Guest: Dr. Kimberly Cress
Presenter: Neal Howard
Guest Bio: Kimberly Cress, MD, has been in private practice in Psychiatry since 2000. A graduate from the University of Texas Health Science Center, San Antonio Medical School, Dr. Cress’ experiences include treating patients with treatment refractory depression, anxiety and bipolar disorders at the Mood Disorder Center at Baylor College of Medicine. Dr. Cress founded the TMS Serenity Center in April 2010 and has administered over 10,000 TMS treatments. She completed Harvard Medical School’s Intensive Course in Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation, along with courses at Duke University in TMS.
Segment overview: Dr. Kimberly Cress, MD, a psychiatrist and founder of the TMS Serenity Center in Sugarland, TX, discusses the peer reviewed TMS clinical results for Major Depressive Disorder and Generalized Anxiety Disorder.
Health Professional Radio – Major Depressive Disorder
Neal Howard: Hello and welcome to the program, I’m your host Neal Howard. Thank you for joining us here on Health Professional Radio. Our guest in studio today is Dr. Kimberly Cress, Psychiatrist and Founder of the TMS Serenity Center in Sugar Land, Texas joining us here in studio today on Health Professional Radio to discuss the Peer Review TMS Clinical results for major depressive disorder and generalized anxiety disorder. Welcome to Health Professional Radio Kimberly.
Dr. Kimberly Cress: Thank you Neal.
N: Thank you. Well I’m glad that you returned and goanna lend us some more of your time. Let’s talk this segment about a peer reviewed TMS Clinical Study. Were you involved in that study, talk about it and if so if you are involved how much were you involved?
C: I have been involved in several different capacities. What I’d like to do is for kind of give a quick overview of initial study that was done for FDA approval back in 2008 though which I was not involved with.
C: It was a randomized controlled trial, individuals had major depression and taken off of all antidepressant medications. In that study they found that one in two responded and one in three went into remission with the use of TMS treatment in comparison to Sham treatment. What this particular study was utilized to help facilitate NeuroStar being the first TMS provider for the treatment of major depression. What was wonderful is then the National Institute of Mental Health went on and created a similar type of randomized controlled study and where actually replicated the same response. One in two went into response and one in three went into remission and NIMH went on to say that daily TMS treatment produce statistically significant and clinically meaningful antidepressant therapeutic effects greater than Sham and the odds of retaining remission were 4.2 times greater with TMS treatment versus Sham treatment. So that data really supported again the value and efficacy of utilizing TMS treatment for depression. Additional studies have been done since that time and in fact 18 studies have been done looking at treatment refractor depression in the use of TMS since 1980 to 2013 and they as well have started the efficacy of TMS. Now, Neuronetics went on and looked at a long-term study which the TMS Serenity Center was involved, we were actually went to 42 sites where 307 patients. Now what which is different about this particular study was these were patients that for example were in my clinic had diagnosis of major depression but they were on antidepressant treatment. So it was a real, it’s a naturalistic study looking at real world outcomes in utilizing TMS because most of our patients are currently receiving antidepressant treatment again still struggling with major depression. This study in turn found that again one in two respondent, one in three went into remission but it went on to follow individuals over the course of time, over a 12 month period and over that timeframe they clinician rated scales came back with a 67% response rate and a 45% remission rate, so again such significant results and once again showing the efficacy of TMS treatment. The other fascinating information that came from this particular study is we were able to identify that if over the course of a year an individual began to experience depression again, we could reintroduce TMS and facilitate relief of their depression by having them receive additional TMS treatments and that certainly something that I had seen in my clinical practice and this is important because unlike treating with antidepressant medications if I have an individual and depression breaks through I don’t find that I can often times have that same efficacy of increasing their dose of antidepressants or switching to another antidepressant and have that same response for it. In fact in my clinic I’ve seen if individual’s initial responded to TMS treatment at a 93% remission rate of getting them back into a state of without depression by reintroducing additional TMS treatments. At the TMS Serenity center we’ve gone on and done additional trials and in fact this past May we presented our results at the American Psychiatric Association. We had a hundred and twenty three patients all with major depression and we actually had a 76% response rate but a 72% remission rate and you’ll notice that those numbers are significantly higher than what we’ve seen in some of the clinical trials. It brings up the question of ‘Why do we think that is?’ I think that we have had, not only the TMS Serenity Center but there’s certainly been other clinics throughout the United States that had seen higher remission rates in comparison to initial trials and I tribute some of that again coz individuals are on antidepressant trials specially in comparison to those initial trials undone for FDA clearance where they were not on medications. And I think the other factor is we at the TMS Serenity Center is we encourage individuals to not only get relief of their depression but really working on taking care of themselves and so we found that individuals with having relief from the depression were able to take charge of their lives and get involved in therapy and facilitating addressing really court issues that can play a role in their depression. They have the ability to take better care of themselves whether if they have a comorbid medical condition they’re better able to get out, exercise, follow-up with their clinician is also what we had seen. In our particular study it’s important to know that we had some significant treatment refractory patients, these individuals and their current episode of major depression had failed 3.9 medication trials prior to receiving TSM. So they had had significant struggles already with depression and these individuals were of the age from 16 to 79 years of age. So we treated individuals over various stages of life and a hundred percent of these individuals did complete the treatment without any type of side effects.
N: When it comes to an individual’s diagnosis of MDD, are there different levels of activity as far as TMS is concerned? Different power, different frequency, different side effects based on a person’s level of major depressive disorder or does it matter?
C: So the treatment does not vary in the sense of the treatment protocol from patient to patient but it is specific in the sense of the amount of the intensity of the magnet we need to get into an individual’s nerves to fire can vary from person to person. And for example that can vary depending on if they’re on other medications, if they are on pain medications or any type of sedatives then they may need a higher strength of the magnet versus somebody who’s not on those stimulant medications. So certainly the setup of TMS treatment is different with each individual.
N: Well Dr. Cress let’s talk briefly about generalized anxiety disorder, does the treatment differ between MDD and GAD?
C: So treatment for generalized anxiety disorder can definitely vary and it’s important to first note that TMS has not been FDA cleared for treatment of generalized anxiety disorder. At the TMS Serenity Center we did present information in regards to our monitoring of individuals with generalized anxiety disorder and the efficacy of using TMS treatment. We utilized a different TMS protocol where we were stimulating the dorsolateral prefrontal cortex but instead of the left side we were doing the right side. In addition we slow down the magnets so instead of a high frequency we call 10 hertz we did a low frequency 1 hertz. And with the treatment of the low frequency on the right dorsolateral prefrontal cortex we had 20 individuals in our poster and we found that we had a 70% response rate and 60 % remission rate using the Beck Anxiety which was interesting also to note is of these 20 individuals we had 11 individuals who had moderate to severe depression as a comorbidity and we monitor the depression as well over the course of their TMS treatment and found that they had 80% response rate and a 70% remission rate. So we were effectively able to help not only their generalized anxiety disorder but their major depression because this we know clinically over 60% of individuals can have both depression as well as anxiety.
N: So do you see the future of TMS in an extremely positive light going mainstream as far as treatment for depression?
C: I’m very much so because I see the efficacy of TMS. Again if we have and we’ve had remission rates of 70% and you compare that to what you’ve seen with various medication studies being for example with the… study of being less than 30% remission rate, those are significant differences and the fact that we can help individuals not only get to a remission but without the risk of side effects that can occur with medications. It definitely needs to be considered as a treatment choice for individuals.
N: Where can we go and get information about the TMS Serenity Center in Texas?
C: So at tmsserenitycenter.com you will find additional information about TMS and our Center.
N: You’ve been listening to Health Professional Radio, I’m your host Neal Howard. We’re in studio with Dr. Kimberly Cress, Psychiatrist and Founder of the TMS Serenity Center in Sugar Land, Texas. And she’s been in studio with us talking about the peer reviewed TMS Clinical Results for Major Depressive Disorder and Generalized Anxiety Disorder. It’s been great having you here with us today Dr. Cress.
C: Thank you Neal.
N: Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm and you can subscribe to this podcast on iTunes.