DEAR DR. ROACH: “TMS” stands for “Transcranial Magnetic Stimulation” and is done for four to five weeks daily and takes about 30 to 40 minutes per treatment in the doctor’s office, with the doctor overseeing it and a trained technician doing the treatment.
Do you know how successful this newest noninvasive treatment for depression is (for those who cannot tolerate antidepressant side effects, or for whom these medications just don’t work)? Is it, to your knowledge, successful, and advised for older people too? It’s been successful for some, according to the research I’ve done, but I wanted to get your input.
I understand that it is not covered yet by Medicare, so for those whose primary is Medicare, that means the secondary doesn’t cover it, either!
It is being recognized in some areas and gradually being covered by some insurance plans. I just wondered if you have had any patients who have had the treatment and if you feel it is a viable alternative treatment for the abovementioned health issues? — J.S.C.
ANSWER: I had not heard of this treatment before your letter, and was surprised to find that there is good evidence to support its use. It is more effective than placebo treatment, but only about 25 percent of people — all of whom had poor response to at least one medication — had a good response to treatment. The major side effect in treatment is seizures, but only in less than 1 percent of cases.
Due to differences in brain structure, the elderly may require a higher intensity of magnetic stimulation.
This treatment appears to be a useful alternative therapy. However, other antidepressant medications, electroconvulsive therapy and especially non-pharmacologic treatments such as cognitive behavioral techniques may be effective in a larger number of people than TMS.
DEAR DR. ROACH: I am 76 and have been diagnosed with a condition called Wenckebach phenomena — an irregular heartbeat. For most of my life, I have exercised frequently and have been in excellent health. I have run 22 marathons. My heart rate is in the low 60s, and I take no beta blockers. The condition is asymptomatic and does not seem to affect my exercise. After consultation with my cardiologist, he determined that I do not need a pacemaker. What is my prognosis for the future? — J.S.