By Dr. David Woo - November 13, 2023

Depression is a widespread and debilitating mental health condition affecting millions worldwide. It can lead to a range of symptoms, including persistent sadness, loss of interest in previously enjoyable activities, changes in appetite and sleep patterns, and even thoughts of self-harm or suicide. The conventional treatment options for depression, such as antidepressant medications and psychotherapy, may not always work for everyone—about 30% of patients using antidepressants fail to achieve long-lasting relief from their symptoms, and some report feeling worse after antidepressants (1). This has led researchers to seek more effective solutions by exploring alternative therapies, including transcranial magnetic stimulation (TMS) and psychedelics for depression.

What Are Psychedelics For Depression?

Psychedelics are a class of substances that alter perception, mood, and consciousness. They include substances like psilocybin (found in magic mushrooms), lysergic acid diethylamide (LSD), and dimethyltryptamine (DMT), known as “classical” psychedelics, as well as ketamine. Psychedelics have a long history of use in various cultures for spiritual and therapeutic purposes and have been shown to have effects on neuroplasticity—the brain’s ability to form new connections (2). Recent scientific studies have reignited interest in their potential for treating mental health disorders, including depression (3).

Research Findings On Psychedelics For Depression:

Several recent clinical trials have investigated the use of psychedelics in the treatment of depression. One notable study published in JAMA Psychiatry in 2020 found that a single dose of psilocybin, in conjunction with psychotherapy, produced significant reductions in depressive symptoms in patients with major depressive disorder (4). The results were sustained for up to four weeks after treatment. These findings have sparked optimism about the potential of psychedelics as a breakthrough therapy for treatment-resistant depression.

Introduction To TMS

Transcranial Magnetic Stimulation (TMS) is a non-invasive treatment method that uses helmet-like device containing electromagnetic coils that deliver tiny magnetic pulses to stimulate targeted brain regions. It is FDA-approved for the treatment of depression and is considered a safer alternative to invasive treatments like electroconvulsive therapy (ECT). TMS is typically administered over a series of sessions, potentially with top-up sessions if symptoms persist after the initial course is finished.

Research Findings On TMS For Depression:

Transcranial Magnetic Stimulation has also shown promise as a treatment for depression. Multiple studies have demonstrated the effectiveness of TMS in reducing depressive symptoms, particularly in individuals who have not responded to traditional antidepressant medications. TMS is believed to work by stimulating neural circuits associated with mood regulation, promoting the release of neurotransmitters like serotonin and dopamine. The cumulative evidence suggests that TMS can be a valuable option for individuals seeking alternatives to conventional depression treatments and provide long-lasting relief from depression symptoms (5).

Combined Therapy: Psychedelics And TMS

As researchers explore novel approaches to treating depression, some have begun to investigate the possibility of combining TMS therapy and psychedelics for depression. This combined approach aims to harness the benefits of both modalities: the rapid, profound experiences induced by psychedelics and the neuromodulatory effects of TMS. Preliminary studies are ongoing, but the idea is that the psychedelic experience could enhance the effectiveness of TMS by priming the brain for positive changes. A recent study on combined therapy using TMS and ketamine noted that the therapy was effective in reducing symptoms over the long term (2 years) and allowed for a higher level of TMS intensity in patients (6).

Risks And Side Effects

While both psychedelics and TMS hold promise in the treatment of depression, they are not without risks and side effects. Psychedelics can lead to unpredictable, intense experiences that may be psychologically challenging for some individuals, potentially causing anxiety or exacerbating existing mental health conditions. TMS is generally considered safe, with mild side effects such as headaches and scalp discomfort being the most common complaints. 

Getting Treatment For Depression

The use of psychedelics for depression represents an intriguing avenue of research in the field of mental health. However, it’s important to emphasize that psychedelics for depression are still in the early stages of exploration, and further research is needed to fully understand their long-term safety and efficacy. TMS, on the other hand, is more established and has been approved by the FDA for treatment-resistant depression, obsessive-compulsive disorder (OCD), and other mental health conditions.

Additionally, the decision to pursue either psychedelic therapy or TMS should be made in consultation with a qualified healthcare provider, taking into consideration an individual’s unique needs and circumstances. 

Madison Avenue TMS & Psychiatry offers psychotherapy and TMS therapy for depression and other mood disorders. For more information or to schedule an appointment, contact us online or call (212) 731-2033.

Resources:

1. Ionescu DF, Rosenbaum JF, Alpert JE. Pharmacological approaches to the challenge of treatment-resistant depression. Dialogues Clin Neurosci. 2015;17(2):111-126. Link. Accessed October 16, 2023.
2. Aleksandrova, L., Phillips, A. Neuroplasticity as a convergent mechanism of ketamine and classical psychedelics. Trends in Pharmacological Sciences. 2021;42,11,929-942. Link. Accessed October 16, 2023.
3. Muttoni, S., Ardissino, M., & John, C. Classical psychedelics for the treatment of depression and anxiety: A systematic review. Journal of Affective Disorders. 2019;258, 11-24. Link. Accessed October 16, 2023.
4. Davis  AK, Barrett  FS, May  DG,  et al.  Effects of psilocybin-assisted therapy on major depressive disorder: a randomized clinical trial. JAMA Psychiatry. 2020. Link. Accessed October 16, 2023.
5. Dunner DL, Aaronson ST, Sackeim HA, et al. A multisite, naturalistic, observational study of transcranial magnetic stimulation for patients with pharmacoresistant major depressive disorder: durability of benefit over a 1-year follow-up period. J Clin Psychiatry. 2014;75(12):1394-1401. Link. Accessed October 16, 2023.
6. Best, SRD., Pavel, DG., Haustrup, N. Combination therapy with transcranial magnetic stimulation and ketamine for treatment-resistant depression: A long-term retrospective review of clinical use. Heliyon. 2019;5(8). Link. Accessed October 16, 2023.

Dr. David Woo

Dr. Woo has been seeing patients in private practice since 2002, always with the goals of combining evidence-based medicine with psychodynamic psychotherapy and collaborating with other mental health professionals to ensure the best possible outcomes for his patients. He has been certified to administer TMS at his practice since 2017. His greatest clinical interests include helping patients suffering from depression, anxiety, and obsessive compulsive disorder.