Dear Dr. Roach: TMS stands for transcranial magnetic stimulation and is done for four to five weeks daily and takes about 30 to 40 minutes per treatment in the doctor鈥檚 office, with the doctor overseeing it and a trained technician doing the treatment.
Do you know how successful this newest non-invasive treatment for depression is (for those who cannot tolerate antidepressant side effects, or for whom these medications just don鈥檛 work)?
Is it, to your knowledge, successful, and advised for older people too?
It鈥檚 been successful for some, according to the research I鈥檝e done, but I wanted to get your input.
TMS is being recognized in some areas and gradually being covered by some insurance plans.
I just wondered if you have had any patients who have had the treatment and if you feel it is a viable alternative treatment for the above mentionedhealth issues.
J.S.C.
I had not heard of this treatment before your letter, and was surprised to find that there is good evidence to support its use.
It is more effective than placebo treatment, but only about 25 per cent of people 鈥� all of whom had poor response to at least one medication 鈥� had a good response to treatment.
The major side effect in treatment is seizures, but only in less than one per cent of cases.
Due to differences in brain structure, the elderly may require a higher intensity of magnetic stimulation.
This treatment appears to be a useful alternative therapy.
However, other antidepressant medications, electroconvulsive therapy and especially non-pharmacologic treatments, such as cognitive behavioural techniques, may be effective in a larger number of people than TMS.
听
Dear Dr. Roach: I am 76 and have been diagnosed with a condition called Wenckebach phenomena, an irregular heartbeat.
For most of my life, I have exercised frequently and have been in excellent health.
I have run 22 marathons. My heart rate is in the low 60s, and I take no beta blockers. The condition is asymptomatic and does not seem to affect my exercise. After consultation with my cardiologist, he determined that I do not need a pacemaker. What is my prognosis for the future?
J.S.
Wenckebach is a heart-rhythm disturbance, called a heart block. There are three degrees of heart block. First-degree block is the mildest and rarely needs treatment, although it may (occasionally) predict more serious heart problems. Second-degree block comes in two varieties: Type I (Wenckebach), which you have, and Type II, which usually requires a pacemaker since it often proceeds to Type III, complete heart block, which requires a pacemaker immediately.
Heart block sounds scary, but Wenckebach usually has a good prognosis. For someone like you, a trained athlete with a slow heart rate, Wenckebach is common (about 10 per cent of trained athletes).
Since you have no symptoms, I agree with your cardiologist completely and can reassure you that the chance of developing worse heart block is low.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
