Repetitive Transcranial Magnetic Stimulation (rTMS) is a growing field which has a strong evidence base as an alternative or additive to medications in depression[1]. Generalised anxiety disorder, obsessive compulsive disorder[2] and post-traumatic stress disorder[3] also display positive outcomes in an expanding set of research data. rTMS has also been used in management of physical symptoms. Evidence is developing in chronic muscular and neuropathic pain[4], various pain syndromes, migraine and headache[5] among others. This is particularly exciting as it is such a well-tolerated treatment with minimal risks.
The late psychiatrist Dr John Rampono made the following quote during a presentation: “those who say the mind and the body are connected are wrong.” The initial reaction was confusion, until he followed with “the mind and the body are the same thing” – a concept I believe to be profoundly accurate. Modern research in medicine also suggests this to be true[6]. One such example is the effect of pain on psychological state and vice-versa. I currently work providing psychiatric care for patients admitted on medical and surgical wards, and in this context this is abundantly clear. Managing pain is extremely difficult if anxiety or depression are not managed. Depression and anxiety are unlikely to be adequately treated if pain is not well controlled. I believe treating each individual person in a holistic way rather than isolating and treating each symptom alone allows for more streamlined and effective outcomes.
A particular area of interest for me is migraines. These can be extremely debilitating for sufferers, and current preventative medications with blood pressure tablets and anti-epileptic medications have numerous side effects. As previously mentioned, migraines are an evolving area which has promising data for rTMS treatment[4,7]. Migraines are 2-3x more likely in those with depression than those without, and depression can result in poor treatment outcomes in pain management in migraines[8]. Therefore given rTMS has been used to treat depression and migraines individually, I believe it is an exciting area is to explore the effect in people who are suffering from both. With the Modalis team under the guidance of Dr Jaroslaw Hryniewicki psychiatrist we aim to assess outcomes on both depression symptoms and migraine symptoms in those undertaking rTMS treatment in order to expand the current literature in treating people as a holistic way. Treating the mind and the body, as one.
Dr Michael Dunne
Trainee in psychiatry
[1] Voigt, J., Carpenter, L. & Leuchter, A. A systematic literature review of the clinical efficacy of repetitive transcranial magnetic stimulation (rTMS) in non-treatment resistant patients with major depressive disorder. BMC Psychiatry 19, 13 (2019). https://doi.org/10.1186/s12888-018-1989-z
[2] Rehn, Simone et al, A Meta-Analysis of the Effectiveness of Different Cortical Targets Used in Repetitive Transcranial Magnetic Stimulation (rTMS) for the Treatment of Obsessive-Compulsive Disorder (OCD) VL – 89 DO – 10.1007/s11126-018-9566-7
[3] Kan, R.L.D., Zhang, B.B.B., Zhang, J.J.Q. et al. Non-invasive brain stimulation for posttraumatic stress disorder: a systematic review and meta-analysis. Transl Psychiatry 10, 168 (2020). https://doi.org/10.1038/s41398-020-0851-5
[4] Hamid P, Malik BH, Hussain ML. Noninvasive Transcranial Magnetic Stimulation (TMS) in Chronic Refractory Pain: A Systematic Review. Cureus. 2019;11(10):e6019. Published 2019 Oct 29. doi:10.7759/cureus.6019
[5] Seoyon Y, Chang Min Cheol, Effect of Repetitive Transcranial Magnetic Stimulation on Pain Management: A Systematic Narrative Review, Frontiers in Neurology 11 2020 114, https://www.frontiersin.org/article/10.3389/fneur.2020.00114
[6] Ohrnberger J, Fichera E, Sutton M, The relationship between physical and mental health: A mediation analysis, Social Science & Medicine, Volume 195, 2017, Pages 42-49, ISSN 0277-9536, https://doi.org/10.1016/j.socscimed.2017.11.008.
[7] Lan L, Zhang X, Li X, Rong X, Peng Y. The efficacy of transcranial magnetic stimulation on migraine: a meta-analysis of randomized controlled trails. J Headache Pain. 2017;18(1):86. Published 2017 Aug 22. doi:10.1186/s10194-017-0792-4
[8] Zhang Q, Shao A, Jiang Z, Tsai H, Liu W. The exploration of mechanisms of comorbidity between migraine and depression. J Cell Mol Med. 2019;23(7):4505-4513. doi:10.1111/jcmm.14390
