Transcranial Magnetic Stimulation (TMS) for Depression in Children and Adolescents

Topics: adolescents | Brain Devices | children | Depression | Free Articles | pediatric | safety | teens | TMS | Transcranial Magnetic Stimulation

Editor’s note: This article is about the “usual” TMS that we have been hearing about for many years. We are covering trigeminal nerve stimulation (eTNS) separately in this issue in a News of Note as it is far newer with far less clarity about its utility. The search for safer treatment With concerns about both safety and efficacy surrounding a

First Non-Drug Treatment Approved by FDA for Treating Children With ADHD

Topics: ADHD | adolescents | Attention Deficit Hyperactivity Disorder | Brain Devices | Child Psychiatry | children | efficacy | eTNS | News of Note | pediatric | safety | teens | treatment | Trigeminal Nerve Stimulation

NeuroSigma made a splash by announcing that the FDA has granted medical device approval for its external Monarch Trigeminal Nerve Stimulation (eTNS) System for treating kids with ADHD ages 7–12 who are not currently taking medications. What does medical device approval mean? The FDA reviewed the Monarch eTNS System through the de novo ­pre-market

Getting Uncomfortable with Esketamine

Topics: Antidepressant Augmentation | Antidepressants | Brain Devices | Depression | Depressive Disorder | ECT | Esketamine | Free Articles | Ketamine | Neurotoxicity | Novel Medications | rTMS | Suicidality | TMS | Transcranial Magnetic Stimulation | Treatment-Resistant Depression

Esketamine (Spravato) was approved for treatment-resistant depression in 2019. In this interview, Dr. Williams (who has no relationship with Janssen Pharmaceuticals, Inc) addresses some lingering doubts that have been raised about the medicine. TCPR: Where does esketamine fit in the list of interventional therapies for depression, like repetitive tra

Transcranial Direct-Current Stimulation in Depression Reconsidered

Topics: Brain Devices | Depression

Review of: Razza LB et al, Depress Anxiety 2020;37(7):594–608 Study Type: Meta-analysis of randomized sham-controlled trials Transcranial direct-current stimulation (tDCS) is a neuromodulatory intervention with putative benefits in depression. The device consists of a headband with two electrodes that delivers a weak electrical current across the br

New Approvals for TMS

Topics: Brain Devices | News of Note

We know that transcranial magnetic stimulation (TMS) works for treatment-resistant depression (TRD) (see TCPR July/August 2017 for our most recent coverage), but one disadvantage is the length of the treatment sessions. We also don’t know if TMS works for other disorders. Recently, the FDA granted new approvals that address both these issues. One a

Does Vagus Nerve Stimulation Work for Treatment-Resistant Depression?

Topics: Brain Devices | Research Update

Review of: Aaronson ST et al, Am J Psychiatry 2017;174(7):640–648 Treatment-resistant depression (TRD) is typically defined as a major depression that fails to remit after at least 2 trials of 2 different classes of antidepressants. Other than electroconvulsive therapy (ECT), there remain few evidence-based biological treatment options for TRD.

Transcranial Direct-Current Stimul­ation: Not Ready for Prime Time Yet

Topics: Brain Devices | Research Update

Review of: Brunoni AR et al, N Engl J Med 2018;376(26):2523–2533 Transcranial magnetic stimulation (TMS) was approved by the FDA in 2009 for the treatment of major depression, but TMS is costly and has so far produced only mixed results. A novel method, transcranial direct-current stimulation (tDCS), applies a weak electrical current to the brain b

Benefits of Alpha-Stim

Topics: Brain Devices | Depressive Disorder | Natural Medications | Practice Tools and Tips

Ongoing ECT Does Not Equal Ongoing Cognitive Problems

Topics: Brain Devices | Research Update

Subject: (Kirov G et al, BJ Psych 2016;208:266–270) Short Description: Electroconvulsive therapy (ECT) is well known to cause short-term amnesia and disorientation around the time of treatment. However, for most of our patients, these cognitive side effects improve and disappear fairly quickly, usually within a few days. We have less informat

Neurostimulation Devices for Depression: An Overview

Topics: Brain Devices | Depressive Disorder | Practice Tools and Tips

When we last reviewed neurostimulation devices 3 years ago, we concluded that there was some promise—but more sizzle than beef. Now there are more devices and more data. But is there more beef? Maybe. We generally think of neurostimulation as a new technology, but its history is long. Beginning in the 1870s and through the turn of the last century,

Fisher Wallace and Alpha-Stim for Depression? Claims vs Evidence

Topics: Brain Devices | Depressive Disorder | Free Articles | Practice Tools and Tips

Carly Simon swears by it. The daytime show “The Doctors” gave it a glowing review. Ads for it seem to be invading psychiatrists’ Google search results. We’re talking, of course, about the Fisher Wallace Stimulator, touted by the manufacturer as being an effective treatment for depression, anxiety, insomnia, and pain (Fisher Wallace website). The

Which TMS Device Should You Buy?

Topics: Brain Devices | Depressive Disorder

So let’s say you’ve decided to take the TMS plunge. With three devices currently FDA cleared, you have some decisions to make. The following table brings together some information you might find useful. I focused on Neuronetics and Brainsway, with a blurb at the end about Magstim, the latest device to be approved. Material for this comparison came f

Reflections on the Past and Future of TMS

Topics: Brain Devices | Depressive Disorder

The Practice of Interventional Psychiatry

Topics: Brain Devices | Depressive Disorder

Do Devices Work for Depression?

Topics: Brain Devices

If your practice is anything like mine, then up to half of your patients with depression are at best partially responsive to the treatment you provide. You may have nodded sympathetically as you read the results of the 2007 STAR*D trials, showing that after two complete trials of standard pharmacotherapy, only half the study participants were truly symp

Neuroimaging of Mood Disorders

Topics: Brain Devices

Most clinicians are familiar with the use of brain CT scans in an emergency situation: when a patient has an acute change in mental status, we need to rule out a large stroke, mass, or hemorrhage before assuming the problem is psychiatric. Given the limitations of CT scanning (low resolution, poor visibility of posterior structures, many types of pathol

ECT Still Alive and Well

Topics: Brain Devices

TCPR: How commonly is electroconvulsive therapy (ECT) performed these days? Does it seem to be getting more or less use, and why is that? Dr. Lisanby: ECT is alive and well. It is still the most effective psychiatric treatment that we have for medication-resistant major depression. Utilization figures are hard to track because it is not centrally rep

The Self-Injurious Patient

Topics: Brain Devices

It can sometimes be hard to distinguish normal adolescence from borderline personality disorder. Both may be characterized by unstable, tumultuous relationships, emotional dysregulation, and incomplete identity formation. Not all adolescents go through such turmoil, of course, but it is common enough that when you see a patient who has cuts on her arms,

Neurofeedback as a Treatment for ADHD

Topics: ADHD | Brain Devices | Child Psychiatry | Neuroscience in Psychiatry

Neurofeedback, also known as “EEG biofeedback,” has been around for a long time, but its history is checkered. Clinicians have hawked devices for treating ADHD and other psychiatric conditions in the absence of reliable efficacy data. Since the treatment is rarely covered by insurance companies, families may pay several thousand dollars for a typica

Can an EEG Predict Antidepressant Response?

Topics: Brain Devices