Transcranial Magnetic Stimulation (TMS) Therapy

A REAL PATIENT TMS THERAPY REVIEW & CASE STUDY

By Dr. Jack Castro of Brandywine Valley TMS in Wilmington Delaware

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TMS THERAPY SUPPORTS MENTAL WELLNESS

  • Depression
  • Lack of Joy
  • Sadness and Despair
  • Low Mood
  • Lethargy
  • Insomnia
  • Oversleeping
  • Social Isolation
  • Self-Harm
  • Substance Abuse
  • Suicidal Ideation
  • Alcoholism
  • Chronic Pain

LEARN HOW TMS HELPED BETTY'S DEPRESSION

Background

In December of 2021 Betty’s previous psychiatrist Dr RC retired and that prompted her to seek care with me. She was 64 y/o. Dr RC had treated her for depression and a questionable history of bipolar disorder. Her medications included Lexapro, Wellbutrin and Xanax and she was doing relatively well on this combination.

 

These medications were intended to treat the low moods associated with depression and they did help to some extent. I never noticed mood elevations consistent with bipolar disorder and therefore we didn’t adjust meds to address that. We did add Abilify which was helpful to her low moods.

 

But then in the Spring of 2023, Betty lost her husband and that threw her into a deep depression. Grief per se is not a psychiatric condition and it’s something we have to muddle through in different ways, using whatever coping mechanism we have, relying on our social network or spiritual life, if we have them. But when functioning is impaired then we may have to use psychiatric treatments.

 

In 5-2023 her depression scored highly at 16 on the PHQ9, a depression symptoms questionnaire that we use to track symptoms. She learned about TMS and decided to try it.

Starting a TMS Treatment Protocol

On 5-17-23 we started TMS. Betty scored 16/27 on the PHQ9, consistent with moderate-to-severe depression. On the GAD7, a survey for tracking anxiety, she scored 13/21, which was also in the moderate-to-severe range.

 

We determined her motor threshold (MT) at 44% for TMS sessions and stimulated her left dorsolateral pre-frontal cortex (in simpler terms, the left side of the head, close to the forehead). Betty was concerned TMS would conflict with her work schedule and she wanted to try it for a brief period of time only. So, we agreed to start her on iTBS or theta burst, which consist of a brief TMS session that lasts only 3 min and a few seconds and we did that for 2 weeks, totaling 10 days. She noticed relief in only 3 days, she was sold on TMS and therefore agreed to sit on the TMS chair for a bit longer, so that she was receiving 3 iTBS sessions each day. This means she was come and be done in about 10 minutes or so.

 

Each one of these iTBS is equivalent to the more popular standard TMS (and FDA-approved) protocol of 3000 pulses @ 10 Hz frequency. I realize this is a lot jargon, AND if my reader ends up working with me, I’d be happy to expand and explain.

 

Back to Betty – by day 4, PHQ9 had dropped from 16 to 6, which is pretty darn good and fast. We proceeded to treat during subsequent days. By day 10 PHQ9 was 4.

Betty's Symptom Tracking with PHQ-9

05-17-23 PHQ9 = 16

05-22-23 PHQ9 = 06

06-01-23 PHQ9 = 04

Hear What Betty Had To Say About TMS Therapy

Final Outcome & Continued Care

Betty completed only 10 sessions as she did not have insurance and this was a pro bono case. Nevertheless, I must admit this was an unusual case of rapid recovery and not everyone experiences such dramatic results. My experience is consistent with that of the scientific literature and other TMS colleagues in that about a third of treatment resistant depression patients experience complete remission of symptoms, another third experiences a 50% improvement of symptoms and the last third does not improve at all. This last group may have to consider more involved and complex treatments such as ECT (electroconvulsive therapy, aka shock therapy) or BBS (deep brain stimulation). I was fortunate Betty fell in the first category, or somewhat between the first and second categories.

 

An additional factor that complicated Betty’s presenation is that she has Parkinson’s disease and this often causes depression in and of itself. Her PD tremors made it challenging for her to remain in steady position for TMS, but we got through that as well.

 

Betty still takes the medications mentioned before and now comes for three 3-minute iTBS sessions about every 3-4 weeks and this has been enough to keep her depression at bay, even as her Parkinson’s disease slowly advances.

Conclusion

This honest TMS therapy review for depression in my patient with grief and Parkinson’s disease highlights the transformative impact of TMS, especially in cases where traditional medication approaches and psychotherapy prove insufficient. TMS does require work and commitment on the part of the patient, but if the above-mentioned treatment options are not being helpful, one must try everything and anything that is available. Fortunately, TMS is available for patients that live in the areas of New Castle, Chester, Delaware, Salem & Cecil County.

References

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By Jack Castro February 20, 2025
Brandywine Valley TMS provides TMS therapy for depression in Delaware. Consult a specialist to see if TMS is right for you.
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Interested in more TMS case studies by Dr. Jack Castro?

TMS Treatment Could Change Your Life!

Experience the Benefits of TMS Therapy Today

TMS Therapy, an FDA-approved treatment, is non-invasive and non-sedative, offering minimal to no side effects. Unlike mental health medications, which frequently bring about undesirable side effects, TMS therapy provides an immediate sense of optimal well-being following treatment sessions. Patients often experience noticeable positive changes as early as the third week, and sometimes even sooner. On this page, we've shared one real-world patient experience.

TMS has gained a strong reputation as an outstanding alternative for individuals who do not experience positive results from traditional mental health medications.

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Dr. Jack Castro with a Magventure TMS Therapy chair and device.
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