Depression treatment

NEW ORLEANS — Retired school teacher Linda Bogle, 65, of Kenner, has lived with depression all her life.

At times, it’s been a “low-grade melancholy;” at other times, in the face of especially difficult life circumstances, her depression has been crushing, she said, adding she believes it runs in her family.

But recently, Bogle, who said she’s been prescribed “every (antidepressant) medicine known to man” without results, has been helped by a new, medical procedure called transcranial magnetic stimulation that uses precisely focused magnetic pulses to stimulate neurons in the brain.

Bogle had 40 treatments this past summer and recently had some “booster” treatments.

About midway through the initial treatments she started feeling an improved mood “I had never felt before,” she said. “As each session went on, I was getting better and better.

“Since I was a child, I never felt a feeling of joy and happiness” until this past summer, Bogle said. “I was euphoric. It was like opening up a door I had never been through before.”

The NeuroStar, a device manufactured by Neuronetics of Pennsylvania that performs transcranial magnetic stimulation, was cleared by the FDA in 2008, as a new way to treat major depression.

The intervention, according to the National Alliance on Mental Illness, could be an option for people diagnosed with major depression who have failed a trial of an antidepressant at an adequate dose and duration.

In treatments lasting about 40 minutes and given daily for four to six weeks, the process sends magnetic pulses to the frontal left side of the brain, generating weak electrical currents.

“This is a very exciting thing if you’re a clinician,” said Dr. James Barbee, of New Orleans, the psychiatrist who is treating Bogle.

He noted the understanding of how transcranial magnetic stimulation works is “still evolving.”

“The theory of the treatment,” according to the National Alliance on Mental Illness “is that the resulting electrical currents activate neurotransmitters implicated in the symptoms of depression — serotonin, norepinephrine and dopamine.”

Images of the brain show that people who are depressed have much less activity in the part of the brain that TMS treats than people who aren’t depressed.

Other physicians in Louisiana now offering the treatment, according to Neuronetics, are Dr. Imran Zahid, of Baton Rouge; Dr. Susan Uhrich, of Lafayette, and Dr. Calvin Walker, of Monroe.

Studies have shown that about half of patients treated with transcranial magnetic stimulation have shown improvement, according to the alliance.

Barbee has been offering the NeuroStar TMS Therapy since December 2011, and of the first 22 patients who have completed treatment, “three out of four are responding and two of the three have gotten well,” he said.

One of the reasons his results have been better than those in some other studies, including one funded by the National Institutes of Health, may be that in those studies the patients receiving TMS were not receiving antidepressant medicine, as his patients are, he said.

“There’s no data published to date in scientific journals on using TMS with medicine. What I’m telling you is my experience,” said Barbee, who was on the faculty of the Department of Psychiatry at LSU School of Medicine in New Orleans for 27 years.

Barbee, who oversaw 50 clinical trials, according to his biography, went into private practice in 2009 and continues as a clinical professor of psychiatry at the medical school.

Until recently, Barbee said, there have been three main treatments for depression: psychotherapy, medication and electroconvulsive therapy, which “is still the most effective treatment for depression.”

In the latter, with the patient under anesthesia, a small amount of current is delivered to cause seizure activity in the brain.

Now, TMS is another option for people, such as Bogle, who have treatment-resistant depression.

“The average patient (treated with TMS) has been depressed for six years,” Barbee said, noting how many of the patients he’s treating or has treated with TMS are or have been on disability due to their depression.

“Some people make the mistake of comparing this to shock therapy. It’s nothing like it,” Barbee said.

The TMS procedure, for one thing, is done without anesthesia.

“People drive here to have it done and drive home,” Barbee said.

In late October, Linda Bogle had come to Barbee’s offices on Magazine Street, with her husband, John.

She rested comfortably in a reclining medical chair, while Josh Jansen, the TMS coordinator on Barbee’s staff, who has been certified for performing the procedure, operated the NeuroStar equipment.

A small device, containing a magnetic coil, rested lightly on the top of Bogle’s head.

When the treatment began, it made a rapid, clicking noise, like a toy machine gun, in intervals, followed by periods of quiet.

“It’s like somebody gently tapping your head,” Bogle said.

At her first appointment for the treatment, Jansen had used the NeuroStar device to find the precise spot in the brain where the magnetic pulses would be focused.

“It’s 5 1/2 centimeters forward from the motor cortex” for every patient, he said.

Not all insurance companies are covering TMS treatment, Jansen said.

Transcranial magnetic stimulation costs a little more than $300 a session, and the average patient has about 27 treatments; the average cost of TMS, then, is about $9,000, he said.

“You know how serious the patient is, by (their) being willing to step out on faith and do that,” said Bogle, who’s in the process of learning if her insurance will pay for her treatment.

Baton Rouge psychiatrist Zahid Imran began offering TMS two months ago.

“I have a lot of good candidates (for treatment), but not many people can do it” because of the cost, Imran said. “My goal is to figure out how to campaign to have it (TMS) covered by insurance.”

Bogle learned about transcranial magnetic stimulation by happenstance this year, after a friend of hers saw Dr. Mehmet Oz, the celebrity physician “Dr. Oz,” talking on TV about the treatment.

The next day, Bogle saw Barbee on a New Orleans talk show speaking about TMS.

In her 20s, Bogle suffered post-partum depression after each of the births of her two children.

“It was wretched, quite debilitating,” Bogle said. “I was teaching school at the time, just barely making it.”

Her doctor tried prescribing medicines, but would only prescribe it for her for a few weeks.

Over and over, she encountered the advice from others that a person with depression should “pull yourself up by your boot straps,” she said. They spoke as if “you could do it on your own, and you can’t.”

To cope, Bogle said, “the main idea was to keep busy 100 percent of the time: Don’t sit down; don’t let yourself think of things. If I slowed down, it would eat me alive.”

She taught fifth-graders for 31 years, before retiring 12 years ago.

Sometimes, in front of the class, a “wave of sadness” would hit her, she said. “I’d go to the back, to the file cabinets, tears falling” down her face, until she could continue the class.

About three years ago, Bogle went through several difficult experiences in close succession.

She lost sight in her right eye, due to retinal detachment. Her father died, and her mother became disabled, Bogle said.

“I became catatonic,” she said. “I wanted to sit on a sofa and not move.”

Her psychiatrist at that time prescribed electroshock therapy for her. And, while electroshock therapy is a highly effective treatment for many people, it did not help her, Bogle said.

Barbee predicts TMS treatments will become more prevalent. “I think, over time, it will get to be used early on in (depression) treatment and more frequently.”

“It is revolutionary,” Bogle said of her experience with the TMS treatments. “It can change the lives of so many people and their families.”