During her 15-year battle with depression, Monte Hoffman of Parkersburg was determined not to surrender to the mood disorder that left her with persistent feelings of sadness and a loss of interest in things that once mattered deeply.
"I spent a lot of time not wanting to get out of bed," she said. "I wasn't able to work. I tried talk therapy and I don't know how many antidepressants, but nothing made me feel that much better."
Hoffman, who sometimes had suicidal thoughts and was hospitalized on a number of occasions, also tried electroconvulsive therapy, or ECT, in which small electric currents are passed through the brains of anesthetized patients to deliberately cause brief seizures, which can produce therapeutic changes in brain chemistry.
While the procedure seemed to temporarily help, "one side effect is that it can cause memory loss, which happened to me," she said.
Hoffman said the benefits of continuing ECT were not worth the risk of experiencing additional memory loss.
With progress at fighting her depression at a standstill, Hoffman's therapist suggested that she contact South Charleston psychiatrist Dr. Dan Thistlethwaite at PsyCare Inc. to see if she was a good candidate for Transcranial Magnetic Stimulation, or TMS - a relatively new method of treating depression by directing pulses of stimulating electromagnetic energy to nerve cells in areas of the brain that involve mood control.
Thistlethwaite and Dr. Russell Voltin, his partner at PsyCare, have been using TMS in their practice since 2010 for depression patients who have given talk therapy, antidepressants and other medications a serious try, but have experienced no significant improvement.
"A lot of people with depression don't get well, even after trying antidepressant drugs and talk therapy," said Thistlethwaite. While using drugs to elevate the levels of neurotransmitters - the chemical messengers that send signals between brain cells - is an effective course of therapy for many depression patients, "it doesn't always get the job done," he said.
By adding TMS as a therapy for treating depression, he said, "we can target structures deep in the brain that control mood and use magnetic pulses to get those circuits to start firing the way they should."
The Food and Drug Administration approved TMS as a treatment for depression in 2008, and in 2012 PsyCare bought its first TMS unit, which featured a superficial figure-eight-shaped electromagnetic coil.
The team reviewed the results after treating 100 patients, and "the outcomes were very encouraging," Thistlewaite said. However, each treatment took 40 minutes, allowing the practice to treat only eight patients per day.
In 2015, they bought a second TMS device called the Brainsway Deep TMS system. This system was FDA-cleared in 2013 and provides deep TMS therapy as opposed to the superficial treatment provided by their first TMS unit.
The Brainsway machine uses a different pattern of electromagnetic coil, called an H-coil, that fits inside a helmet which is placed securely onto the patient's head, enabling a deeper stimulation of the mood circuit in the frontal lobe of the brain.
"The Brainsway system stimulates more brain tissue and our patients are more comfortable during and after the treatment," said Voltin.
The new device also cuts the time of each treatment session from 40 minutes to 20 minutes and can reduce the number of follow-up sessions needed for the acute treatment phase.
"Some people are doing really great after 20 treatments, which are generally done five days a week for four weeks," Voltin said. "Others feel better, but aren't completely well and need more treatments."
A study by the University of Toronto's Center for Addiction and Mental Health released late last year involving a regimen of deep TMS therapy for treatment-resistant depression patients 60 years old or older showed that 50 percent of the participants achieved total remission, compared with a 16 percent total remission rate reported for survey subjects who were given placebo treatments.
"We've been seeing remission rates of about 70 percent," said Voltin.
However, many patients who have benefited from an initial series of treatments require follow-up TMS therapy, administered at more dispersed intervals, to maintain their improved state of well-being. Hoffman said she is among PsyCare TMS patients receiving such maintenance therapy.
Having her brain stimulated by pulses of electromagnetic energy "is not uncomfortable," she said. "It feels like something is kind of pecking at your head, but not hard enough to hurt. I could easily fall asleep during my treatments."
Completing an initial regimen of TMS therapy requires a degree of faith that the process will eventually work, since results are not immediate.
"It took me about 15 treatments until I felt noticeably better," Hoffman said. "Now, I'd say I'm at least 50 percent better than I was before I started. It's the best relief from depression I've had since I started getting help 15 years ago. I still do talk therapy and medicine, but less of it. I spent a lot of time not wanting to get out of bed. Now, I want to get out and do things that make me happy."
Voltin and Thistlethwaite, who both studied medicine at West Virginia University, have donated their first TMS device to WVU's Ruby Memorial Hospital. TMS therapy is available at two other locations in the state - the Louis A. Johnson Veterans Administration Medical Center in Clarksburg and at WVU's Chestnut Ridge Center.
The therapy is approved by Medicare and many insurance carriers and is offered by scores of hospitals and clinics around the country, including the Johns Hopkins Hospital in Baltimore and McLean Hospital, an affiliate of Harvard Medical School. While TMS therapy is not widely practiced throughout the state, interest in it is coming around among psychiatrists and patients, according to Voltin. "Young residents are very excited about it," he said.
TMS therapy is also being studied for use in treating dementia and obsessive-compulsive disorder.
For more information on TMS therapy at PsyCare, visit their website at psycareinc.com or call 304-768-6170, ext. 202.
Reach Rick Steelhammer at rsteelhammer@wvgazettemail.com, 304-348-5169 or follow @rsteelhammer on Twitter.