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Could TMS therapy replace long-term use of antidepressants?

Antidepressants are well-known for their long-term use to alleviate the symptoms of depression. It should come as no surprise they are among the most commonly prescribed drug since depression is the leading cause of disability in the United States. Major Depressive Disorder (MDD) affects more than 16.1 million American adults, or about 6.7% of the U.S. population age 18 and older in a given year.

While antidepressants are primarily prescribed for various types of depression, they are also used for a multitude of other conditions. For instance, antidepressants are also prescribed to treat conditions such as bipolar disorder, neuropathy, anxiety, stress, smoking cessation, childhood bedwetting, fibromyalgia, or post-traumatic stress disorder. Antidepressants are typically prescribed for chronic conditions; however, they often come with debilitating side effects and coming off these medications after long-term use can be a surprising challenge.

The effects of antidepressants on the human brain

The two most common methods for treating major depressive disorder are psychotherapy and antidepressant medications. However, a Truman State University professor of psychology, Jeffrey R. Vittengl, PhD, said that while the short-term benefits of antidepressants are well established, the longer-term picture is a different story. Antidepressants essentially cause chemical changes in the brain that commonly result in short-term side effects, such as dry mouth, appetite changes and weight gain, gastrointestinal problems, headaches, changes in sleep, and emotional numbness. While these symptoms are considered short-term and normal side effects of antidepressants, they don’t necessarily alter your life in the long run or permanently.

There is a lot of controversy concerning the overuse of antidepressant medications, especially SSRI (selective serotonin reuptake inhibitors), such as Prozac, Zoloft, Paxil, Lexapro, Trintellix, and Celexa. There’s certainly a need for these medications, but the question is – should psychotherapy be prescribed first to see how well patients respond before jumping to an antidepressant, or could other methods of treatment be considered? In an international debate over the long-term use of antidepressants, A Denmark-based researcher, Peter C. Gøtzsche, argued that taking antidepressants could increase a person’s risk of dying prematurely, and that the drugs do little for patients over a placebo and that the medicines should be scrapped altogether. Gotzsche estimated there were likely 15 times more suicides among people taking antidepressants than reported by the Food and Drug Administration, which issued a black-box warning on antidepressants more than a decade ago. Others argued that psychiatric medications were critical in treating mental health conditions and that these drugs were necessary for certain patients. Certainly, psychiatric medications are needed for those experiencing moderate to severe depressive symptoms that clearly have an impact on their quality of life.

There is some evidence that suggests that high doses of antidepressants for a long period of time can lead to heart rhythm irregularities and even seizure. While the research is minimal, the concern has been raised by Dr. Dost Ongur, Chief of Psychotic Disorders at Boston’s McLean Hospital

We all know that those taking certain types of drugs, such as pain pills and anti-anxiety medications, such as Xanax, can cause withdrawal symptoms when stopping the medication. In fact, these medications can easily become habit-forming, leading to addiction. Those taking antidepressants long-term typically would never imagine going through withdrawal once stopping the medication. However, discontinuation syndrome can be a consequence of stopping certain types of antidepressants: selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Discontinuation syndrome can occur in as little as six weeks after stopping the medication, and create sleep issues, gastrointestinal upset, dizziness, anxiousness and other symptoms.

Antidepressants alter the level of neurotransmitters in the brain. Neurotransmitters are commonly referred to as ‘chemical messengers’ that attach to the receptors of nerve cells (neurons) throughout the body, thus influencing their activity. Over time, the body begins to adapt to a certain level of neurotransmitters. So, you can imagine what happens if you stop taking your antidepressant(s). When the level of neurotransmitters drops significantly, then withdrawal symptoms are likely to occur. However, unlike the withdrawal from opiates, benzodiazepines, or other controlled or addictive substances, withdrawing from antidepressants does not indicate an addiction to the medication. It is not common for people coming off of antidepressants to develop any type of craving.

Is there an alternative to antidepressants?

There are other alternatives to taking antidepressants. Psychotherapy and other forms of therapy can be effective for a select few; however, not everyone benefits from therapy. For milder forms of depression there are a number of lifestyle changes that can be done to assist in alleviating symptoms, such as eating a healthy diet, exercise, minimizing stress, and developing a good sleep routine.

Today, transcranial magnetic stimulation (TMS) is the most advanced form of depression treatment. TMS therapy is a very safe and effective option for those suffering from moderate to severe forms of depression. Unlike antidepressants, TMS does not cause any undesired systemic side effects and there are no withdrawal symptoms. TMS is a simple magnetic therapy that targets a very specific area of the brain known as the left dorsilateral prefrontal cortex (just above the left eyebrow). The therapy takes about 20-minutes a day, and over a period of time the repeated stimulation of the neurons in prefrontal cortex begin to release the neurochemicals that are lacking in a depressed brain. While TMS is not a permanent cure for depression, it often lasts for up to two years in some patients. More importantly, TMS is non-invasive, FDA-approved, and patients can immediately return to their activities without any restrictions or limitations.

The downside to TMS is that while it is covered by insurance, including Medicare and Tricare, a patient must have tried at least two to four antidepressants before insurance will cover the treatment. Each insurance provider has their own set of criteria that must be met prior to approval for TMS; however, the upside is that most TMS providers can determine whether a person is covered by their insurance and will obtain a prior authorization if required.

Today, there are approximately 40 antidepressants available on the market, and they are among the most commonly prescribed medications in Western countries. Before making any decisions about stopping your medications or reducing the dosage you should always speak with your doctor. And, for those who prefer to steer from long-term use of antidepressants, or those unable to tolerate their side effects, then perhaps TMS therapy would be a viable option.

For more information about TMS therapy visit or call 1-833-TMS-HELP to schedule a free consultation with TMS Institute of America . TMS Institute helps people all across the United States to find a TMS clinic nearest to you.

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