About 350 million people suffer from depression, the leading cause of disability, according to the World Health Organization.
Story: Leigh Neely Photo: Fred Lopez
Grief and sadness are normal human emotions you will experience at some point in your life. However, if you find yourself feeling an overwhelming sadness to the point of losing interest in your favorite activities, noticing a lack of concentration and focus, or even experiencing physical symptoms like aches and pains in joints and muscles, you may be suffering from depression.
Fortunately, a variety of pharmaceutical medications can treat depression. However, for those who suffer long-term issues or those who have excessive side effects from medication, there finally is another solution: transcranial magnetic stimulation (TMS). It’s a new medical technology available in Lake and Sumter counties only from Dr. Pritha R. Dhungana, who has an office in Lady Lake. She also is a psychiatrist with Serenity Health Center, with offices in Clermont, Leesburg, and Windemere treating children, adolescents, and adults.
“I practice what is called neuropsychiatry, which involves much more,” she says.
By definition, neuropsychiatry treats mental disorders that come from the nervous system. It combines the disciplines of psychiatry and neurology.
“The mental, the brain health, is the most important, though most medicine focuses on the other organs—the heart, the liver—and not on the organ that controls all of them,” Dr. Dhungana says. “Now we work on the biological part, which is the body; the psychological part; and the social.”
The doctor uses diabetes as an example. “You have a physical condition—the nutrition, hydration, weight, stress—which makes the condition worse and causes depression, which also makes the condition worse,” she says. “It’s the same in psychiatry. I have so many patients who suffer from depression, but after using three or four medications, they find it no longer works.”
According to Mental Health America, in 2018, one in five adults have a mental health condition.
However, as many as 56 percent of adults with mental health issues do not receive treatment. Add to that the shortage of mental health professionals, and it makes the problem much worse.
Among the many mental health issues is post-traumatic stress syndrome, common among veterans, first responders, and trauma victims. It can be debilitating, and Dr. Dhungana believes TMS can offer help for this that medication cannot.
“TMS is a breakthrough, and it was approved by the FDA (Food and Drug Administration) in 2008 for recurrent depression disorder and recurrent depression,” she says. “At Duke University, when they did a PET scan, they realized they could recognize a depressed brain. There is very little activity in a depressed brain. When they started doing the TMS treatment, the activity increased.”
“With treatment, it’s like night and day for me. I told the doctor I was afraid I was dreaming and would wake up and be back the way I was.”
— Cheryl Monaco
This noninvasive procedure uses magnetic fields to stimulate nerve cells in the brain, which improves symptoms of depression. An electromagnetic pulse is painlessly delivered to the part of the brain that controls moods and depression, sometimes activating parts of the brain that had decreased activity due to the depression.
It is nothing like electroconvulsive therapy (ECT), which is generally used for the most severely depressed or suicidal patients.
This caused researchers to rethink their treatments, and now, Dr. Dhungana says, TMS has become the norm for treatment of depression. “It is 100 percent safe, and the fastest, most effective treatment so far,” she says.
By the time Dr. Dhungana sees most patients, they are totally frustrated. They’ve been to multiple doctors, tried multiple medications, therapy, and still have no relief. “Even though they’re trying their best and trying to use coping skills, they’re not feeling any better,” she says.
“There are no lifestyle changes, no down time (with TMS). All we ask is that the patient do it every day to increase effectiveness,” she says. “TMS has improved to the point where it used to take more than 45 minutes for treatments, but now it is reduced to about 18 minutes.”
After a designated period of time, treatments are tapered until they end.
Thirty-three studies were reviewed and provided scientific evidence that there is strong benefit of using TMS to treat post-traumatic stress, an article from the National Institutes of Health states.
“In my practice, almost 75 percent of the people who received treatment have gone into remission and 80 percent have a reduction of symptoms, and we have graphs to show that,” Dr. Dhungana says. “The way we track it is by the patient’s self-report. The human being is the best judge of how they are feeling.”
The doctor says her patients are improving to the point where they’re getting off opioids for pain, their lifestyles are improving, and she has seen a variety of other changes in a large number of patients.
“Most of them found us by Googling ‘What’s best for depression?’” she says. “They come to us on their own, not by referral.”
The treatment is done in a chair, and the important part is patients are relaxed. They can watch television and go back to work or other duties when treatment is complete.
Though TMS is not recommended for those under 18, approval for adolescents is very close, the doctor says. Another positive note is that insurance and Medicare cover treatments now.
The doctor takes the patient’s history and determines if they qualify for the treatment. “The first treatment is the mapping session to determine what’s needed, and the information is fed into the computer to ascertain what the patient currently needs,” she says.
Dr. Dhungana does the first treatment and after that, it is done by a certified TMS treater, overseen by the doctor. After treatment ends, if the patient feels a relapse, Medicare will pay for maintenance.
“They may need one or two boosters, but it’s less and less,” Dr. Dhungana says. “With ECT, there was memory loss. With TMS, the patients find their memory becomes sharper. So now they’re looking at Parkinson’s, cognitive enhancement, and even migraine headaches (for treatment with TMS).”
Cheryl Monaco was diagnosed with chronic fatigue syndrome in 1998 at the age of 68. “I was wrecked with illness and terrible depression,” Cheryl says. “I didn’t want to get out of bed, didn’t want to live.”
When Cheryl heard about Dr. Dhungana and TMS, she was eager to see if it would help. The results were stunning. She feels physically and mentally healthier than she has in years.
“With treatment, it’s like night and day for me. I told the doctor I was afraid I was dreaming and would wake up and be back the way I was,” Cheryl says. “It’s life-changing, extraordinary. If I hadn’t experienced it myself, I wouldn’t have believed it. God has really smiled on me.”
“The brain is the only organ that continues to grow throughout your life. That’s neuroplasticity, which is the brain’s way of forming new neural connections throughout your life,” Dr. Dhungana says. “That why we do all this cognitive therapy. That’s why the brain needs continuous stimulation, and patients doing their part with nutrition and psychological therapy. That’s why it’s so important to keep the brain healthy.”