This presentation gives an over view: of the depression, its symptoms, prevalence, and patho-physiology. It then reviews various treatment options for depression, first starting with medication, and then moving to neuro-modulation. Focus is then on the similarities and differences of ECT and TMS. And finally information is provided about PineWood TMS.
Brain Stimulation & Neuromodulation September 2016 - BH SummitJay Yeomans
Brain stimulation techniques like transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT) show promise for treating neuropsychiatric conditions like depression. TMS uses magnetic fields to noninvasively stimulate areas of the brain and has been FDA approved for treating depression, while ECT uses electric currents to induce controlled seizures and is very effective for severe depression. Newer non-invasive techniques like transcranial direct current stimulation (tDCS) are also being studied for modulating brain activity. These neuromodulation approaches aim to alter brain circuits and neurotransmitter activity to improve mood and other symptoms.
transcranial magnetic stimulation , deep brain stimulation and vagal nerve st...أنس زيتون
This document discusses several neuromodulation techniques for treating neurological conditions like depression. It describes transcranial magnetic stimulation (TMS), which uses magnetic fields to stimulate brain regions involved in mood control. Deep brain stimulation involves implanting electrodes in the brain to regulate abnormal impulses through electrical stimulation. Vagus nerve stimulation stimulates the vagus nerve with electrical impulses to treat epilepsy and depression. All three methods aim to improve symptoms but have risks like infection, side effects from stimulation, and require follow up surgeries as batteries need replacement over time.
Neuromodulation therapies like TMS and ECT allow targeted delivery of electrical or magnetic signals to specific areas of the nervous system to improve neural function. TMS uses magnetic pulses to induce currents in the brain non-invasively, while ECT induces seizures via electrodes. Both can have antidepressant effects by modifying neurotransmitter systems and inducing neuroplasticity. Ongoing research aims to better understand mechanisms of action, optimize dosing parameters, and expand indications to other psychiatric conditions.
This document provides an overview of different non-invasive brain stimulation techniques, including electroconvulsive therapy (ECT), transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (TMS), and theta burst stimulation (TBS). It describes the history, mechanisms, applications, and side effects of each technique. ECT involves inducing seizures with electricity to treat conditions like depression. tDCS uses weak electrical currents to modulate cortical excitability. TMS uses electromagnetic induction to stimulate targeted brain regions without surgery. These non-invasive methods can modulate brain activity and connectivity to treat various neurological and psychiatric disorders.
Magnets - Not Drugs: TMS IMMH San Antonio 2014Louis Cady, MD
In this talk, Dr. Cady covers a remarkable new treatment for depression: transcranial magnetic stimulation. The historical roots of this treatment are traced, followed by a review of the literature in terms of the proven efficacy of this treatment. A comparison with ECT shows that TMS has a very favorable profile, with remarkably fewer side effects and incredibly better tolerated side effects compared to ECT. Given that this was a "CME" talk, off-label uses of TMS were reviewed, including stepping stones for future avenues to explore
rTMS therapy uses magnetic pulses to the brain to treat depression. It works by increasing or decreasing activity in targeted brain areas like the left prefrontal cortex. Studies show rTMS is effective for medication-resistant depression, with over 30% of patients experiencing remission of symptoms and over 50% experiencing an improvement. Brain imaging studies also show rTMS may normalize activity in limbic and cortical brain regions involved in mood regulation. Potential side effects include headache or discomfort at the site of stimulation, but rTMS is considered safe and better tolerated than antidepressant medications.
Repetitive transcanial magnetic stimulation(r tms) for depression treatmentGuru Prasath
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive treatment used for depression when common treatments do not work. rTMS uses rapidly changing magnetic fields to induce weak electric currents in neurons, targeting areas of the limbic system associated with depression. This triggers neurotransmitter secretion and facilitates neural activity in the targeted area. rTMS has advantages over antidepressants as it does not cause side effects and its effects can last beyond the stimulation period.
Brain Stimulation & Neuromodulation September 2016 - BH SummitJay Yeomans
Brain stimulation techniques like transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT) show promise for treating neuropsychiatric conditions like depression. TMS uses magnetic fields to noninvasively stimulate areas of the brain and has been FDA approved for treating depression, while ECT uses electric currents to induce controlled seizures and is very effective for severe depression. Newer non-invasive techniques like transcranial direct current stimulation (tDCS) are also being studied for modulating brain activity. These neuromodulation approaches aim to alter brain circuits and neurotransmitter activity to improve mood and other symptoms.
transcranial magnetic stimulation , deep brain stimulation and vagal nerve st...أنس زيتون
This document discusses several neuromodulation techniques for treating neurological conditions like depression. It describes transcranial magnetic stimulation (TMS), which uses magnetic fields to stimulate brain regions involved in mood control. Deep brain stimulation involves implanting electrodes in the brain to regulate abnormal impulses through electrical stimulation. Vagus nerve stimulation stimulates the vagus nerve with electrical impulses to treat epilepsy and depression. All three methods aim to improve symptoms but have risks like infection, side effects from stimulation, and require follow up surgeries as batteries need replacement over time.
Neuromodulation therapies like TMS and ECT allow targeted delivery of electrical or magnetic signals to specific areas of the nervous system to improve neural function. TMS uses magnetic pulses to induce currents in the brain non-invasively, while ECT induces seizures via electrodes. Both can have antidepressant effects by modifying neurotransmitter systems and inducing neuroplasticity. Ongoing research aims to better understand mechanisms of action, optimize dosing parameters, and expand indications to other psychiatric conditions.
This document provides an overview of different non-invasive brain stimulation techniques, including electroconvulsive therapy (ECT), transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (TMS), and theta burst stimulation (TBS). It describes the history, mechanisms, applications, and side effects of each technique. ECT involves inducing seizures with electricity to treat conditions like depression. tDCS uses weak electrical currents to modulate cortical excitability. TMS uses electromagnetic induction to stimulate targeted brain regions without surgery. These non-invasive methods can modulate brain activity and connectivity to treat various neurological and psychiatric disorders.
Magnets - Not Drugs: TMS IMMH San Antonio 2014Louis Cady, MD
In this talk, Dr. Cady covers a remarkable new treatment for depression: transcranial magnetic stimulation. The historical roots of this treatment are traced, followed by a review of the literature in terms of the proven efficacy of this treatment. A comparison with ECT shows that TMS has a very favorable profile, with remarkably fewer side effects and incredibly better tolerated side effects compared to ECT. Given that this was a "CME" talk, off-label uses of TMS were reviewed, including stepping stones for future avenues to explore
rTMS therapy uses magnetic pulses to the brain to treat depression. It works by increasing or decreasing activity in targeted brain areas like the left prefrontal cortex. Studies show rTMS is effective for medication-resistant depression, with over 30% of patients experiencing remission of symptoms and over 50% experiencing an improvement. Brain imaging studies also show rTMS may normalize activity in limbic and cortical brain regions involved in mood regulation. Potential side effects include headache or discomfort at the site of stimulation, but rTMS is considered safe and better tolerated than antidepressant medications.
Repetitive transcanial magnetic stimulation(r tms) for depression treatmentGuru Prasath
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive treatment used for depression when common treatments do not work. rTMS uses rapidly changing magnetic fields to induce weak electric currents in neurons, targeting areas of the limbic system associated with depression. This triggers neurotransmitter secretion and facilitates neural activity in the targeted area. rTMS has advantages over antidepressants as it does not cause side effects and its effects can last beyond the stimulation period.
Repetitive Transcranial Magnetic Stimulation at Southeastern Psychiatric Asso...Miriam Isreb
Repetitive Transcranial Magnetic Stimulation is a noninvasive treatment that uses a magnetic field to stimulate nerve cells in the dorsolateral prefrontal cortex, to relieve symptoms of depression. For more information, please review the e-brochure.
If you have any questions or are interested in receiving this treatment, please email sepa.tms@gmail.com
1) Repetitive Transcranial Magnetic Stimulation (rTMS) is a new tool that could provide a new therapy and hope for treating ADHD. It has been found effective in treating other neurological and psychiatric disorders.
2) rTMS may target the prefrontal-caudate-cerebellar pathways and dopamine abnormalities involved in ADHD by modulating neurotransmitters like dopamine through cortico-striatal projections.
3) Carefully conducted clinical trials are still needed, but initial evidence suggests rTMS may help treat ADHD symptoms and is a safe technique worth exploring further.
Transcranial magnetic stimulation (TMS) is a noninvasive method to cause depolarization or hyperpolarization in the neurons of the brain.
This video explains the physics of this method and how it can be used in daily practice.
More about magnetic simulators: http://www.neurosoft.ru/eng/product/neuro-msd/index.aspx
Brain stimulation therapies involve directly activating or touching the brain with electricity, magnets, or implants to treat mental disorders. The main therapies discussed are electroconvulsive therapy (ECT), vagus nerve stimulation (VNS), repetitive transcranial magnetic stimulation (rTMS), magnetic seizure therapy (MST), and deep brain stimulation (DBS). These therapies are still being researched but show promise, especially for treating depression and other disorders that do not respond to more conventional treatments. Research is ongoing to better understand how these therapies work in the brain and to reduce potential side effects.
Regulation of depression by a new type of brain stimulation in addicted patie...Mrsunny4
Depression is also known as clinical depression and major depressive disorder (MDD). This severe medical illness affects 15 million American adults every year or about 5-8% of the adult population of the US. Women are nearly twice as likely as men to develop major depression.
Electroconvulsive therapy (ECT) involves inducing a seizure through electrodes placed on a patient's head to treat various mental disorders like depression, schizophrenia, and mania. There are different types of ECT based on technique and electrode placement. ECT is indicated for severe cases when rapid recovery is needed or drugs cannot be used. Risks include temporary memory loss and fractures, so thorough screening is required. The mechanism is not fully understood but may involve changes in neurotransmitters, neuroendocrine function, or brain damage/placebo effects. Precise administration and monitoring during treatment aims to reduce risks and side effects.
Electroconvulsive therapy (ECT) was developed in the 1930s-40s as a safer alternative to inducing seizures through chemicals. It involves inducing a seizure through electric currents passed through the brain under anesthesia. Modern ECT uses brief pulse machines and muscle relaxants to reduce side effects. While its exact mechanism is unclear, leading theories involve anticonvulsant effects and neurochemical changes impacting neurotransmitters like serotonin, dopamine, and GABA. ECT remains an effective treatment for severe depression, mania, and catatonia when other options have failed or risks are high. Guidelines recommend its use in such situations.
ECT, or electroconvulsive therapy, is a treatment that induces seizures in patients to provide therapeutic benefits for certain mental health conditions like severe depression. It works by altering neurotransmitter and receptor activity in brain regions involved in mood regulation. While its use declined due to negative portrayals, ECT is considered very effective and safe for treating conditions like major depression when other options have failed or cannot be tolerated. Common side effects include temporary memory loss that usually improves after treatment ends. Informed consent discussing risks, benefits, and alternatives is important given the cognitive effects.
Neuropathic pain is caused by damage or disease affecting the somatosensory nervous system and is characterized by abnormal sensations such as burning or stabbing pain. It is estimated to affect 7-8% of adults. Common causes include diabetes, shingles, HIV, cancer treatments and injuries. Diagnosis involves medical history, exams and tests to rule out other conditions. Treatment involves pharmacologic options like antidepressants, anticonvulsants and opioids as well as non-pharmacologic therapies. However, neuropathic pain is difficult to treat and a multidisciplinary approach combining several therapies is often needed to provide effective relief.
Treating Treatment Refractory Depression With TMS, Transcranial Magnetic Stimulation. TMS is for patients suffering from depression who have not achieved satisfactory improvement from prior antidepressant treatment. These slides show research and anecdotes taken from actual results of patients who've tried TMS.
The presentation part of a two-day workshop on ECT held at al-Hussain University Hospital of al-Azhar Univeristy. It was accompanied by one-to-one training on the Thymatron system IV machine in the ECT suite of al-Hussain hospital.
ECT, or electroconvulsive therapy, has been used to treat mental illness since the 1930s but remains controversial. While proponents view it as a safe and effective treatment for severe mental disorders like depression, opponents argue it is an abusive procedure that risks damaging the brain. The debate around ECT touches on whether mental illness should be viewed as a medical condition, the historical misuse of psychiatric treatments, and the power dynamic between patients and doctors. Both the risks and benefits of ECT must be considered, as well as alternative treatment options.
This document summarizes the pharmacotherapy of migraine. It outlines the pathophysiology including vascular, neurogenic, and neurovascular theories. It discusses acute treatment with non-specific medications like NSAIDs and specific treatments like triptans. Preventive treatment options are also covered including antidepressants, beta-blockers, anti-epileptics, calcium channel blockers, and newer targets such as CGRP antagonists and nitric oxide synthase inhibitors.
This document summarizes the treatment of neuropathic pain. It discusses the various causes of neuropathic pain including diabetes, shingles, and spinal cord injuries. It then describes common neuropathic pain conditions and symptoms. The document outlines the pathophysiology of neuropathic pain in both the peripheral and central nervous systems. It provides details on different drug classes used to manage neuropathic pain such as antidepressants, antiepileptics, opioids, topical agents, and other possibilities. The summary notes that neuropathic pain has no single highly effective treatment and often requires a trial-and-error process to determine the appropriate polypharmacy regimen for each patient.
This document provides a history of electroconvulsive therapy (ECT) and discusses how it works and is administered. It describes how ECT was developed in the 1930s-1940s and became widely used before declining in popularity from the 1960s-1980s due to negative perceptions. It then discusses how ECT use resurged in the 1980s when studies found it superior to other treatments for severe depression. The document explains that ECT modifies mood by impacting brain structure, neurotransmitters, neuroendocrine systems, and electrophysiology. It also reviews patient selection, risks/benefits, the treatment process, and factors like consent, monitoring, and anesthesia administration.
ECT was first used in 1938 to treat psychiatric disorders and involves inducing a seizure via electric shock under anesthesia. It remains an effective treatment for severe depression, bipolar disorder, and other conditions when medications are ineffective. ECT is generally safe but can cause short-term memory loss and other cognitive side effects. Recent research indicates that electrode placement and dosage affect efficacy and side effects, with bilateral placement being more effective but also more likely to cause memory issues than unilateral right placement. Guidelines recommend ECT only for treatment-resistant cases and that it be administered properly by credentialed psychiatrists.
The document discusses neuropathic pain management and treatment options. It defines neuropathic pain and differentiates it from acute pain. It describes the pathophysiology and possible descriptions of neuropathic pain. The goals of clinical assessment are to achieve diagnosis, identify underlying causes, evaluate comorbidities, and develop a targeted treatment plan. Treatment options discussed include nonpharmacological approaches, topical medications, systemic medications like anticonvulsants, antidepressants, and opioids. New treatments and applications of existing treatments are improving management of neuropathic pain conditions.
This document provides an overview of electroconvulsive therapy (ECT). It defines ECT as producing a seizure through electric current. ECT works by exceeding the seizure threshold through electricity. While the exact mechanism is unknown, animal studies show it increases sensitivity of neurotransmitter receptors. ECT is 70-85% effective for severe depression, particularly with agitation or delusions, and when other treatments are contraindicated or ineffective. It may also be used for psychosis during pregnancy, chronic schizophrenia, or acute schizophrenia when drugs don't work or urgent treatment is needed. The document outlines the method, side effects, complications, contraindications, and obstacles of ECT.
Goldman grand rounds, electroconvulsive therapy (ect)...mysterious rebootLisa E Goldman, MD, MSW
How does ECT work? Is it dangerous? Is it scary? Does it work? What mental health conditions can be effectively treated by ECT? Is it true that ECT works better than prescription antidepressants? What are common side effects of ECT and how are this managed? Has the practice of ECT changed over time? What patient factors are the best predictors of positive and negative outcomes of ECT treatment? Come with me on a journey as I present my grand rounds lecture for the department of psychiatry as I complete my 4th year of psychiatry residency at UTHSC Memphis. These are exciting times. Recovery is definitely an option.
The document summarizes research on transcranial magnetic stimulation (TMS) and its ability to induce savant-like skills in normal individuals. The research involved using TMS to inhibit the left fronto-temporal lobe and test effects on drawing ability and proofreading skills. Some participants showed enhanced attention to detail, changing their drawing style and improving at detecting errors. This suggests suppressing certain brain regions can produce savant-like abilities temporarily. TMS provides a method to study brain-behavior relationships and further research may help understand cognition.
Transcranial Brain Stimulation: Science and EthicsJames David Saul
This document discusses the promise and potential risks of noninvasive brain stimulation techniques like transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). It notes that these techniques have shown promise in transiently improving cognition in domains like language, learning, attention, and problem-solving. They have also shown potential for mood enhancement and manipulating social cognition. However, the document also discusses safety concerns, issues of character and justice, and questions around autonomy that arise from the ability to manipulate human cognition and behavior without consent through these techniques.
Repetitive Transcranial Magnetic Stimulation at Southeastern Psychiatric Asso...Miriam Isreb
Repetitive Transcranial Magnetic Stimulation is a noninvasive treatment that uses a magnetic field to stimulate nerve cells in the dorsolateral prefrontal cortex, to relieve symptoms of depression. For more information, please review the e-brochure.
If you have any questions or are interested in receiving this treatment, please email sepa.tms@gmail.com
1) Repetitive Transcranial Magnetic Stimulation (rTMS) is a new tool that could provide a new therapy and hope for treating ADHD. It has been found effective in treating other neurological and psychiatric disorders.
2) rTMS may target the prefrontal-caudate-cerebellar pathways and dopamine abnormalities involved in ADHD by modulating neurotransmitters like dopamine through cortico-striatal projections.
3) Carefully conducted clinical trials are still needed, but initial evidence suggests rTMS may help treat ADHD symptoms and is a safe technique worth exploring further.
Transcranial magnetic stimulation (TMS) is a noninvasive method to cause depolarization or hyperpolarization in the neurons of the brain.
This video explains the physics of this method and how it can be used in daily practice.
More about magnetic simulators: http://www.neurosoft.ru/eng/product/neuro-msd/index.aspx
Brain stimulation therapies involve directly activating or touching the brain with electricity, magnets, or implants to treat mental disorders. The main therapies discussed are electroconvulsive therapy (ECT), vagus nerve stimulation (VNS), repetitive transcranial magnetic stimulation (rTMS), magnetic seizure therapy (MST), and deep brain stimulation (DBS). These therapies are still being researched but show promise, especially for treating depression and other disorders that do not respond to more conventional treatments. Research is ongoing to better understand how these therapies work in the brain and to reduce potential side effects.
Regulation of depression by a new type of brain stimulation in addicted patie...Mrsunny4
Depression is also known as clinical depression and major depressive disorder (MDD). This severe medical illness affects 15 million American adults every year or about 5-8% of the adult population of the US. Women are nearly twice as likely as men to develop major depression.
Electroconvulsive therapy (ECT) involves inducing a seizure through electrodes placed on a patient's head to treat various mental disorders like depression, schizophrenia, and mania. There are different types of ECT based on technique and electrode placement. ECT is indicated for severe cases when rapid recovery is needed or drugs cannot be used. Risks include temporary memory loss and fractures, so thorough screening is required. The mechanism is not fully understood but may involve changes in neurotransmitters, neuroendocrine function, or brain damage/placebo effects. Precise administration and monitoring during treatment aims to reduce risks and side effects.
Electroconvulsive therapy (ECT) was developed in the 1930s-40s as a safer alternative to inducing seizures through chemicals. It involves inducing a seizure through electric currents passed through the brain under anesthesia. Modern ECT uses brief pulse machines and muscle relaxants to reduce side effects. While its exact mechanism is unclear, leading theories involve anticonvulsant effects and neurochemical changes impacting neurotransmitters like serotonin, dopamine, and GABA. ECT remains an effective treatment for severe depression, mania, and catatonia when other options have failed or risks are high. Guidelines recommend its use in such situations.
ECT, or electroconvulsive therapy, is a treatment that induces seizures in patients to provide therapeutic benefits for certain mental health conditions like severe depression. It works by altering neurotransmitter and receptor activity in brain regions involved in mood regulation. While its use declined due to negative portrayals, ECT is considered very effective and safe for treating conditions like major depression when other options have failed or cannot be tolerated. Common side effects include temporary memory loss that usually improves after treatment ends. Informed consent discussing risks, benefits, and alternatives is important given the cognitive effects.
Neuropathic pain is caused by damage or disease affecting the somatosensory nervous system and is characterized by abnormal sensations such as burning or stabbing pain. It is estimated to affect 7-8% of adults. Common causes include diabetes, shingles, HIV, cancer treatments and injuries. Diagnosis involves medical history, exams and tests to rule out other conditions. Treatment involves pharmacologic options like antidepressants, anticonvulsants and opioids as well as non-pharmacologic therapies. However, neuropathic pain is difficult to treat and a multidisciplinary approach combining several therapies is often needed to provide effective relief.
Treating Treatment Refractory Depression With TMS, Transcranial Magnetic Stimulation. TMS is for patients suffering from depression who have not achieved satisfactory improvement from prior antidepressant treatment. These slides show research and anecdotes taken from actual results of patients who've tried TMS.
The presentation part of a two-day workshop on ECT held at al-Hussain University Hospital of al-Azhar Univeristy. It was accompanied by one-to-one training on the Thymatron system IV machine in the ECT suite of al-Hussain hospital.
ECT, or electroconvulsive therapy, has been used to treat mental illness since the 1930s but remains controversial. While proponents view it as a safe and effective treatment for severe mental disorders like depression, opponents argue it is an abusive procedure that risks damaging the brain. The debate around ECT touches on whether mental illness should be viewed as a medical condition, the historical misuse of psychiatric treatments, and the power dynamic between patients and doctors. Both the risks and benefits of ECT must be considered, as well as alternative treatment options.
This document summarizes the pharmacotherapy of migraine. It outlines the pathophysiology including vascular, neurogenic, and neurovascular theories. It discusses acute treatment with non-specific medications like NSAIDs and specific treatments like triptans. Preventive treatment options are also covered including antidepressants, beta-blockers, anti-epileptics, calcium channel blockers, and newer targets such as CGRP antagonists and nitric oxide synthase inhibitors.
This document summarizes the treatment of neuropathic pain. It discusses the various causes of neuropathic pain including diabetes, shingles, and spinal cord injuries. It then describes common neuropathic pain conditions and symptoms. The document outlines the pathophysiology of neuropathic pain in both the peripheral and central nervous systems. It provides details on different drug classes used to manage neuropathic pain such as antidepressants, antiepileptics, opioids, topical agents, and other possibilities. The summary notes that neuropathic pain has no single highly effective treatment and often requires a trial-and-error process to determine the appropriate polypharmacy regimen for each patient.
This document provides a history of electroconvulsive therapy (ECT) and discusses how it works and is administered. It describes how ECT was developed in the 1930s-1940s and became widely used before declining in popularity from the 1960s-1980s due to negative perceptions. It then discusses how ECT use resurged in the 1980s when studies found it superior to other treatments for severe depression. The document explains that ECT modifies mood by impacting brain structure, neurotransmitters, neuroendocrine systems, and electrophysiology. It also reviews patient selection, risks/benefits, the treatment process, and factors like consent, monitoring, and anesthesia administration.
ECT was first used in 1938 to treat psychiatric disorders and involves inducing a seizure via electric shock under anesthesia. It remains an effective treatment for severe depression, bipolar disorder, and other conditions when medications are ineffective. ECT is generally safe but can cause short-term memory loss and other cognitive side effects. Recent research indicates that electrode placement and dosage affect efficacy and side effects, with bilateral placement being more effective but also more likely to cause memory issues than unilateral right placement. Guidelines recommend ECT only for treatment-resistant cases and that it be administered properly by credentialed psychiatrists.
The document discusses neuropathic pain management and treatment options. It defines neuropathic pain and differentiates it from acute pain. It describes the pathophysiology and possible descriptions of neuropathic pain. The goals of clinical assessment are to achieve diagnosis, identify underlying causes, evaluate comorbidities, and develop a targeted treatment plan. Treatment options discussed include nonpharmacological approaches, topical medications, systemic medications like anticonvulsants, antidepressants, and opioids. New treatments and applications of existing treatments are improving management of neuropathic pain conditions.
This document provides an overview of electroconvulsive therapy (ECT). It defines ECT as producing a seizure through electric current. ECT works by exceeding the seizure threshold through electricity. While the exact mechanism is unknown, animal studies show it increases sensitivity of neurotransmitter receptors. ECT is 70-85% effective for severe depression, particularly with agitation or delusions, and when other treatments are contraindicated or ineffective. It may also be used for psychosis during pregnancy, chronic schizophrenia, or acute schizophrenia when drugs don't work or urgent treatment is needed. The document outlines the method, side effects, complications, contraindications, and obstacles of ECT.
Goldman grand rounds, electroconvulsive therapy (ect)...mysterious rebootLisa E Goldman, MD, MSW
How does ECT work? Is it dangerous? Is it scary? Does it work? What mental health conditions can be effectively treated by ECT? Is it true that ECT works better than prescription antidepressants? What are common side effects of ECT and how are this managed? Has the practice of ECT changed over time? What patient factors are the best predictors of positive and negative outcomes of ECT treatment? Come with me on a journey as I present my grand rounds lecture for the department of psychiatry as I complete my 4th year of psychiatry residency at UTHSC Memphis. These are exciting times. Recovery is definitely an option.
The document summarizes research on transcranial magnetic stimulation (TMS) and its ability to induce savant-like skills in normal individuals. The research involved using TMS to inhibit the left fronto-temporal lobe and test effects on drawing ability and proofreading skills. Some participants showed enhanced attention to detail, changing their drawing style and improving at detecting errors. This suggests suppressing certain brain regions can produce savant-like abilities temporarily. TMS provides a method to study brain-behavior relationships and further research may help understand cognition.
Transcranial Brain Stimulation: Science and EthicsJames David Saul
This document discusses the promise and potential risks of noninvasive brain stimulation techniques like transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). It notes that these techniques have shown promise in transiently improving cognition in domains like language, learning, attention, and problem-solving. They have also shown potential for mood enhancement and manipulating social cognition. However, the document also discusses safety concerns, issues of character and justice, and questions around autonomy that arise from the ability to manipulate human cognition and behavior without consent through these techniques.
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that uses low direct current delivered through electrodes placed on the scalp to modulate cortical excitability. Several studies reviewed found that anodal tDCS over the affected motor cortex and cathodal tDCS over the unaffected motor cortex improved motor performance in stroke patients. Parameters like current dosage, electrode size and position, and stimulation duration need to be defined to induce different physiological effects. tDCS shows promise as a treatment for stroke rehabilitation and other neurological conditions by enhancing or inhibiting neural activity in targeted brain regions.
Marom Bikson speaks at the BrainSTIM2015 - Targeting transcranial Electrical Stimulation (tES) using EEG. Includes how to use EEG to inform transcranial Direct Current Stimulation (tDCS) montages. And critical pitfalls in concurrent recording. Stay tuned for our upcoming paper on reciprocity.
The complete video can be found here: https://www.youtube.com/watch?v=yYmDQB7qSCE
The first publication on the topic can be found here http://neuralengr.com/wp-content/uploads/2016/05/2016-Cancelli-A-simple-method.pdf
Related technology can be found here http://soterixmedical.com/research/monitoring/eeg
Transcranial direct current stimulation Andri Andri
Transracial direct current stimulation (tDCS) is a non-invasive form of brain stimulation that delivers low currents of electricity to modulate neuronal activity. It has been studied as a treatment for conditions such as depression, stroke rehabilitation and cognitive impairment. While generally safe with minor side effects like skin irritation and fatigue, more research is still needed on its efficacy and long term effects before it can be recommended in clinical practice. tDCS holds promise as a treatment to induce neuroplasticity but requires further evaluation in controlled trials.
This document provides an overview of library resources for a Psych 331 course on research methods in brain, behavior, and cognitive science. It summarizes how to search key databases like PubMed and PsycINFO to find information on topics like brain stimulation and social cognition. The librarians describe searching techniques like using subject headings, Boolean operators, and filters to refine searches. They also explain how to access full text articles through the university's subscriptions.
This document discusses various neurotechnologies including EEG, tACS, PEMF, and sensory substitution. It provides links to research on using EEG-guided meditation and EEG to study working memory. It also provides information on DIY options for EEG using OpenBCI, tACS using BrainKit, and PEMF coils and waveforms. Applications discussed include using tACS to modulate working memory and tactile perception and sensory substitution technologies. Overall resources and links are presented for neurofeedback, brain stimulation, and DIY neuroscience projects.
Technological innovations in neurology 1Sanjoy Sanyal
1. The document outlines various technological innovations used in neurology, including deep brain stimulation (DBS), vagus nerve stimulation (VNS), radiofrequency ablation, high-intensity focused ultrasound (HIFU), transcranial magnetic stimulation (TMS), and other devices.
2. DBS involves surgically implanting electrodes into the brain which are connected to a pulse generator to electrically stimulate areas of the brain involved in movement disorders. TMS uses magnetic fields to non-invasively stimulate areas of the brain from outside the skull.
3. HIFU is a non-invasive technique that uses focused ultrasound to heat and destroy targeted brain tissue, avoiding the risks of surgery. These technologies are used
What’s next: The future of non-invasive neurotechnologySharpBrains
(Session held at the 2014 SharpBrains Virtual Summit; October 28-30th, 2014)
3-4pm. What’s next: The future of non-invasive neurotechnology
- Dr. Bruce Cuthbert, Director of Adult Translational Research and Treatment Development at the NIMH
- Charles Fisher, President of Fisher Wallace Laboratories
- Chair: James Cavuoto, Editor and Publisher at Neurotech Reports
Learn more here:
http://sharpbrains.com/summit-2014/agenda/
The document discusses developing new speech and language therapy techniques for treating aphasia after a stroke. It explores combining Intensive Language Action Therapy with Transcranial Magnetic Stimulation to maximize brain plasticity and speed recovery from aphasia. A current study is randomly assigning groups to different combinations of these therapies to understand their effects. The long term goal is to develop new rehabilitation methods and services based on these findings.
Stroke occurs when blood supply to the brain is interrupted, causing neurological deficits. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, caused by a burst blood vessel in the brain. Common medications used for stroke treatment include antiplatelets like aspirin for prevention, anticoagulants like warfarin, and thrombolytics like rt-PA administered during an acute ischemic stroke. Actilyse is a thrombolytic medication derived from rt-PA that works to break down blood clots and restore blood flow by activating plasminogen to form the enzyme plasmin. While effective, challenges remain to develop variants of Actilyse with better properties like enhanced clot penetration
This document discusses the risks and benefits of using thrombolysis (tPA) to treat acute ischemic stroke. It references several studies on this topic, including the NINDS trial, ECASS III trial, and systematic reviews by Wardlaw et al and Thompson. It also discusses the complexity of evaluating individual studies, systematic reviews, clinical guidelines, and potential conflicts of interest around this medical issue.
Physiology of Neuromodulation and neuromodulators. Difference between neuromodulation and synapse. Recent advances in neuromodulation, clinical application of neuromodulation.
The document discusses the potential for transcranial direct current stimulation (tDCS) technology to help treat chronic neuropathic pain and assist with post-stroke rehabilitation, outlining statistics on the prevalence and societal costs of these conditions. It then introduces Neuroelectrics Barcelona and their StarStim wireless tDCS neurostimulator, highlighting regulatory approvals and efficacy evidence from previous studies using competitor devices. The presentation proposes a treatment innovation and business model where clinics prescribe home use of StarStim with internet-based attendance and supervision.
Major depressive disorder (MDD) affects approximately 14 million adults in the United States, though only around 7 million receive treatment. Current antidepressant medications are ineffective for many patients, leaving around 4 million people with MDD poorly served. Transcranial magnetic stimulation (TMS) therapy using the NeuroStar TMS System offers an alternative treatment option that works via a different mechanism of action than antidepressants to target underlying brain circuits involved in mood regulation without systemic side effects.
03 13-12 neuro-modulation power point-2PineWood TMS
This presentation gives an over view: of the depression, its symptoms, prevalence, and patho-physiology. It then reviews various treatment options for depression, first starting with medication, and then moving to neuro-modulation. Focus is then on the similarities and differences of ECT and TMS. And finally information is provided about PineWood TMS.
03 13-12 neuro-modulation power point-2PineWood TMS
1) PineWood TMS is a transcranial magnetic stimulation clinic located in Brattleboro, Vermont. It was founded by Julie Plummer, a psychiatric nurse and CEO, to provide alternative treatment for depression.
2) TMS works by using magnetic pulses to directly stimulate neurons in the brain and release neurotransmitters, targeting the circuits involved in mood without systemic side effects.
3) At PineWood TMS, nurses play a key role in assessing and educating patients, overseeing their treatment, and monitoring outcomes under a psychiatrist's supervision.
Addiktológiai kutatások Magyarországon 2013 - Új fejlemények az addiktológiában (ELTE Pszichológiai Intézet - Klinikai Pszichológia és Addiktológia Tanszékének konferenciája, 2013. február 19)
Depression and anxiety are common mental health issues that can be treated. The brain controls functions like breathing, heart rate, movement, sleep, mood and thought. It contains regions like the cerebral cortex, limbic system, hypothalamus and brainstem that regulate these functions. Neurotransmitters such as serotonin, norepinephrine and dopamine transmit signals between neurons. Depression is characterized by low mood, loss of interest and changes in appetite or sleep. Anxiety involves feelings of fear or worry that can cause physical symptoms. Conditions like generalized anxiety disorder, panic disorder and PTSD involve excessive uncontrollable anxiety. Treatment options depend on the diagnosis and can include therapy and medication.
This document discusses several theories of depression from a neurobiological perspective. It summarizes the monoamine hypothesis, which proposes that depression is caused by deficiencies in neurotransmitters like serotonin and norepinephrine. However, evidence for this theory is lacking. Alternative hypotheses examine abnormalities in neurotransmitter receptors and the impact of stress on factors like BDNF and brain atrophy. The document also reviews how depression affects various neuroendocrine systems and discusses symptoms in relation to specific brain circuits involved in emotional processing.
This is a presentation that was given at the Lost in Translation 2013: Exploring the Origins of Addiction conference, that took place on March 25 - 26, 2013 in Vancouver, British Columbia, Canada
lecture 28 from a college level introduction to psychology course taught Fall 2011 by Brian J. Piper, Ph.D. (psy391@gmail.com) at Willamette University, includes drugs, electroconvulsive therapy
This document discusses amphetamine usage in adolescents. It provides background on the history and chemical structure of amphetamines. Adolescent usage has been increasing, particularly in nightclub settings. Amphetamines have immediate stimulating effects but also carry risks of neurotoxicity and prolonged neurological and physical harms. Long term and high dose usage can damage dopamine and serotonin pathways in the brain. Even a single exposure during adolescence increases the risk of addiction due to heightened neural sensitization during developmental periods. Further research is still needed to fully understand the mechanisms of amphetamine-induced neurodegenerative damage.
This document discusses depression, including its definition, types, causes, pathophysiology, symptoms, and drug therapy options. Depression is defined as a mood disorder rather than a thought or cognitive disorder. There are two main types: unipolar, involving single episodes, and bipolar, involving one or more severe mood episodes. Causes include genetic, biochemical, and endocrine factors. The pathophysiology involves decreased neurotransmitters like serotonin, norepinephrine, and dopamine in areas of the brain like the hypothalamus. Symptoms include depressed mood, loss of interest, fatigue, sleep issues, appetite changes, guilt, and thoughts of self-harm. Drug therapy options discussed are TCAs, SSRIs,
Neurophysiology of Emotion I Sports Psychologyshantisphysio
The neurophysiology of emotion involves a complex interplay of various brain structures and neurotransmitter systems. Emotions are a fundamental aspect of human experience, influencing our behavior, decision-making, and overall well-being. Understanding the neural mechanisms underlying emotions is crucial for gaining insight into psychological disorders, improving mental health treatments, and enhancing emotional regulation skills.
Key Brain Structures Involved in Emotion:
Amygdala: The amygdala is a small, almond-shaped structure located deep within the temporal lobes of the brain. It plays a central role in the processing and regulation of emotions, particularly fear and threat detection. The amygdala receives sensory information from various regions of the brain and initiates the physiological and behavioral responses associated with emotional arousal.
Prefrontal Cortex (PFC): The prefrontal cortex, especially the ventromedial prefrontal cortex (vmPFC) and orbitofrontal cortex (OFC), is involved in higher-order cognitive processes related to emotion regulation, decision-making, and social behavior. These regions help modulate emotional responses and integrate contextual information to guide appropriate behavior in different situations.
Hippocampus: The hippocampus, primarily known for its role in memory formation and spatial navigation, also contributes to emotional processing. It interacts with the amygdala and prefrontal cortex to encode and retrieve emotional memories, which influence our emotional responses to similar situations in the future.
Hypothalamus: The hypothalamus is a key regulator of the autonomic nervous system and endocrine system, making it integral to the physiological aspects of emotion. It coordinates the body's stress response through the release of hormones such as cortisol and adrenaline, triggering changes in heart rate, respiration, and other bodily functions during emotional arousal.
Neurotransmitter Systems Involved in Emotion:
Serotonin: Serotonin is a neurotransmitter associated with mood regulation, emotional processing, and stress response. Dysregulation of serotonin signaling has been implicated in mood disorders such as depression and anxiety, highlighting its importance in emotional well-being.
Dopamine: Dopamine plays a critical role in reward processing, motivation, and pleasure. It influences our emotional responses to rewarding stimuli and reinforces behaviors associated with positive outcomes. Dysfunctions in the dopamine system have been linked to conditions like addiction and schizophrenia.
Norepinephrine: Norepinephrine, also known as noradrenaline, is involved in the body's fight-or-flight response to stress and danger. It enhances alertness, arousal, and vigilance, preparing the body to respond to threatening situations. Dysregulation of norepinephrine has been associated with anxiety disorders and post-traumatic stress disorder (PTSD).
about the drugs acting on central nervous system, also their physiological effect on the brain and how Neurottransmiters in the brain response to these agents
This document provides information about antidepressants including:
- It defines depression and discusses its types such as major depression, chronic depression, seasonal affective disorder, and postpartum depression.
- It describes the diagnosis process for depression which includes seeing a doctor if symptoms persist for over 2 weeks and undergoing tests and assessments to diagnose depression.
- It discusses the biological mechanisms of depression including neurotransmitter deficiencies and the role of the serotonin transporter.
- It provides an overview of different classes of antidepressants like MAOIs, TCAs, SSRIs, and atypical antidepressants and discusses their mechanisms of action, examples of drugs in each class, and common side effects.
- It
This document discusses various psychotropic drugs, including their classification, mechanisms of action, effects, and uses. It covers antipsychotic drugs, mood stabilizers like lithium, antidepressants, anti-anxiety drugs, and hallucinogens. Antipsychotics work primarily by blocking dopamine receptors in the brain and include first generation "typical" antipsychotics like chlorpromazine as well as newer "atypical" antipsychotics. Lithium is used to treat mania and bipolar disorder by stabilizing mood, though its exact mechanism is unknown. Hallucinogens can cause psychedelic experiences by mimicking serotonin and other neurotransmitters but are rarely used therapeutically.
This document discusses psychiatric illnesses and psychotropic drugs used to treat them. It focuses on psychosis, specifically schizophrenia. Schizophrenia is a severe mental disorder affecting around 1% of the population. It involves positive symptoms like hallucinations and delusions as well as negative symptoms like social withdrawal. Dopamine hyperactivity in the mesolimbic pathway is thought to underlie positive symptoms, while brain atrophy may contribute to negative symptoms. First-generation antipsychotics, also called neuroleptics, are discussed. These include phenothiazines like chlorpromazine and piperidines/piperazines that work by blocking dopamine receptors.
This presentation explores neuropharmacology of TBI treatment. Including anatomical impacts of TBI, pharmacotherapy, implications for treatment and behavioral interventions.
The document provides an overview of foundations of psychiatric mental health nursing. It discusses definitions of mental health and mental illness. It describes the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and issues of self-awareness for nurses. Neurobiological theories of mental illness are presented, including the roles of neurotransmitters and neuroanatomic structures. Psychopharmacological treatments for conditions such as schizophrenia, depression, and anxiety are summarized. Finally, psychosocial theories of Sigmund Freud are briefly introduced.
Neurotransmitters are chemical messengers that transmit signals between neurons. They are produced in neuron cell bodies, stored in vesicles, and released into the synaptic cleft upon neuronal stimulation. Common neurotransmitters include acetylcholine, dopamine, norepinephrine, serotonin, GABA, glutamate, and endorphins. Neurotransmitters play important roles in functions like movement, cognition, mood, sleep, and pain perception. Imbalances can result in conditions such as depression, anxiety, Parkinson's disease, and Alzheimer's disease.
Neurotransmitters are chemical messengers that transmit signals between neurons. There are several major neurotransmitter systems, including acetylcholine, dopamine, norepinephrine, serotonin, GABA, glutamate, and endorphins. Each neurotransmitter has a distinct function, such as regulating mood, movement, learning, sleep, and pain. Imbalances in neurotransmitter systems can lead to neurological and psychiatric disorders.
12.04.08(a): Pathogenesis and Treatment of FibromyalgiaOpen.Michigan
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View additional course materials on Open.Michigan:
openmi.ch/med-M2Muscu
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NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
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Are you looking for a long-lasting solution to your missing tooth?
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The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
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Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
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Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
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Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
4. Neuro-Modulation Programs
in the North East
Legend
PineTree= PineWood TMS, Brattleboro, VT
Red Dots= TMS
Magenta= ECT + TMS
Blue Dots= ECT
5. Many Patients with Depression Remain Poorly Served:
14 Million US Adults
7.2 Million 6.8 Million
Treated Untreated
Inadequate response
3.2 Million 4 Million Intolerant to side effects
Adequately Poorly
Treated Served
Kessler RC et al. JAMA. 2003;289(23):3095-3105.
6. Major Depressive Disorder
“Adequate” Treatment
Is Difficult to Achieve
Adequate Dosage Adequate Duration
Factors contributing to inadequate treatment include:
Lack of Poor
Efficacy Tolerability
Nonadherence Safety Issues
Comorbidities
1. Nemeroff CB. Depress Anxiety. 1996/1997;4(4):169-181; 2. Oquendo MA et al. J Clin
Psychiatry. 2003;64(7):825-833; 3. Oquendo MA et al. Am J Psychiatry. 1999;156(2):190-194.
6
7. Neuro-anatomy and physiology
of Major depressive disorder
anterior
HIGH prefrontal cingulate
cortex cortex
striatum
Neural
Activity
hypothalamus
thalamus
LOW
brainstem
neurotransmitter
In MDD, some centers
amygdala
areas of the
hippocampus
brain are
hypoactive and
others are
hyperactive.
8. Major Depressive Disorder:
Circuits and Neurotransmitters
concentration
pleasure/ psychomotor fatigue (physical)
interests pleasure/interests
psychomotor When there is an
fatigue (mental) appropriate
monoamine • Monoamine
sleep
Regions implicated in MDD are amount of
neurotransmitter dysfunction is
guilt appetite
connected to the brainstem via monoamine
projections linked to MDD
suicidality monoaminergic circuits neurotransmitter
worthlessness
•activity, neuronal
Malfunctioning
mood activity
circuits lead to
throughout the
specific
brain functions
symptoms
guilt normally.
suicidality
worthlessness
mood
Monoamine Serotonin (5-HT) Dopamine (DA) Norepinephrine (NE)
Neurotransmitters
9. Chemical Antidepressants
Antidepressant
Antidepressant
Therapeutic Effects such as:
increased
concentration blurred vision insomnia
agitation dry mouth fatigue
insomnia nausea blood
pressure
GI changes
distress
sexual
dysfunction weight gain
improved
mood
reduced feelings of
guilt, suicidality, and weight gain
worthlessness
10. APA Accepted Treatment
Algorithm for MDD 10M Primary Care
Psychiatry
• Initial Diagnosis
• Improved Diagnosis
8M • Early Treatment
Attempts • Improved Dosing
• Psychotherapy
Number of MDD Patients
• New Treatment
6M Options
4M
Combination & Augmentation
– Atypical Antipsychotics
SSRI – Mood Stabilizers
2M
SNRI
NDRI
MAOI & TCA
ECT VNS
TMS
0 1 2 3 4 5 6 7 8
Failed Treatment Attempts in Current Episode
Treatment-Resistance Continuum
Kessler RC et al. Arch Gen Psychiatry. 2005;62(6):617-627; Kessler RC et al. JAMA.
2003;289(23):3095-3105; Herrmann RC. Am J Psychiatry. 1995;152(6):869-875.
13. Transcranial Magnetic Stimulation
Therapy System
Treatment coil
Head support unit
Touchscreen
Mobile console
Treatment chair
13
NeuroStar TMS Therapy System User Manual. Neuronetics, Inc: Malvern, PA; 2008.
15. TMS Directly Depolarizes Cortical
Neurons
Depolarization leads to action
potentials in local neurons and
thereby releases neurotransmitters
Pulsed magnetic fields
Neuron from TMS Coil:
• induce a local electric
current in the cortex
which depolarizes
neurons
Neurons are • elicit action potentials
“electrochemical • cause the release of
cells” and respond to chemical
either electrical or
neurotransmitters
chemical stimulation
16. TMS Releases Neurotransmitters
in the Brain
Depolarization of neurons Depolarization of pyramidal Activation of deeper brain
in the DLPFC causes local neurons in the DLPFC causes neurons then exerts secondary
neurotransmitter release neurotransmitter release in effects on remaining portions of
deeper brain neurons targeted mood circuits
Dorsolateral
prefrontal
cortex
Cingulate
cortex
Kito (2008) J Neuropsychiatry Clin Neurosci
These effects are
associated with
improvements in
depressive symptoms
17. TMS Mechanism of Action Summary
TMS Therapy:
Specifically targets the underlying brain circuits
involved in mood regulation
Directly depolarizes cortical neurons and
modulates neurotransmitter release in the brain
Effects involve both the local and deep neural
circuits in the brain
Accomplishes these effects without unwanted
systemic adverse effects
18. Feature-Benefits Table
Features Benefits
No Anesthesia Physiological, psychological,
logistical
Non-Systemic Minimal side effects, no
memory loss or confusion
Non-Invasive TMS is not disfiguring
Concurrent use of Potentiate Positive Outcomes
other therapies
20. The Clinical Role of Psychiatric RNs in TMS
• Initial patient
assessment
• Education
• Establish therapeutic
treatment setting
• Observe therapy
• Assess patient
outcomes
21. Process for Patients Entering
PineWood TMS
1. Referral.
2. Education.
3. Evaluation.
4. Informed Consent.
22. Process TMS When
Treatments are Ordered
1. Treatment Parameters Set.
2. Treatment Commences.
3. Weekly Assessment of Depression.
4. Psychiatrist is Updated Weekly.
23. Frequently Asked Questions
• What are the chances it will work?
• How long will it take to feel better?
• How long will the effect last?
• What are the side effects?
24. Contact Information
PineWood TMS
Supporting Integrated Wellness
167 Main Street
Brattleboro, VT 05301
802-246-1304
WWW.PineWoodTMS.com
Julie@PineWoodTMS.com
Editor's Notes
Julie Plummer, RNGraduated from GCC AND Program 1998Private boarding schoolCommunityGeneral HospitalInpatient Mental Heath UnitECT for 4.5 years-> introduced to TMSprimarily cared for patients with acute mental health issues for 10 + yearsEducation Never EndsCPIACLSECTTMSReikiEFTNVCReceived TMS certification in May 2009Won BDCC Business Plan Competition June 2011
PineWood TMS PhilosophyThe pine’s strength in the face of adversity makes it symbolic of those who have become strong through suffering.Symbolically people living with depression are living through the depths of what appears to be lifeless winter. Pines are known for their endurance, steadfastness, resiliency, even in the most harsh weather conditions. Pines are evergreen, ever full of life because no matter the weather around them (wind, snow, ice or rain), their needles remain green and full of life.Ah, but hope continues as the pine endures because after long-suffering, steadfast friendships and fame endure. In many traditions, they are associated with life, longevity and immortality, suggesting tranquility, faithfulness, and integrity. As a Christmas symbol, the tree was also a symbol of communication and mediation between heaven and earth because its roots reach into the earth and its branches soar into the heavens.After meditation and communication, peace is found. Among Native Americans it is known as Haudenosaunee, the Tree of Peace. The Chinese recognize pines as symbols of friendship in adversity.Interestingly, its essence has been used to treat despondency, despair, and self-condemnation. And pine resin and needles have been used medicinally to treat respiratory problems (in traditional Chinese medicine the lungs have long has associated with grief, something people suffering with depression often can relate to).This program has been named PineWood TMS to honor the inner core strength people need to recognize as they overcome depression.
Psychiatric prescribers and patients have asked about alternative treatment options treating depression
CLICK There are several brain regions known to play a role in the regulation of mood (Stahl 2008, pp. 492-499). This slide shows a general “neuroanatomy” of major depression. Neuroimaging studies of patients during an episode of major depression, and following recovery from depression, have shown specific patterns of change in the metabolic activity of these different regions. CLICKA reduction in activity is seen in many areas, including the left dorsolateral prefrontal cortex, and deeper areas including the amygdala and hippocampus (Epstein 2006, pp. 1786A, 1787A; Fu 2007, pp. 601A, 602A;Lee 2007, pp. 1489A, 1490A, B, 1491A; Lee 2008, pp. 781A, 782A, 783A). The rostral anterior cingulate cortex is unique among these brain regions in that its activity, as compared to the other major regions of the brain involved in depression, tends to be increased during executive tasks at a time when its activity should be decreased (Pizzagalli 2011, p. 196A). References:Stahl SM. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. 3rd ed. New York, NY: Cambridge University Press; 2008.Epstein J, Pan H, Kocsis JH, et al. Lack of ventral striatal response to positive stimuli in depressed versus normal subjects. Am J Psychiatry. 2006;163:1784-1790.Fu CHY, Williams SCR, Brammer MJ, et al. Neural responses to happy facial expressions in major depression following antidepressant treatment. Am J Psychiatry. 2007;164:599-607.Lee B, Cho SW, Khang HS, et al. The neural substrates of affective processing toward positive and negative affective pictures in patients with major depressive disorder. ProgNeuropsychopharmacolBiol Psych. 2007; 31:1487-1492.Lee B, Seok J, Lee B, et al. Neural correlates of affective processing in response to sad and angry facial stimuli in patients with major depressive disorder. ProgNeuropsychopharmacolBiol Psych. 2008; 32:778-785. Pizzagalli DA. Frontocingulate Dysfunction in Depression: Toward Biomarkers of Treatment Response. Neuropsychopharmacology. 2011;36: 183-206.
The brain regions involved in MDD are connected to the brainstem through neuronal circuits. CLICK These regions are shown in purple on the figure (Stahl 2008, pp. 204A, 205A, 206A). CLICK The neuronal circuits connecting these areas release several monoamine neurotransmitters including dopamine, norepinephrine, and serotonin (shown here as purple circles, squares, and triangles). When there is an appropriate physiological amount of neurotransmitters being released within these neuronal pathways, communication among these brain regions is optimal, and the brain circuits function normally. CLICK However, it has been hypothesized that if the normal amount of neurotransmitters becomes reduced, depleted, or dysfunctional for some reason, depression may ensue (Stahl 2008, pp. 480A, 487A). In addition, there is a hypotheticallink between reduction of neurotransmitters in these regions and several symptoms key to a DSM-IV-TR diagnosis of Major Depressive Disorder (Stahl 2008, p. 491A). References:Stahl SM. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. 3rd ed. New York, NY: Cambridge University Press; 2008.
CLICK Antidepressant medications are thought to treat MDD by chemically boosting the synaptic actions of one or more of the three monoamine neurotransmitters in these brain regions: dopamine, serotonin, and norepinephrine (Stahl 2008, p. 520A, B).However, because antidepressant medications are ingested and metabolized systemically (meaning they are absorbed through the gastrointestinal tract, distributed by the blood stream, and then metabolized, usually by the liver or kidneys), antidepressants may exert actions anywhere throughout the body. This means that they can elicit undesirable effects on sites both in the brain and throughout the body (Stahl 2008, pp. 531A, 547A).As shown on this slide, the result of these undesirable actions may be the development of a wide variety of medication side effects.CLICK References:Stahl SM. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. 3rd ed. New York, NY: Cambridge University Press; 2008.
Important distinctions need to be made about TMS Therapy as compared to Electroconvulsive Therapy or ECT. TMS Therapy is NOT ECT. TMS is very different from ECT, both in terms of the technology itself and when it is appropriate for use.TMS Therapy is utilized much earlier in the depression care pathway than ECT.TMS Therapyis an office based procedure and is utilized after initial antidepressant medications have failed. In contrast, ECT uses direct electrical stimulation of the whole brain, requires anesthesia for delivery and is associated with cognitive side effects, some of which may be long term. TMS Therapy uses a focused electromagnetic field to stimulate a specific,targeted region of the brain. It does not require any sedation or anesthesia and has a mild adverse event profile. Because of the invasive nature of ECT and its side effects, ECT is usually reserved for patients who have exhausted most treatment options. Therefore, TMS, due to its targeted efficacy and mild adverse event profile is used much earlier in the treatment spectrum than ECT.
Movies with ”Hollywood Flash”- reinforce negative stigma of mental illness and ECT”One Flew Over the Cuckoo’s Nest” “A Beautiful Mind”“Girl Interrupted”ECT VideoPatients are carefully selected for ECT- it doesn’t treat Axis II, addictionsTimeTreatment Room for ~10 min.Recovery Room for ~ 30 min.Monitored and evaluated for 1 hour after leaving the recovery areaMemory lossDisorientation immediately following ECT typical of confusion after patients receive general anesthesiaLeast likely with RULMore likely in older patientsMany patients report improvement in their memory as their depressive symptoms resolve and they are better able to focus and concentratePatients can exhibit conditioned belief that they will always be depressed-Not uncommon for patients depressed for an extended time to doubt ECT is working (even if family and friends notice improvements in patient’s symptoms)
CLICK The underlying rationale for the use of TMS exploits the fact that neurons are electrochemical cells. This means that neuronal activity can be affected either chemically, via the use of drugs, or electrically, via interventions like TMS.Unlike drug action, whose effects tend to be anatomically diffuse, the effects of TMS are anatomically focused, and by design are non-invasive and non-systemic in action. Under normal conditions of use, TMS therefore incurs far fewer adverse events, and is devoid of undesired systemic adverse events commonly observed with antidepressant medications.The TMS device is a powerful electromagnet, which is turned on and off in a rapid fashion, producing a pattern of “pulsed” magnetic fields. The patient receives 40 pulses for 4 seconds with a 26 second interval repeated 75 times (trains) for a total of 3000 pulses per session.CLICK When pulsed magnetic fields are positioned close to an electrical conductor, like neurons, a local electrical current is produced in that conductor. This electric current is powerful enough right under the magnetic coil to elicit action potentials, which then travel down the neuron, ultimately causing the release of neurotransmitters at the synapse (Post 2001, p. 193A).References:Post A, Keck ME. Transcranial magnetic stimulation as a therapeutic tool in psychiatry: what do we know about the neurobiological mechanisms? J Psychiatric Research. 2001;35: 193-215.
When the pulsed magnetic fields from the TMS coil are applied to the left dorsolateral prefrontal cortex, there are a series of events that are thought to underlie the therapeutic effects of TMS in the treatment of major depression.First, direct neuronal depolarization under the coil leads to local action potentials in neurons and the local release of neurotransmitters in the cortex.CLICK In addition to these local effects, depolarization of cortical pyramidal neurons is thought to occur (as represented by the blue neural pathway), reaching to deeper brain regions that lie outside the direct action of the pulsed magnetic fields.Activation of these deeper brain regions is presumed to cause secondary activation of brainstem neurotransmitter centers, which results in upward influences on the remaining brain regions involved in mood regulation (represented by the purple neural pathway).CLICK As a result, dopamine (Kanno 2004, pp. 75A, 76A, 77A) and serotonin (Juckel 1999, pp. 393A, 394A) activity are increased in areas of the brain whose low neurotransmitter activity have been linked to depression. The net action of TMS, is therefore targeted on the specific brain areas known to be involved in the regulation of mood, and is comprehensive in that its action has both direct effects on local neurons in the cerebral cortex, and then results in deeper actions on brain regions that are distant from the site of stimulation, but neurally connected to these cortical areas.CLICK & CLICK These effects can be demonstrated in human neuroimaging studies of patients who have undergone treatment with TMS for their depression, as shown in the SPECT(single photon emission computed tomography) scan on the right (Kito, et al, 2008). In this image, the TMS coil has been positioned over the dorsolateral prefrontal cortex on the left side of the head. The area just underneath the coil is showing increased metabolic activity as a direct result of the magnetic stimulation. You can also see that the increase in metabolism reaches secondarily the deeper brain regions, in this case the regions of the cingulate cortex also show increased activation.CLICK The activity may be increased both in the short term by increasing release of neurotransmitters and in the long term by modulating expression of proteins involved in neurotransmitters signaling (Post 2001, p. 200A,B). Presumably, as a result of these changes, depression lifts (Slotema 2010, p. 876A). References:Kanno M, Matsumoto M, et al. Effects of acute repetitive transcranial magnetic stimulation on dopamine release in rat dorsolateral striatum. J Neurological Sciences. 2004;217:73-81.Juckel G, Mendlin MA, et al. Electrical Stimulation of Rat Medial Prefrontal Cortex Enhances Forebrain Serotonin Output: Implications for Electroconvulsive Therapy and Transcranial Magnetic Stimulation in Depression. Neuropsychopharmacology. 1999;21(3):391-398.Slotema CW, Blom JD, et al. Should we expand the toolbox of psychiatric treatment methods to include repetitive transcranial magnetic stimulation (rTMS)? A meta-analysis of the efficacy of rTMS in psychiatric disorders. J Clin Psychiatry. 2010;71(7):873-884.Kito, S, Fujita, K, Koga, Y. Changes in Regional Cerebral Blood Flow After Repetitive Transcranial Magnetic Stimulation of the Left Dorsolateral Prefrontal Cortex in Treatment-Resistant Depression. J Neuropsychiatry ClinNeurosci. 2008; 20(1):74-80.
To summarize, TMS Therapy offers a unique mechanism of action unlike conventional antidepressant medication treatment.CLICK TMS Therapy specifically targets the underlying brain regions known to be involved in the regulation of mood. CLICK It works by direct depolarization of cortical neurons, and then CLICK by modulating the deeper brain regions which have a neuronal connection to these areas of the cortex.CLICK This allows TMS Therapy to effect both local and deep neural circuits – all without causing unwanted systemic side effects.Reference:NeuroStar TMS Therapy User Manual (Neuronetics, Inc., 2011).
no anesthesia, no sedationMedical-People suffering with depression are more likely to have other co-morbid medical concerns and issues (e.g. obesity, decrease liver and kidney function, substance abuse- including nicotine, alcohol, and other substances) making elective treatments with anesthesia several times a week less ideal. Also ECT does occasionally cause transient cardiac changes.Psychological- People who are severely depressed frequently also have PTSD due to histories a traumatic life events. Going under anesthesia can be especially difficult for people with PTSD, as it can bring up a lot of fears. While they are under anesthesia they are unaware of what’s going on around them. This sense of lack control can feel scary.Logistic- no escort needed. Symptoms exhibited by severely depressed patients can be misunderstand by family and friends. Consequently, these patients can alienate friends and family. Making arranging for an escort for difficult.Private, convenient treatment- No Stigma. People are often ashamed of their depression, as though they are to blame for it. Friends and family often unwittingly reinforce these beliefs. Non systemic- no side effects such as: weight gain, sexual dysfunction, nausea, dry mouth, or sedation, Seizures, adverse effect on cognitionNon- Invasive- no surgery, no voice changeOther Therapies- DBT, EFT, Music, Visualizations, Diaphragmatic Breathing- Improvement pts sense of self-empowermentTMS Therapy SummarySignificant chance of improvement (50% in clinical trials, 70-80% now being seen in clinical practice)Associated with less hospitalizations, doctor visits, drugs, etc.Favorable benefit/risk ratio compared to alternatives Fewer than 5% of patients discontinued due to adverse events -The most common adverse event related to treatment was scalp pain or discomfort TMS therapy for patients with MDD can easily be applied in psychiatrists’ clinical practices.Advances in TMS technology have taken it out of the hospital and into the psychiatrist’s officePatients can resume all normal activities immediately after each treatment sessionTMS is an “observed therapy,” meaning that a clinical professional, under the supervision of the attending psychiatrist, should be present during the treatment session
Complimentary Therapies can be used simultaneously while patient receive TMS include:Diaphragmatic BreathingMeditation VisualizationsMusic TherapyFocusingEmotional Freedom TechniqueReiki
Referral: Patient’s may self refer or call on recommendation of their out patient provider. Education: Welcome Packets contain:questionnaires regarding health, illness history, and demographics. BECK’s depression rating scale.Evaluation Appointment:Patient meets with MD and RN. Patient sits in the treatment chair to watch video and has the opportunity to ask questions.This appointment is an important part of the process to help insure that patient feels they have all the information needed to make an informed decision about TMS therapy.Psychiatric Evaluation:The psychiatrist reviews all referral forms in the charts of potential patientsDetermines if pt:Meets treatment criteria for TMSHas contraindications to TMSAssessment and discussion about how TMS will fit into treatment of patient’s depression.Prescribes a course of treatment Obtains signed Inform Consent formEstablishes treatment parameters
Motor Threshold DeterminationFirst treatment session requires determination of treatment settings. The first step requires isolating the area on the left Motor Cortex that elicits a right thumb twitch. This requires stimulation of the left motor cortex with multiple single magnetic pulses until right hand or thumb twitches are observed. This process determines the amount of magnetic energy required to stimulate the motor cortex.Once MT is determined the coil is placed over the prefrontal cortex 5.5 cm forward of this landmark. This area is believed to be over the limbic system (area that controls mood) and is the treatment site. Once parameters are recorded, treatment may begin.
What are the chances it will work?In open-label trial (most like real-world), 1 in 2 patients had significant improvement. 1 in 3 had complete symptom resolution In clinical practice 70-80% seeing improvementHow long will it take to feel better?May feel some improvement in 2 weeks, but most improvement will take 4-6 weeks.How long will the effect last? - In a 6-month follow-up study, patients received a single medication as maintenance treatment.Approximately 1/2 had symptom recurrence and required TMS re-treatment.Through the maintenance medication and the TMS re-treatment, less than 10% of patients relapsed.What are the side effects?Scalp pain or discomfort and headacheDecreased significantly after the 1st week of treatment