TMS offers hope for patients with treatment resistant depression


By Aleksandra Vujicic

Communications Coordinator, Department of Psychiatry

Sixty-three-year-old Brenda Griffith was first diagnosed with depression two decades ago.

“I couldn’t feel,” she said. “I lost the ability to feel anything positive or just feel good about things because I felt dead inside. You feel like an outsider because you have [depression].”

James Beeghly, MD, a UI clinical associate professor of psychiatry, started seeing Griffith in the early 90’s, prescribing various medications over the years and even conducting electroconvulsive therapy (ECT) in hopes of getting Griffith to a better mood.

One thing that struck Beeghly early on was a picture he saw of Griffith as a young nurse. In the photo, Beeghly says Griffith is seen smiling and looking happy.

“I’ve always had that picture as a standard of where she should be, a baseline. But I’ve never seen her that way--until recently,” he said.

In January, Griffith completed a treatment course of transcranial magnetic stimulation (TMS) at University of Iowa Hospitals and Clinics.

“About halfway through it I started feeling changes,” she said. “As the sessions went on, I kept feeling better and my kids noticed I was laughing more, I was talking more, I wasn’t just sitting there.”

Beeghly also noticed a change.

“She smiles spontaneously,” he said, with a proud smile.

James Beeghly, MD, a UI Clinical Associate Professor of Psychiatry​

TMS is a non-invasive treatment for patients with major depressive disorder who do not respond to medications. In Griffith’s case, over a dozen different prescriptions didn’t seem to do the trick and came with a number of unwanted side effects, including weight gain. She also underwent years of ECT, which provided her some relief and prevented suicidal thoughts, but it came at the cost of some short term memory issues.

She eventually had to give up her 30 year nursing career due to the cognitive impairments caused by ECT. 

“It was important to be able to function on a high level,” she said. “I was respected back then and that’s something that was taken away from me.”

In December 2016, TMS was introduced in UI Psychiatry and Griffith was the first patient on the list.

The technology delivers magnetic stimulation to the left frontal cortex of the brain, a region that tends to be underactive in people who are severely depressed.  When the region is stimulated daily it causes long-lasting changes in the excitability of the cortex that has an antidepressant effect, according to Aaron Boes, MD, PhD, assistant professor of pediatrics, neurology, and psychiatry who runs the TMS program along with Ki Won Nam, MD, a clinical assistant professor of psychiatry. 

Griffith came into the TMS clinic five days a week for six weeks. She stayed awake for the sessions, which typically last 40 minutes and do not require sedation. She spent much of the time talking to TMS coordinator and technician Chris Sanborn.

“It feels like a woodpecker on your head,” she said, describing the pulses. “I was happy about the whole set up they had, and the friendliness of Chris. We talk through it.”

A few weeks into treatment, Griffith started noticing unusual changes in her mood. 

“It was kind of like day and night, how I felt,” she said. “I was starting to feel things that I hadn’t felt for so long.”

Numerous large clinical trials have shown an antidepressant effect of repetitive TMS and the treatment was FDA-cleared for treating depression in 2008. TMS doesn’t come with any major memory or cognitive side effects either, Boes said.

A good response to TMS can last anywhere between a couple of months to several years, depending on the person.

“TMS is not a cure for depression but it’s often a treatment that lasts a long while,” Boes said.

If Griffith starts to notice a dip in her mood, she plans to return to the clinic for further sessions. Boes says people typically respond more quickly to the treatment the second time around.

“I know that this is not just a quick fix,” Griffith said. “It gives me hope for the future. It gives me hope that I can continue being more outgoing, and smiling.”

Friday, February 24, 2017