The technique will gradually spread, but the Bellvitge hospital is the first public center in Catalonia to implement transcranial magnetic stimulation (TMS) to treat resistant depression. The advantage over standard alternatives such as electroshock and deep brain stimulation is that it is a minimally invasive therapy for addressing depression cases that do not respond to drugs or psychological treatment, which account for between 20% and 40% of patients.
Bellvitge’s resistant depression treatment unit also uses repetitive EMT in cases of obsessive-compulsive disorder and, in the future, will use it in other neuropsychiatric pathologies, such as schizophrenia.
It is a neuromodulation procedure that consists of the application of focal electrical stimuli to different regions of the cerebral cortex by means of an electromagnetic coil placed on the scalp. It is very well tolerated by the patient, does not require anesthesia, does not cause cognitive deficits and the side effects are mild, explains Pino Alonso, head of psychiatry at Bellvitge.
The first tests with EMTr were done at the beginning of this century and shortly after the drug authorities in Europe and the United States approved the technique, despite the fact that it was not sufficiently refined from the point of view of psychiatry. “The coils that are placed on the scalp allowed one centimeter to enter the brain and the response was small and short-lasting,” says Dr. Alonso. “In recent years, coils have been developed that allow electromagnetic stimulation to reach three centimeters, and navigation techniques have been added that allow us to locate the areas of the brain we want to study”, he points out.
Bellvitge psychiatrist Sergi López has spent time at the psychiatry and neuromodulation laboratory at Massachusetts General Hospital (Boston) to learn about treatment protocols. The Catalan hospital, a reference for the southern metropolitan region and the Terres de l’Ebre, estimates that it will be able to take on 80 patients a year. Each protocol consists of 30 sessions over six weeks, lasting between 10 and 20 minutes per session (not long ago it was 37 minutes). “It is applied on an outpatient basis, without anaesthesia, it does not cause memory difficulties or loss of concentration and the side effects are usually limited to local discomfort or headache that resolve within 24 hours”, points out Alonso. Each program of 30 sessions costs public health between 3,000 and 4,000 euros.
The number of candidates for the EMTr is significant, considering that between 10% and 12% of the general population may have depressive symptoms, of which between 20% and 40% will not respond to the usual treatments, with drugs and psychotherapy. The disease has a high incidence of work incapacity and affects the person’s functional impairment.
What can patients expect from EMTr? Depression symptoms may improve or disappear completely, at least temporarily. The percentage of positive response reaches between 50% and 60% of treatments, according to scientific evidence, the experience of international reference clinical centers that use this technique and the first results that have been obtained in Bellvitge, according to Dr. Alonso.
