Using magnetic fields for stimulating the nerve cells in brain can lead to the improvement in symptoms of depression. This procedure is called as Transcranial magnetic stimulation.

Transcranial magnetic stimulation is a relatively new procedure that is recommended in patients who do not respond to other standard treatments such as medications and psychotherapy.

Although the exact role played by transcranial magnetic stimulation in relieving depression is not clear, the magnetic pulses stimulate the nerve cells in brain and thereby improve the depression symptoms in patients.

Preparation for Transcranial Magnetic Stimulation

Transcranial magnetic stimulation is performed as an outpatient procedure in doctor’s office. There is no elaborative preparation needed as it is non-invasive procedure that doesn’t require anaesthesia.

  • Your psychiatrist will perform complete physical examination before surgery to ensure that it is a safe for you.
  • You may be asked to conduct blood tests or other laboratory tests to ascertain that you are medically fit for the procedure
  • You should inform your doctor regarding any medications you are taking as you may be asked to stop or adjust the doses of certain medications before the surgery
  • You should inform your doctor if you are pregnant or planning to get pregnant.
  • You should inform your doctor if there are any implanted metallic devices in your body because Transcranial magnetic stimulation is not recommended in such cases.
  • You should also inform the doctor of any previous surgeries or associated health conditions.

Duration of Transcranial magnetic stimulation

Patient needs a series of treatment sessions for optimal results. The procedure is usually performed daily at least five times a week for 5 to 6 weeks.

Transcranial magnetic stimulation procedure

Before the procedure, the psychiatrist identifies the most suitable region for placing the magnets on your head. Moreover, psychiatrist also decides about the optimal dose of magnetic energy for the treatment.

  • You may be asked to sit comfortably in a reclining chair and wear earplugs during the treatment.
  • Psychiatrist places an electromagnetic coil against your head. He/she switches the electromagnetic coil off and on repeatedly couple of times for producing stimulating pulses.  It causes a tapping sound that lasts only for few seconds followed by pause.
  • Doctor will determine the appropriate dosage of magnetic energy required and increases the magnetic dose until your fingers or hands begin to twitch.
  • Depending on your symptoms and side effects, the amount of stimulation is changed during the procedure.
  • After the placement and dose of electromagnetic coil are determined, your treatment begins and it lasts for about 40 minutes.

Risks of Transcranial magnetic stimulation

The Transcranial magnetic stimulation is a relatively safe procedure and causes mild side effects.

Most of these side effects are short term in nature and usually improve after the first week or two of treatment.

Common Side Effects

  • Headache
  • Lightheadedness
  • Spasms or twitching of facial muscles
  • Scalp discomfort at the site of stimulation
  • Tingling

Complications

In some rare cases, the procedure may lead to certain serious side effects.

  • Seizures
  • Mania in patients with bipolar disorder
  • Hearing loss due to inadequate ear protection

Results of Transcranial magnetic stimulation

  • In majority of the cases, depression symptoms will improve or diminish completely.
  • The optimal results are obtained after several weeks of treatment
  • Patient should continue to take antidepressant medication or attend psychotherapy sessions even after transcranial magnetic stimulation.
  • The effectiveness of transcranial magnetic stimulation may improve once the optimal sites for stimulation and numbers of stimulations needed are identified.

Brain Stimulation methods have been used successfully as effective treatment options for improving symptoms of chronic depression. They are usually recommended in patients who do not respond to other treatments.

A Vagus Nerve Stimulation is newly designed brain stimulation procedure where electrical impulses are sent into the patient’s brain for treating depression symptoms.

What is vagus nerve?

On each side of our body, a vagus nerve runs from brain through neck and chest to abdomen.

Indications for Vagus nerve stimulation

It is indicated as an added treatment for improving the symptoms of depression in patients who do not respond to following standard treatments.

  • Antidepressant medications
  • Psychological counselling (psychotherapy)
  • Electroconvulsive therapy (ECT)

Eligibility of vagus nerve stimulation

As per FDA guidelines, vagus nerve stimulation is performed in patients who satisfy below mentioned criteria.

  • Adults (age 18 or older)
  • Patients who have chronic and treatment-resistant depression
  • Patients who have not responded to antidepressant medications or electroconvulsive therapy (ECT)

Preparation for Vagus nerve stimulation

  • Your psychiatrist will perform complete physical examination before surgery.
  • You may be asked to conduct blood tests or other laboratory tests to ascertain that patient is medically fit for the procedure
  • Your doctor will prescribe antibiotics for preventing infection prior to the surgery
  • You should inform your doctor regarding any medications you are taking as you may be asked to stop or adjust the doses of certain medications before the surgery

Vagus Nerve Stimulation Procedure

During the vagus nerve stimulation, surgeon implants a device known as pulse generator in the chest of patient.  This pulse generator is connected to the left vagus nerve in patient’s neck through a wire threaded under the patient’s skin.

Doctors can monitor the activity of pulse generator and stimulates it to send out various electrical signals. These electrical signals are carried along the vagus nerve to the patient’s brain. It causes improvement in the symptoms of depression.

Risks of Vagus nerve stimulation

Although vagus nerve stimulation is a safe procedure, there are certain risks associated with surgery for implanting the device and during brain stimulation procedure.

Surgery risks

  • Pain at a point of incision
  • Infection
  • Heart problems
  • Incision scarring
  • Vocal cord paralysis
  • Breathing problems
  • Damage to the vagus nerve
  • Nausea

Side effects associated with vagus nerve stimulation

  • Chest pain
  • Cough
  • Throat pain
  • Voice changes
  • Breathing problems during exercise
  • Difficulty swallowing
  • Neck pain
  • Hoarseness
  • Prickling of the skin

Most of the side effects may improve over time, however certain side effects can be managed by adjusting the electrical impulses.

Other complications of vagus nerve stimulation

  • Pulse generator malfunction
  • Worsening of depression
  • Suicidal thoughts or behaviour

Results of Vagus nerve stimulation

  • In majority of the cases, depression symptoms will improve or diminish completely.
  • The optimal results are obtained after several months of treatment
  • Patient should continue to take antidepressant medication or attend psychotherapy sessions even after Vagus nerve stimulation.

You would be amazed to learn that doctors remove a very small piece of lung for examination by performing lung needle biopsy. A lung needle biopsy is performed in severe complicated cases associated with lung and its tissues.

Doctors perform the biopsy after detecting the abnormalities on chest x-ray or CT scan.

The lung biopsy performed through the chest wall, is known as transthoracic lung biopsy.

Indications for Lung needle biopsy

                    Abnormal condition surrounding the lungs

                    Infections inside the lungs

                    Severe infection on the chest wall

                    To rule out the presence of cancer

Preparation for Lung needle biopsy

Patient should follow the below mentioned guidelines before lung needle biopsy procedure.

                    Patient is asked to not eat 6 – 12 hours prior to the procedure.

                    Patient should avoid certain medications like aspirin, NSAIDs or blood thinners, etc; few weeks before the procedure. However one should discuss with doctor before changing or adjusting the doses of these medications.

                    Doctors usually perform a chest x-ray or chest CT scan before the procedure.

                    Patient is administered with mild sedative for relaxation prior to biopsy.

                    Patient is asked to sign a consent form before the procedure.

                    Patient is asked to avoid coughing and remain as still as possible during the biopsy.

Lung needle biopsy Procedure

                    The exact spot for the biopsy is determined by using a chest x-ray or chest CT scan.

                    Patient is made to sit with his/her arms resting forward on a table. Patient is asked to avoid any coughing and remain still during the biopsy.

                    The small patch of the skin scrubbed and patient is asked to hold his/her breath. Doctor injects the local pain-killing medicine for numbing the area.

                    Doctor makes a small cut of about 0.12 inches into the skin and inserts the biopsy needle into the lung tissue. It is followed by removing a small piece of tissue with the needle.

                    The removed lung tissue is sent to laboratory for further examination. After the procedure, the bleeding is stopped by exerting pressure on the site.

                    Once the bleeding is stopped, a bandage is applied on the operated region. Patient is sent for chest X- ray immediately after the biopsy.

                    The time duration for the entire procedure vary from 30 – 60 minutes. The sample obtained from lung needle biopsy is sent for Lab analysis which takes few days to get completed.

Lung needle biopsy Results

The results of the lung needle biopsy are obtained after the analysis of obtained lung tissues is completed.

Normal Results indicate the presence of normal tissues and absence of any bacteria, viruses, or fungi.

Abnormal Results indicate the presence of following infections.

                    Bacterial or viral infection

                    Fungal lung infection

                    Cancerous cells

                    Pneumonia

Lung needle biopsy Risks

                    Occurrence of collapsed lung called as pneumothorax

                    Higher risk in case of certain lung diseases like emphysema

                    Air leakage from the lung that gets trapped in the chest

                    Risk of excessive bleeding (haemorrhage)