Dr Terry Boyadjis speaks: Depression Update: TMS

A version of this article will appear in our next Compass magazine.

We met in the many windowed Classroom of the Willow Grove Giant Supermarket.

Our guest speaker Terrence Boyadjis, MD, drove in from West Chester PA with his wife Lorraine to give a New Directions' presentation on Hope for Hard-to-Treat Depression: TMS new leading technology.

Come in, come in. Have a seat, ladies, plenty of room.

We had nearly 20 people and filled the room. There was a lively give n take between Dr Boyadjis (his dad hails from Cyprus) and the group. He and his wife have two grown daughters - cost-analysts who live in DC. Dyou spose they went to the Jon Stewart Comedy Central Rally today in the National Mall?

If they ever get depressed, he said, he would not hesitate to give them what he believes is the best non-drug treatment for depression: TMS - transcranial magnetic stimulation.

Drugs, he noted, have notoriously unpleasant side effects such as drowsiness, weight gain, oh you know them all already.

Before he became a psychiatrist, Boyadjis was a radiologist, which he hated, and decided to switch to psychiatry. "I love psychiatry," he said, noting that the long road getting there made his choice all the more meaningful.

Hmmm, perhaps we can say that about many of his patients and their long road toward recovery.

Clearly a knowledgable psychopharmacologist - or medicine prescriber - who might add a little-used tricylic or even the often-overlooked Emsam patch to jiggle the sluggish chemical and electric pathways of the brain - Boyadjis was fascinated when TMS was approved by the FDA in 2008.

The machine evolved from the MRI and has been around in England since 1985, a descendant of Michael Faraday's studies of electric current. Fascinated with the concept of powerful non-invasive help for depression, he jumped wholeheartedly to champion it with his patients in September 2009.

He ordered the NeuroStar machine for his office, a machine he prefers for its safety and ease of operation, made nearby in Malvern, PA by Medtronics. Other companies worldwide make similar devices.

Don't panic! This picture of the brain below is from one of his brochures but does show graphically the way the machine 'pings' its ways into the brain.



His success with his patients is nothing short of amazing considering these are patients for whom often nothing has worked to "bring them back." But how does it work? Or why? "There's no clear consensus on how the treatment works. The brain is vast and mysterious."

Treatment lasts a full 30 days. Anything less doesn't give the brain the full benefit of this powerful treatment modality. The patient comes in every day, Monday through Friday, sits in a comfortable chair, not unlike a the dentist, and the doctor places the treatment coil atop the scalp.

A jolt of electricity is inserted into selected areas of the brain. If, for example, you suffer from anxiety, he will set the machine to direct electricity into the right side; for depression, on the left. For both depression and anxiety, both sides will be tapped.

Electrical bursts are seven seconds long. A series of about 30 bursts are given for a total of a 37-minute treatment session. Not bad once you adapt to the rather noisy bursts. No one drops out. Side effects are minimal. No memory loss, no seizures, no cognitive distortion. The only side effect is the discomfort of the "taps" during the treatment, which lessen with habituation. The patient drives himself home. Improvement can be seen immediately or more likely during the course of the 30 days. All his patients have found success.

Boyadjis himself tried it. But only for about four seconds. Very unpleasant, he says. It felt like an ice pick on his scalp. But it's worth it to the nearly 20 patients, ages 21 to 70, he's treated so far who have gotten their lives back including a heart surgeon so depressed he hadn't worked for four years.

Although the surgeon has been restored to health, he faces other problems that the 14 million other depressed Americans face: the breakup of his family. Tired of waiting for him to get better, his wife is filing for divorce.

Such is the difficulty of depression, whose name belies a chronic whole-body illness that makes an individual more vulnerable to other diseases that come along in addition to the crippling inertia that keeps a person from going about their daily tasks and enjoying life.

It's imperative, says Boyadjis, that the illness be treated immediately. To wait is to face certain worsening of this true ruination of human lives, far harder to wrest from its grip.

Of much promise, he notes, is the use of TMS on pregnant women. No drugs to pass into the growing fetus.

The one severe drawback is the cost of the procedure and the reluctance of insurance companies to pay. "They are dragging their feet," says Boyadjis, "but the day is coming closer when they'll pay up."

Meantime he has a payment agreement with NeuroStar to help finance the costly payments that run $250 to $300 per session.

Boyadjis is currently treating three to four patients in his West Chester office and looks forward to adding a new patient after his release from a psychiatric facility. His office is one of 70 private offices in the country to offer the service. Nationwide there are 250 institutions where it's done including top hospitals such as Johns Hopkins, Mayo Clinic, and Mass General.

Are you a candidate? Probably except if you have an electronic device such as pacemaker, defibrillator, or vagal nerve stimulator.

Boyadjis has no doubt that this "neuromodulation device" is where the field of psychiatry is headed. First there was ECT - electroshock therapy - which, while effective, requires anesthesia and inducing of brain seizures. Some memory loss and cognition impairment are famously frequent.

Vagal nerve stimuation - VNS - arrived next but Boyadjis was unhappy about the need to surgically install the implants to deliver a pulse of electricity to the vagus nerve. Interest has waned and its manufacturers are losing money.

Magnetic seizure therapy has a low-response rate and DBS - deep brain surgery - is serious inpatient brain surgery, still in experimental stages.


Quick conference to get the audio-visuals a'working.

Thrilled by its possible uses, Boyadjis has used it on a young schizophrenic man to quell his alarming voices. Together, they tracked the voices before and after treatment. From 30 times a day, the voices had quieted to only 5 times, a manageable amount, simply by placing the coil at a low-pulse dose in the back of the brain.

Trial and error, patient and doctor, working together to get the brain balance right. Although none of his patients have come in for a "touch-up," if necessary that is what he'll do. He's a true believer.


Afterward, a dozen of us met in the Giant Coffeeshop. Fontaine ordered a delicious cocoa.

Ruth, feeling grateful after a great program and a pad full of notes.

Linda has a Halloween party tonite.

Dennis made the food pronouncement of the day: In the morning, eat like a king; at lunch, like a king and queen, and at dinner, like a pauper.


Ruthie pulled out her cellphone and flashed its jewel-like interior. "I've gotta keep it on all the time," she said. "Guess why?"

"I'm on the active list for a kidney transplant! I could be called at any time."

Drugs, they did her in. Lithium. If only, if only.