Illustration by Sam Island
Dr. Oludamilola Salami has a map of the brain. And he knows how to use it.
To treat depression, he heads over to the dorsolateral prefrontal cortex (on the left front of the brain), which modulates mood, behavior and higher cognitive functions (like planning, organization and multitasking). Once he gets there, he uses magnetic fields to stimulate brain activity by way of a hand-held electromagnetic coil. “It is similar to a magnet used in an MRI but of less strength, and the magnetic field is focused to a specific part of the brain, unlike an MRI, which is generalized,” says Salami, an assistant professor in the Medical College of Wisconsin’s department of psychiatry and behavioral medicine. He’s also a practitioner at Froedtert Hospital.
Salami started using this treatment – called repetitive transcranial magnetic stimulation (rTMS) – to treat depression in fall 2011. So far, only three patients have completed the therapy, which consists of 30-minute treatments five days a week. “The first two individuals experienced almost complete remission,” he says. The third patient did not go into complete remission, and no significant change was observed. Where the magnetic stimulation occurs makes all the difference: It’s a much more targeted approach than antidepressants.
Although antidepressants became popular in the 1970s and ushered out the era of shock therapy, they aren’t without their own side effects. Transcranial magnetic stimulation is different. There is no anesthesia or needles. Nor is there electricity – meaning no shock therapy or electroconvulsive therapy. And because it’s targeted directly at the brain, the side effects are minimal but can include short-term headaches or tenderness of the scalp. The treatment was cleared by the FDA at the end of 2008 and was recommended by the American Psychiatric Association in 2010.
Salami says Froedtert is one of only two Wisconsin health care providers using rTMS to treat depression (with the other being ThedaCare in the Fox Valley). The Froedtert treatment was developed by Salami and Dr. Christopher R. Butson, an associate professor of neurology and neurosurgery at the Medical College of Wisconsin, who created a 3-D model of the brain. “This model is an example of the insight we’re now able to get,” Butson says. “We know for certain that the outcomes are chemically dependent on where triggers are delivered.”
After initial screenings to weed out other conditions such as bipolar or personality disorders – which could inhibit the treatment’s success – patients slide into a comfortable armchair, much like a visit to the dentist or barber, in a small, windowless room tucked into the hospital’s outpatient neurology clinic. “It’s attractive because it’s noninvasive and outpatient,” says Salami, who began researching cognitive disorders while completing a fellowship at Johns Hopkins University School of Medicine.
“Usually, after the first three or four sessions, they do notice improvement,” Salami says of the patients. Among their reported areas of relief: better sleep, a higher level of concentration and a noticeable increase in energy.
Salami says the total cost for treatment is $7,000-$9,000, and insurance coverage varies widely – though some Medicare programs funded by individual states now cover it. “Down the road, it will probably be funded like medication,” he says. “Adherence is a big problem with medication, and you eliminate that possibility with rTMS.”