Down With Depression: A Malvern Company Develops a New Treatment

It’s not a cure, but Neuronetics’ FDA-approved NeuroStar Transcranial Magnetic Stimulation therapy can keep those clouds of clinical depression at bay.

See also “Depression 101: Understanding the Symptoms and the Medications.”

John Rochester became a millionaire by investing in companies’ futures, which is somewhat ironic for a man who has often considered suicide. Major depressive disorder is the medical diagnosis of what’s commonly known as clinical depression. Rochester describes it as a dark, heavy cloud that hovers above him and has, at several points in his life, descended.

Rochester’s first depression besieged him when he was in his 20s and a student at the Wharton School at the University of Pennsylvania. “I became reclusive, and then it got to the point where I couldn’t get out of bed,” says Rochester, which is a pseudonym. “I became disheveled, and I completely disassociated from everyone. I knew that others were seeing me that way, and that I wouldn’t come across well in a job interview, and wouldn’t get hired. I didn’t see a future for myself. I thought that I was just … finished.”

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In time, his depression lifted, and he began a successful career in insurance and investing. It was also the beginning of a lifelong battle.

First-line depression treatments often involve medication and talk therapy. Many patients are successfully treated with the former. Others are severely hampered by the drugs’ side effects, which can include weight gain, sexual dysfunction, insomnia or fatigue. “Many patients do begin to feel better but can’t deal with the drugs’ side effects,” says Dr. Kevin Caputo, chairman of psychiatry at Crozer-Chester Medical Center. “So we change medications to try to relieve them.”

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Now there’s another option. Developed by the Malvern-based company, Neuronetics, NeuroStar Transcranial Magnetic Stimulation therapy received FDA approval in 2008. It uses a patented coil to deliver electromagnetic pulses to the left prefrontal cortex of the brain, the area that medical research has shown modulates mood.

Dr. Mark Demitrack, chief medical officer of Neuronetics, explains further. “The electrical currents activate the brain’s cells—called neurotransmitters—that have gone dormant in depressed patients. Those neurotransmitters release dopamine, serotonin and other biochemicals that regulate mood and provide relief from depression.”

It’s not a cure, he stresses. “But it does treat the symptoms of depression and provide relief from them.”

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NeuroStar isn’t yet covered by insurance, but Rochester would’ve paid almost any price to find relief. He was introduced to NeuroStar by Dr. Christina Herring, a psychotherapist who studied with Anna Freud and has been in private practice in Bryn Mawr for more than 20 years. Herring was one of the first in the country to have NeuroStar, making Rochester one of its first patients. “I was in a depression at the time,” Rochester says. “I tend not to remember how bad they are, so I really can’t describe it.”

Herring remembers: “I feared for his life, as I have in the past.”

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According to the National Alliance of Mental Illness, 15 million Americans battle depression. “It’s accompanied by symptoms that can include a loss of appetite, insomnia, a loss of energy, difficulty concentrating and difficulty enjoying life,” says Dr. Stephen Mechanick, chairman of Main Line Health’s psychiatry department. “They’re only the outward signs of what is real psychic pain. It can be crushing, omnipresent and debilitating. At the minimum, depression can cause people to lose their jobs and have strained marriages and friendships. At the maximum, depression can lead to suicide.”

For treatment-resistant depression, options include electroconvulsive therapy (aka shock therapy) or a surgical procedure called vagus nerve stimulation. “Both are considered effective,” Mechanick says. “But they have many risks and side effects—so much so that patients are wary to try them.”

NeuroStar treatments are performed in sessions that last about 40 minutes. Patients sit in what looks like a cushioned dentist’s chair—wide awake during the procedure. No anesthesia is required.

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Bruce Shook, president and CEO of Neuronetics, says there are 330 NeuroStar systems in the market, including one at Bryn Mawr Hospital. Each NeuroStar costs $70,000, and psychiatrists charge an average of $400 for each of the 15-20 treatments required.

For Shook, NeuroStar isn’t just about neuroscience, medical products and profitability. He has a personal connection to depression. Members of his family have suffered from it, and some have been successfully treated with NeuroStar.

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“It’s a terrible disease,” says Shook. “It’s painful in every sense of the word—and it’s a pain that’s every bit as physical and biological as any disease. The solutions, for many years, were imperfect, and not being able to help people close to me was gut-wrenching.”

Rochester had 20 NeuroStar sessions, during which time he continued with medication and talk therapy. The result? Rochester’s depression went into remission. He’s even felt well enough to stop his talk therapy sessions with Herring.

“Now, I want to say that my depressions have, in the past, lifted on their own,” he says. “And there’s no way for me to know if that happened, or if NeuroStar ended it, or perhaps NeuroStar ended it earlier than it would have otherwise.”

For Rochester, it doesn’t matter. “NeuroStar helped in some measure, and it gives me another tool to use against depression,” he says.

“NeuroStar is not magic,” Herring says. “But I have seen that it works.”

Herring has used NeuroStar on about 20 of her patients. All but one saw relief.

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Some doctors are using NeuroStar “off-label” to treat other diseases that involve the brain’s neurotransmitters, like fibromyalgia, tinnitus, Parkinson’s disease and the intractable auditory hallucinations that are part of schizophrenia. NeuroStar is not yet approved for use on patients with any of those illnesses, but one expert explains why it might be effective.

“Parkinson’s is a disease of specific neurotransmitters that affect the release of dopamine, which controls movement,” says Neuronetics’ Demitrack. “If TMS can control the release of dopamine, it might help patients control their movements and alleviate shaking and tremors.”

Research into those areas is being conducted by NeuroStar, medical centers and universities, along with the federal government. Should NeuroStar receive FDA approval for treatment of other diseases, it’s poised to expand. Shook says the company has already raised $128 million from private sources and venture-capital firms.

Rochester hasn’t yet invested in Neuronetics, but he very well may.

“I say this as a man who’s lived with depression for over 40 years: There is hope,” he says.

» Depression 101: Understanding the Symptoms and the Medications
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