. Due to the various factors that influence major depression, each patient will have his or her own unique response to TMS therapy. In many cases a 4-6 week treatment regimen will provide remission that lasts for about six months or longer. Occasional TMS maintenance sessions are sometimes needed to prolong remission. Some patients may be placed on a post-TMS schedule of one session per month for a specified period of time.
TMS maintenance sessions have been found to be useful in extending the depression remission status. This proactive strategy can help maintain the overall treatment effects experienced after the initial full course of treatment.
In addition to scheduled follow-up sessions, patients are encouraged to also make lifestyle changes that can enhance clinical results. These might include establishing a regular exercise program that involves at least 3 or 4 workouts per week. In addition, some holistic therapies, such as mindfulness meditation, yoga, and acupuncture may be helpful in stress reduction and emotion regulation.
Can TMS Help Co-Occurring Anxiety?
One of the discoveries since TMS was FDA-cleared for treating depression was that patients who had co-occurring anxiety found those symptoms improved, too. TMS therapy targets the prefrontal cortex for both disorders, but its effects extend to the cortical and subcortical brain regions it is connected to. It is believed that stimulating these brain structures on the right prefrontal cortex can help normalize brain chemistry and help mitigate generalized anxiety disorder symptoms.
Studies have shown that applying low frequency TMS therapy for anxiety to the right dorsolateral prefrontal cortex shows promising results. Participants in sham-controlled trials reported a significant decrease in anxiety symptoms, which can be attributed to an increase in theta activity. This placement of the coil and the frequency used differs from TMS treatment for depression, which is typically placed over the left DLPFC and utilizes a high frequency.
Can Antidepressants Be Prescribed With TMS?
For patients who can tolerate antidepressants and weight gain is not an issue, there is evidence that the medication can augment TMS treatment results or vice versa. There is evidence that using the two treatment protocols together can optimize results, and eventually the antidepressant therapy can be tapered and eliminated as symptoms normalize. Utilizing antidepressants as a complementary therapy with the TMS can also positively impact how long the effects of TMS treatment might last.
When the doctor determines that augmentative TMS is a safe treatment option, the individual will be closely monitored to identify and prevent any adverse reactions. Certain antidepressants, such as tricyclic antidepressants, would not be considered for this combined therapy, as seizures could result. In most cases, TMS therapy is administered as a stand-alone treatment, or in conjunction with psychotherapy.
Anew Era Psychiatry Offers Expert TMS Services in Southern California and Texas
Anew Era Psychiatry is a leading mental health provider that is dedicated to assisting individuals to overcome major depressive disorder. Living with depression is exhausting and even debilitating, but our top-notch psychiatric team specializes in treating depression. If antidepressants and weight gain made you miserable, call Anew Era Psychiatry for a review of your medications and a discussion about alternative treatments. Call us today at (888) 561-0868.