Geriatric Depression and its treatment: TMS & Ketamine
Treatments for Major Depression
In addition to psychotherapy and medication management for depression, recent years have seen the development of two promising and very well tolerated therapies, transcranial magnetic stimulation (TMS) and ketamine.
Transcranial Magnetic Stimulation
TMS is the use of a figure of eight magnetic coil that is positioned on the scalp in a precise location known to be involved in regulating mood state. This part of the brain is known at the dorsolateral prefrontal cortex (DLPFC). The DLPFC is located prior to the first treatment in what is known as a mapping procedure. TMS is a series of between 30-36 treatments that are administered in a psychiatrist’s office five times per week. Depending on the machine used, treatments can be as short as 3 minutes or up to 37 minutes in length. The treatment involves the repetitive activation of a magnetic field to induce electrical currents to cause chemical changes in the brain that leads to antidepressant effect. The treatments are totally pain free, and the patient may read or watch TV during the treatment. Earplugs are used. TMS treats an episode of illness. It is exceedingly well tolerated. Patients may drive to and from their TMS treatment and many patients have a treatment before or after work or during a lunch hour.
Ketamine is a veterinary anesthetic agent and club drug that is structurally similar to the hallucinogen LSD. Studies have shown ketamine to be an effective antidepressant, and is particularly effective for treating the suicidal ideation of depression.
Ketamine is available as an intravenous infusion delivered weekly for six weeks, or more recently, as an intranasal agent on a schedule. Both are done outpatient but require an individual to accompany the patient. Perceptual disturbances such as visual effects can occur, but tend not to be disturbing for most patients.
Both transcranial magnetic stimulation and intravenous ketamine are available through my practice, and more information for both can be found at www.ketaminekc.com.
In the last blog, on depression treatments, we discuss hands down the most effective treatment for depression, electroconvulsive therapy (ECT).