Dear Doctor: How does the new magnetic therapy for depression work?

Dear Dr. ROACH: I am a former medical/surgical nurse. I have a daughter-in-law who was treated for depression with magnetic therapy. My psychiatric exposure in the 1950s was to electroshock therapy and insulin shock therapy. Can you explain how the new magnetic therapy for depression works, compared to the other two treatments?

PS Is electroshock therapy still being used? — NP

ANSWER: Electroconvulsive therapy (ECT) is still used for the treatment of drug-resistant severe depression. However, despite decades of use, the exact mechanism of how it works is not understood. ECT increases neurotransmitters such as dopamine, serotonin, and norepinephrine (as do some medications). ECT also releases hormones such as prolactin, thyroid-stimulating hormone, and endogenous endorphins, and also has anticonvulsant properties.

A more recent theory is that ECT increases the body’s ability to respond to the brain atrophy that is often caused by long-standing depression. I hardly ever see it used. Of nearly a million people treated for depression in a 2014 study, only 1/4 of 1% were treated with ECT. Still, I’ve seen remarkable success with this treatment, which works much faster than medication. Meanwhile, insulin shock therapy was first tried in the 1930s, but was discredited and abandoned in the 1960s.

Transcranial magnetic stimulation (TMS) is a new treatment that has been shown to be relatively safe. The main serious side effect is seizures, although these are rare. It can also cause headaches and temporary hearing loss.

Unfortunately, I can’t tell you exactly how TMS works either. The strong magnetic field of the TMS machine (much like an MRI machine) is rapidly alternated, generating electrical currents in the brain, both on the surface of the brain and deep in the brain in some cases. TMS is in some ways similar to ECT.

TMS and ECT are appropriate to consider when medications are ineffective or cannot be used and when psychotherapy (the other mainstay of depression treatment) cannot be accessed. Unfortunately, this is a common problem.

Dear Dr. ROACH: I read your recent column about medications for gastroesophageal reflux disease (GERD) in people with Barrett’s. What about surgical procedures such as Nissen fundoplication or the LINX procedure? I want to end my GERD symptoms and stop taking daily medication. — DC

ANSWER: Although surgery has played a role in the treatment of GERD, surgical treatments in people with Barrett’s esophagus are controversial, and the manufacturer of the LINX devices recommends against the device in people with Barrett’s.

People with GERD who have not been effectively treated with medications, or those with persistent symptoms who do not want a lifetime of medications, may be considered for surgical therapy. The LINX procedure uses a ring of magnets to keep the sphincter in the lower part of the esophagus closed most of the time, but opens when food is swallowed.

One problem with Nissen fundoplication is that many people can no longer burp or vomit after the procedure, which causes swelling. This gives an advantage to the LINX procedure, where capacity is usually preserved. The choice of procedure is always made after careful discussion with a surgeon, including the possibility that medications may still be needed.

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