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Transcranial magnetic stimulation (TMS) may be a new alternative to
electric shock therapy in treating severe depression.
For severe depression, electro-shock therapy is nowadays
the last hope. However, it can impair memory for weeks after
therapy. A less aggressive alternative seems to be provided
by what is known as "transcranial magnetic stimulation".
This is the conclusion arrived at by doctors and
psychologists of the Bonn University Clinic in an article
which has just appeared in the British Journal of Psychiatry
(vol. 186 , pp. 410-416).
Nowadays depression is seen as amenable to treatment: with
psychotherapy or medication most patients affected can be assisted
out of their depressive phase. About five per cent of all patients,
however, fall into such profound depression that they do not respond
to these methods. Because depression is one of the most frequent
psychological diseases ? every sixth person suffers from it at least
once in their lives ? this affects a large number of people.
In these cases electro-shock therapy is one option. This involves
the patient being anaesthetised. Then the doctors pass electrical
impulses through the patient's head via two electrodes, thereby
triggering an epileptic spasm. This changes the cerebral chemistry
in the area of the forehead, a region which, among other things,
regulates the emotions and steers the psycho-motor reflexes.
Effective therapy ? bad image
One in two patients who previously did not respond to other
therapies improve after a series of therapy to the extent that
therapy can be continued by using medication or psychotherapy. 'In
the severest cases of depression electro-shock therapy is nowadays
still an important therapeutic option,' the head of the Bonn
Psychiatric Clinic, Professor Wolfgang Maier, emphasises. Despite
this, the public image of this method has long been very negative ?
not least due to the movie classic 'One Flew Over the Cuckoo's
Nest'. In the film the inmate of a psychiatric clinic (played by
Jack Nicholson) is subjected to electro-shock to curb his rebellious
The type of electro-shock now used is regarded as a form of
therapy which is well tolerated by patients. However, the therapy
may impair memory even several weeks later. 'As a rule, this
impairment of memory does gradually recede, but understandably it is
often experienced by patients as annoying,' Bonn lecturer Dr.
Michael Wagner says. The reason is that the flow of electricity is
not precise enough, also hitting the hippocampus, our brain's
This is why recently a different therapy has come to the fore
which has few side-effects: in 'transcranial magnetic stimulation'
(TMS) the doctors place a coil on the patient's forehead. For
several minutes this produces a strong pulsating magnetic field
which in turn produces a flow of electrical current. However, this
is so weak that it does not trigger an epileptic attack. The patient
remains fully conscious during the treatment.
The Bonn researchers have treated a total of 30 patients
suffering from severe depression either with electro-shock or
magnetic stimulation. Both methods were roughly equally effective:
every second patient experienced a marked alleviation of their
depression a week after their stint of therapy. 'Admittedly, the
division of the groups was not made on a random basis, which reduces
the reliability of the findings,' Dr. Wagner warns. 'The number of
patients taking part is also too small for us to draw final
conclusions about the effectiveness.' However, other studies also
confirm that the effect of magnetic stimulation is to improve the
Memory unimpaired by magnetic stimulation
The patients who had been treated with magnetic stimulation later
did as well as or even better than before therapy. By contrast, the
patients taking part in electro-shock suffered memory loss,
psychologist Svenja Schulze-Rauschenbach confirmed. Even so,
magnetic stimulation is not a miracle cure, since, like
electro-shock, it is not a lasting cure for depression. The patients
still have to continue to be treated afterwards with other methods.
'TMS is just a new therapeutic tool which can't help in all cases of
depression,' adds Michael Wagner, cautioning against excessively
There are only a few institutions in Germany where the effects of
this relatively new therapy for severe depression are being
investigated. However, new instruments are in the offing which could
be even more effective. The magnetic field which they produce is so
strong that it can trigger an epileptic spasm. Yet unlike with
electro-shock the flow of current in TMS remains restricted to the
area of the brain which is responsible for mood ? the hippocampus is
not affected. Dr. Wagner says, 'We are therefore hoping that this
will be an additional very effective method without undesirable
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