Magnetic wave therapy not for everyone

People with depression, particularly hard-to-treat cases, now have a fresh option to turn to.

Called repetitive transcranial magnetic stimulation (rTMS), the outpatient treatment uses magne-tic waves to stimulate a specific part of the brain that is dysfunctional in patients with depression.

The treatment is available at a private clinic in Singapore, and the Institute of Mental Health (IMH) is set to offer it by the end of the year.

Twenty patients have tried rTMS at Winslow Clinic, the psychiatric clinic of Promises Healthcare in Novena Medical Centre, since the beginning of last year.

At IMH, it will be offered to selected patients, said Dr Tor Phern Chern, a consultant at its department of general psychiatry.

The rTMS treatment will be added to the psychiatric hospital's stable of treatment programmes for major depressive disorder (MDD), the most severe form of depression, also known as clinical depression. This spells hope for people with depression, one of the most common mental health conditions in Singapore. The Singapore Mental Health Study (2011) showed that 5.8 per cent of the population will suffer from MDD at some point in their lives.

The rTMS treatment was first approved for use by the United States Food and Drug Administration in 2008 in patients whose depression has not responded to at least one anti-depressant medication.

It works on all forms of depression, said Dr Munidasa Winslow,

executive director and senior consultant psychiatrist at Promises.

"As it is a newer treatment, we focus on treating those who have already tried the traditional treatments," he said.

Clinical depression is traditionally treated with psychotherapy and anti-depressant drugs. "However, each person has a different genetic make-up. Medicine works differently on the mind. There will also be a significant proportion who suffer from side effects," said Dr Winslow.

If there are no alternative therapy methods, patients for whom traditional treatments do not work

or the side effects are intolerable may try electroconvulsive therapy, he said.

Electroconvulsive therapy involves sending electric currents through the brain to trigger a brief seizure. It can be a very effective emergency treatment - for someone who is highly suicidal, for instance - but the patient has to be put under anaesthesia and hospitalised. He may also suffer short-term side effects, including confusion and memory loss. "It works and it's fast," said Dr Winslow. "The main problem is that the effect wears off after a month or so."

With rTMS, the effect can last a lot longer, though it does not work on everyone. Dr Winslow said that 12 of the 20 patients who tried the therapy have experienced "at least three to nine months of significant improvements in their lives".

They also required fewer medications, though they still needed psychotherapy as behavioural changes are needed to achieve long-term wellness, he said.

The 40 per cent of patients who did not seem to benefit from rTMS have other conditions, such as anxiety and obsessive-compulsive disorder.

To date, rTMS has been approved for the treatment of clinical depression in the US, Canada, the United Kingdom, Australia, New Zealand, Japan and South Korea, said the Academy of Medicine, Singapore in a position paper dated last November.

"With the growing body of evidence supporting its anti-depressant efficacy, rTMS may be considered as an alternative treatment option for MDD that can be administered in an outpatient setting in Singapore," it said.

However, the jury is out on whether it is better than traditional therapy methods for

depression. Said Dr Tor: "While there is growing evidence of the clinical effectiveness of rTMS, there is no evidence to demonstrate the superiority of rTMS over standard therapy."

A subset of patients with clinical depression could potentially benefit from rTMS, he said, for example those who do not respond to or are unsuitable for other forms of treatment, such as psychotherapy and electroconvulsive therapy.

Dr Tor added that IMH is evaluating the evidence before it introduces the treatment at the end of the year.