In the world of depression, there is now hope without shock. 

Transcranial Magnetic Stimulation offers a brief, noninvasive treatment for depression that is gaining popularity as an alternative to electroconvulsive therapy. Since the U.S. Food and Drug Administration approved the new therapy a year ago, six centers have opened in Chicago alone.  

Thea Craig, a fifth year doctoral candidate for clinical psychology, said her experience in a downtown center administering the treatment has been “nothing short of remarkable…We've had two catatonic patients, almost completely nonverbal who are now functioning. They have spontaneous conversation, walk quicker, regained interest in doing things that used to bring them pleasure. It's been that dramatic.” 

Depression affects over 14 million Americans per year, and though antidepressants are widely prescribed, there are many individuals for whom the treatment is insufficient or causes unacceptable side effects. 

ECT is a very effective alternative, but requires six to 12 sessions to work and can require downtime between treatments that make the process time-consuming. There is also an expectation of overnight stays after each session. The prospect of inducing a seizure, potential short-term memory loss, and the fear surrounding the perceived danger, also deters many people.

In sharp contrast, TMS treatments take 37 minutes, require no sedation or anesthesia and the prescribed 20 to 30 treatments take only four to six weeks. The treatment consists of magnetic pulses to the prefrontal cortex, which stimulate neurons in the brain. The patient feels only a light tapping sensation.

But though Craig, who works with psychiatrist Carl M. Wahlstrom Jr., has seen these kinds of stunning turnarounds, she warns against the initial fascination of a new treatment turning into “the new quick fix, as a band-aid for a deeper problem.”

Dr. Philip Janicak, who oversees the new clinic and is both a psychiatrist at Rush and the lead investigator in the clinical trials of TMS, also warns against any claims that TMS is a miracle cure or the ultimate treatment.

“There are now eight studies comparing TMS to ECT, and in each of those studies, ECT is more effective. However, many patients are not that severely depressed. They do not display psychotic symptoms, and are not suicidal and requiring hospitalization,” Janicak said. “This is where TMS, which causes no cognitive deficits, is an important addition in the continuum of treatment.”
Rush has Chicago’s sixth center offering TMS.

In open clinical studies, TMS benefitted 50 percent of people suffering from depression, while ECT has a success ratio closer to 70 percent.

The other major barrier for the treatment is cost. TMS treatment costs between $8,000 and $12,000 and currently is not covered by any major insurance companies. Some patients are fighting for coverage, but the process is lengthy: the patient must submit a claim, receive a rejection, resubmit it with a letter of medical need and receive another rejection, and then begin appeal processes.

ECT, though it can cost between $12,000 and $15,000, is widely covered by insurance.

“It’s important to remember that this treatment is new. There are 40 or 50 cases around the country where insurance companies have reimbursed patients, and they’re getting increasing amounts of requests,” Janicak said. “As those requests continue, the companies will look carefully at the treatment, and we’re hoping that within the next year many of these companies will introduce TMS coverage on a policy-wide basis.”