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A depression treatment like rebooting the brain

Allentown doctor uses device to zap patients' mood center. It's an option if drugs fail.

Technician Alisson Stauffer prepares Rick Mosher for transcranial magnetic stimulation at the TMS Center of the Lehigh Valley in Allentown, Dr. Paul Gross oversees this new method to treat depression. (Harry Fisher, THE MORNING CALL / September 3, 2011)

By Tim Darragh, Of The Morning Call

9:51 p.m. EDT, September 3, 2011

The dark cloud wouldn't leave Rick Mosher.

The 50-year-old East Stroudsburg man struggled with depression for years. One drug after another failed to lift his mood or his low energy level. He gained weight, which fed into his depression. He lost his job at Abilities of Northwest Jersey, a vocational training program for the disabled.

But as he sat last week in a chair in the Allentown office of Dr. Paul Gross, Mosher looked nothing like the person he had described. Buoyant and clear-eyed, Mosher said he felt like a new man.

The change, he said, was thanks to Gross and the contraption that was pointed at the left side of Mosher's head. The machine, which looks something like an X-ray machine in a dentist's office, is a transcranial magnetic stimulator.

Mosher just calls it a "godsend."

Transcranial magnetic stimulation is a process in which a highly concentrated magnetic pulse is directed toward the prefrontal cortex, the part of the brain thought to regulate mood. It's a last resort for depressed people who have tried and failed to treat their disorder with medications.

During the treatment, the patient remains awake as a periodic burst of energy, like that from a magnetic resonance imaging machine, fires toward the head. According to Mosher, the pulses felt like a painless tapping on his scalp. A patient will receive treatment five days a week for four to six weeks, Gross said, with each session lasting less than 40 minutes.

According to the manufacturer of the NeuroStar TMS Therapy system, Neuronetics of Malvern, Chester County, the magnetic pulses cause neurons in the brain to fire, stimulating what scientists believe is the mood center of the brain.

"I think it works like rebooting a computer," Gross said.

The result, Mosher said, is like the difference between night and day. He said he is mentally sharper and more focused, and able to function better with his wife and four children. He even was able to resume playing the guitar with his church worship group. "I felt sharp," he said. "It actually caught me by surprise."

The therapy, Mosher said, "effectively gives you back your life."

Gross, an Allentown psychiatrist who has the only transcranial magnetic stimulation service in the Lehigh Valley, started using the technology in January. The U.S. Food and Drug Administration approved the procedure in 2008 for treatment of depression for adult patients for whom traditional therapies had failed.

Gross said his record for patient improvement with the product is better than the two-thirds success rate NeuroStar claims. The American Psychiatric Association hasn't touted the therapy as a breakthrough success, saying in a practice guideline that results of the therapy in four limited studies were "inconsistent." Researchers at Rush University Medical Center in Chicago last year found that the procedure appears to have "durable" results, however.

At $300 per session, the stimulation therapy will cost patients $6,000 to $9,000. In many cases, Gross acknowledged, insurance companies deny coverage for the treatment, saying they are "skeptical" about a therapy that is relatively new on the market. "I feel it's only a matter of time" before patients get coverage, he said. Gross also said his office staff works with patients through the lengthy process of appealing denials of coverage.

Neuronetics is planning a second generation of the NeuroStar, said President and CEO Bruce Shook. The company is working on getting FDA approval for other uses, including tinnitus (ringing in the ears), depression during pregnancy and chronic pain, Shook said. Neuronetics has sold about 350 of the units throughout the United States, he said.

Meantime, Mosher last week said he will be on a low-dose antidepressant, but believes it will be nothing like his prior medications. "I'm fine with that very low dose," he said. "That's very liberating… I know what it's like to struggle on medications and not receive any benefit."

Mosher also said he is not the only one who needs to adjust to his reinvigorated life. "This morning," he said, "my wife told me she is going to have to get used to a whole new me."

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