Conditions that may be treated with rTMS

Depression is a complex illness which can affect all areas of one’s life. Repetitive Transcranial Magnetic Stimulation (rTMS) is an innovative, non – invasive treatment for depression.
If you are suffering with depression, you are not alone. About one in ten people are living with depression or an anxiety disorder, and it is believed that there are still many undiagnosed. Despite its prevalence and the severe impact that depression can have on people’s lives, many of those affected try to put up a brave front, not wishing to “trouble” their loved ones with the problem. Unfortunately, if left untreated, depression often worsens over time.

Am I depressed?

Depression is a complex condition, and no two sufferers will feel exactly the same way. However, there are some general symptoms that doctors have identified as being common, such as a persistent low mood, lack of energy, reduced interest in life and problems with concentration.
If you are suffering from Depression, you may be likely to experience the following symptoms:
Experience a low mood for extended periods of time
Lose your ability to enjoy life – even activities you used to love, such as hobbies
Feel difficulty in connecting and enjoying spending time with people, even those closest to you
Sometimes Depression sufferers can even lose their ability to feel love for family and friends
Suffer with anxiety. This can be extremely troubling, sometimes even more so than the low mood. It can at times make everyday activities almost impossible
Have problems with your appetite. Many people struggle to eat enough when they are depressed. Or others may comfort eat to try to counteract negative emotions
Experience disturbed sleep patterns. Some people sleep more when they are depressed Others suffer with problems getting to sleep at night, followed by a tendency to wake very early
Be preoccupied with the past, often with a sense of regret or guilt
Find it difficult or even impossible to concentrate
Be irritable
Suffer with poor short-term memory or a sense of absent-mindedness
Avoid socialising
Experience a sense of dread or hopelessness about the future

What can I do when prescribed treatments for depression don’t work?

The most commonly prescribed treatments for Depression – antidepressants and talking therapies – sadly do not always work. In fact, treatment-resistant depression is all too common. Research studies have shown that up to two thirds of people with depression continue to suffer with symptoms despite taking antidepressants and/or undergoing psychotherapy. Up until recently, little or nothing could be done for these people.
In other cases, the side effects that can result from medication – such as weight gain, decreased sex drive, sleep problems and tiredness – can put such a strain on a sufferer that taking the medication just doesn’t seem worth it.
Smart CNS Center is able to offer patients rTMS, a highly sophisticated, scientifically-proven intervention to beat depression.

How does rTMS treat depression?

The efficacy of rTMS in the treatment of depression is unquestionable and scientifically substantiated. As early as 2008, the FDA approved the application of rTMS for the treatment of persistent depression in the US. In fact, official guidelines for the application of rTMS have been issued by the American Clinical TMS Society, namely:

Guideline No.1: Treatment with TMS is recommended as the main treatment for symptomatic relief in depression.

Guideline No.2: TMS treatment may be used as follow-up or maintenance therapy for patients who have benefitted from a previous course of treatment.

Guideline No.3: TMS treatment is recommended for use as a follow-up option for patients who have benefitted from a previous course of treatment have a recurrence (continuation or maintenance) of their illness.

Guideline No.4: TMS treatment may be repeated in patients experiencing a recurrent depressive episode, after an initial response to TMS therapy.

Guideline No.5: TMS treatment may be administered in its own, or in conjunction with antidepressants or other medications.

Long – term efficacy depends on several factors, such as the specific nature and severity of the disorder, the number of depressive episodes, environmental factors, the response of each patient to biological therapies, and more.
Our team designs and applies an individual approach – protocol for each patient, to ensure the best chance of an optimal, long – term outcome.

In addition to the standard 20 – 36 session cycle which is necessary to achieve remission in a depressive episode, we apply maintenance and enhancement protocols that may include weekly, 15 – day or monthly follow – up sessions, in conjunction with psychiatric assessment. This way, we make the most of rTMS’ benefits in terms of efficacy and safety, while providing patients with an opportunity for immediate and lasting relief from depression, without the inhibiting side effects that can come with antidepressant medication. Indeed, for many patients, it has proved to be the most significant investment they have ever made.

If you are suffering with depression, there is a solution. At our clinic, our help is completely confidential. Our experts will take the time to assess you thoroughly, to ensure rTMS is right for you.

Obsessive – Compulsive Disorder is a chronic mental disorder that occurs in approximately 1 – 3 % of the population, with varying degrees of severity. Its main symptoms are repetitive, unacceptable and uncontrolled thoughts, impulses or images, which in most people cause intense anxiety or discomfort, and compulsions, that is, repetitive behaviours (eg. hand washing, tidying) or mental actions (eg. prayers, counting, silent repetition of words) than the person feels compelled to perform, often in response to an obsession. In addition, both obsessions and compulsions are time consuming and cause a significant reduction in one’s social, occupational or familial functioning. The available therapies so far (pharmaceutical and psychotherapy) deliver significant benefits, either alone or in combination. However, about 60% of patients are expected to experience relapse in symptomatology, while a total of 40 – 60% will only respond to treatment partially, for various reasons. Therefore, it appears that there is still progress to be made in order to provide new, more effective treatment for Obsessive – Compulsive Disorder. The application of Transcranial Magnetic Stimulation (TMS) aims to do just that. Current research data suggest that rTMS therapy may be a solution to many patients who suffer from OCD and have not benefited from either medication or psychotherapy. There is an extensive and promising field of research working to optimize the efficacy of this approach in the present and in the future.
Repetitive Transcranial Magnetic Stimulation (rTMS) is a safe new approach which may be used as a “third” way of treating OCD symptoms through targeted magnetic stimulation, as opposed to the approaches of medication or psychotherapy.
Also, due to its favourable profile in terms of side effects, rTMS may be a valuable option for patients who have not been prescribed or cannot tolerate pharmacological treatment, or for patients who have experienced limited benefits from psychotherapy. In addition, rTMS may be used to treat Obsessive – Compulsive Disorder either as a main treatment, or in conjunction with other approaches, in order to enhance treatment effects.

Substance use and dependence disorders are a particularly challenging area of Psychiatry,mainly due to the high rate of recurrence seen in more than 50% of patients within the first
year of treatment. Consequently, there is great need to introduce new treatment methods.

Modern research is expanding on the effects of transcranial magnetic stimulation for substance use disorders. Based on our existing knowledge of neurobiology, and since rTMS
can affect cortical excitability and enhance dopamine release in the brain, we believe that
repeated use may affect long-term adjustments that occur in the brain from chronic
substance use.

The main positive rTMS effect is the reduction of craving, which is mediated by the
application of high-frequency stimulating sessions to the left frontal cortex. Stimulating this area appears to enhance the inhibitory control it exerts on other closely related brain structures, by reducing impulsivity and improving decision – making abilities.  

• Nicotine addiction
• Cocaine addiction
• Alcohol dependence

Relevant research can be found on heroin, amphetamines and gambling addiction.

It should be noted that despite the aforementioned data, scientific research on this field is ongoing and the overall treatment of addiction remains a challenge, which requires comprehensive planning and, potentially, a combination of each available treatment. Our team implements the appropriate approach individually for each patient to ensure the best chances at an optimal, long – term result. .

Fibromyalgia is a syndrome that consists of a set of symptoms, most notably the widespread pain in multiple parts of the body. The pain is chronic and causes severe discomfort to the individual, often leading to impaired functioning. It is estimated that 2 – 8% of the population can be affected (this refers to the American population, where the studies were conducted), mostly women (8:1).
Fibromyalgia commonly includes a wide range of additional symptoms:

• Dizziness
• Excessive fatigue from daily activities, occasionally leading to Chronic Fatigue Syndrome
• Sleep disorders, with the most common disturbances occurring during the the slow wave sleep (SWS), which is said to have a rejuvenating role
• Irritable bowel, stomach pain
• Headaches (tension, migraines)
• Dry mouth
• Dry skin
• Rhinitis
• Difficulty swallowing
• Dysuria or increased urination
• Dysmenorrhea, premenstrual worsening of the symptoms

At the same time, a characteristic aspect of the syndrome is the so – called “fibro fog” or “fibrillation”, which refers to the cognitive impairment that accompanies fibromyalgia, including concentration difficulties, a subjective sense of working memory loss, difficulty in expression or difficulty finding the right words, difficulty drawing patterns and more.

Fibromyalgia has been found to frequently co-occur with depression and anxiety disorders. In such cases, treatment of depression or any other underlying disorder may cause improvement in fibromyalgia symptoms, or even help achieve full remission of fibromyalgia. Of course, there are also cases of fibromyalgia alone, without comorbidity. Repetitive Transcranial Magnetic Stimulation (rTMS) is a new therapeutic approach for fibromyalgia.
It is a non – invasive, non – pharmaceutical method which utilizes a magnetic field to improve painful symptoms of fibromyalgia as well as co-existent emotional symptoms. rTMS is gradually being established as a leading treatment of depression and there is a growing body of research on rTMS and fibromyalgia. It is a safe method, free of the common side effects of medications, and can be implemented as an alternative to them. In addition, rTMS may be applied in cases where traditional treatment methods have failed, or in conjunction with other treatments.

Get diagnosed; don’t allow fibromyalgia to be an obstacle in your life anymore.

“Neuropathic” pain results from damage or dysfunction anywhere in the peripheral or central nervous system. In contrast, “normal”, typical pain refers to the irritation of the intrinsic or extrinsic nerve fibers. Often, in neuropathic pain, no cause is found. However, it should be strongly emphasized that this does not imply if pain does not exist and is “in the patient’s mind”. It could, however, be said, given its definition, that neuropathic pain is caused by some pathology of the human nervous system. Neuropathic pain occurs in up to 8% of the general population and may have numerous causes. Potential causes include diabetes mellitus (diabetic neuropathy), herpes (postherpetic neuralgia), alcoholism and neurological disorders/illnesses, such as strokes or multiple sclerosis. Neuropathic pain causes stress and often has negative emotional consequences, such as significant anxiety, depression and more. Repetitive Transcranial Magnetic Stimulation (rTMS) has been researched extensively and shown to have efficacy in reducing neuropathic pain, as well as the patients’ quality of life. The strength and duration of the pain-relieving effects vary from small to large, depending on the application protocols. In a one-year study, with sparse frequency of applications, the pain-relieving effects lasted up to 20 days.
rTMS is introduced as an alternative solution to treating pain, without medications. It offers the benefit of reducing the over-consumption of analgesic medications. Additionally, it can be used in conjunction with any existing pharmacological treatment in order to maximize benefits, making it an ideal option for patients who have been suffering from long-term pain and no longer respond to medications alone.

Generalized Anxiety Disorder (GAD) is characterized by excessive anxiety and worry over a series of events or activities, for at least 6 months. In GAD, anxiety and worry are associated with symptoms such as nervousness, feeling anxious, hypertension, excessive distress, difficulty concentrating, irritability, muscle tension and sleep disturbance. In addition, anxiety, worry or physical symptoms cause significant discomfort and impair day-to-day functioning.

Repetitive Transcranial Magnetic Stimulation has shown satisfactory effects in the treatment of GAD. Recent studies report potentially mid-term benefits of applying a low-frequency brain stimulation to the right frontal cortex, which helps reduce stress. In addition, research is constantly growing and focusing on additional parts of the brain, such as the parietal lobe; a low-frequency stimulation was found to be effective in reducing anxiety and co-existing insomnia. rTMS is an ideal therapeutic option for patients who are resistant to pharmacotherapy, but also for those who experience adverse side effects or have been subscribed anxiolytics (benzodiazepines) for too long, having developed addiction and/or tolerance.

rTMS therapy can be applied exclusively or in combination with medication or psychotherapy, in order to optimize the outcome.