Can Magnets Really Help Depression? TMS Therapy Results

TMS Therapy and Depression Treatment

TMS and Depression Treatment

If you are suffering from major depression, you know that every day can seem difficult and hopeless. And you are not alone. The Latest Statistics on Major Depression from the National Institute of Mental Health(NIMH) in 2016 show that:

  • In the United States, an estimated 16.2 million adults in the United States had at least one major depressive episode. This number represents almost 7% of the United States population.
  • The prevalence of adults with a major depressive episode was highest among individuals aged 18-25 (10.9%).
  • The prevalence of major depressive episode was higher among adolescent females (19.4%) compared to males (6.4%).

Symptoms of Major Depressive Disorder

There are many different types of major depressive disorder. Each type can have a different cause, however, they all involve the same feeling of disinterest in activities you once enjoyed and feelings of hopelessness, sadness or anxiousness as well as other symptoms. See a mental health professional for a formal diagnosis, but to have a formal diagnosis of major depressive disorder you will need to experience a primarily depressed mood for two weeks or more, as well as other symptoms as outlined below.


Although the number and intensity of symptoms will vary for each individual, they are typically as follows:

  • Persistent sad, anxious, or “empty” mood
  • Feelings of hopelessness, or pessimism
  • Irritability
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies and activities
  • Decreased energy or fatigue
  • Moving or talking more slowly
  • Feeling restless or having trouble sitting still
  • Difficulty concentrating, remembering, or making decisions
  • Difficulty sleeping, early-morning awakening, or oversleeping
  • Appetite and/or weight changes
  • Thoughts of death or suicide, or suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment


Major Depression Can Cause Severe Impairment

In 2016, an estimated 10.3 million U.S. adults aged 18 or older had at least one major depressive episode with severe impairment. Severe impairment was indicated if their depression caused severe problems with their ability to manage at home, manage well at work, have relationships with others, or have a social life. Those adults who had major depression with severe impairment represented 4.3% of all U.S. adults.

For adolescents aged 12 to 17, approximately 9.0 percent had a Major Depressive Episode with severe impairment. Adolescents were defined as having a Major Depressive Episode with severe impairment if their depression caused severe problems with their ability to do chores at home, do well at work or school, get along with their family, or have a social life.


Depression Treatment Options

Common treatments for a major depressive episode may include antidepressants,  psychotherapy, exercise, TMS and electroconvulsive treatment (ECT). A prescribing psychiatrist can provide both psychotherapy services and prescribe antidepressants, which may differ for each person based on their individual considerations. However, ECT is generally avoided, except in extreme circumstances, in favor of both psychotherapy and antidepressants. ECT is generally avoided because the patient typically needs to be in the hospital and receive anesthesia. ECT may also cause some side effects, including confusion, disorientation, and memory loss. Unlike the TMS treatment that is noninvasive and done with the patient being awake, without any need for anesthesia.


Depression Treatment With TMS Therapy

What Is TMS Therapy?

tms machine depression treatmentTranscranial magnetic stimulation (TMS) is a non-invasive method for using a magnetic field to cause an electric current to flow in a small region of the brain via electromagnetic induction, which causes the excitation of neurons in the brain. During a TMS procedure, a magnetic field generator, or “coil”, is placed near the head of the person receiving the treatment. The neuron excitation is caused by the electric currents induced in the tissue by the rapidly alternating magnetic fields, a process called electromagnetic induction. The TMS machine triggers activity in the brain without applying electrodes on the brain and without surgery.


Who Is A Good Candidate For TMS?

A doctor can help decide if NeuroStar TMS Therapy is right for you. TMS Therapy has been approved for the treatment of Major Depressive Disorder in adult patients who have failed to receive satisfactory improvement from prior antidepressant medication in the current episode.

NeuroStar TMS Therapy is only available by prescription.


What Happens In A Typical TMS Procedure?

A typical TMS session lasts approximately 30-50 minutes and does not require anesthesia. Patients come to the office five times per week. The treatment goes on for six to eight weeks, for an average of 20-30 total treatments. The TMS treatment is time-intensive, but research shows it can provide long-lasting improvements.


What Happens During The TMS Procedure:

An electromagnetic coil is held against the forehead near an area of the brain that is thought to be involved in mood regulation.

Short electromagnetic pulses are administered through the coil. The magnetic pulses easily pass through the skull, and causes small electrical currents that stimulate nerve cells in the targeted brain region.

Generally, the person feels and hears a slight knocking or tapping on the head as the pulses are administered.


Side Effects of TMS

For those who experience side effects, the most common side effect they have reported is a headache and/or pain or discomfort (tenderness) on the scalp, at or near the treatment site. However, this is usually transient; it occurs typically during the TMS treatment course and does not occur for most patients after the first week of treatment. There is a rare risk of seizure associated with the use of NeuroStar TMS (less than 0.1% per patient).


Who Is Not A Candidate For TMS

NeuroStar TMS Therapy should not be used with patients who have non-removable conductive metal in or near the head. NeuroStar TMS Therapy has not been studied in patients who have not received prior antidepressant treatment.


How To Pay For TMS Therapy Treatment

Insurance Coverage For TMS Therapy

Insurance coverage for TMS is expanding due to the increasing recognition by the insurance companies of the effectiveness of TMS. In Texas, TMS treatment is covered by Blue Cross Blue Shield, Cigna, and Optum (formerly United Behavioral Health).

If you don’t have these carriers, TMS Therapy® may be covered by your health insurance provider on a case-by-case basis.  Currently, insurance coverage for the TMS procedure varies and individual carriers and plans may determine coverage on a case-by-case basis.

Most insurers will only cover members after they have tried 3 or 4 medications without success, although this may change in the future, as was seen with Medicare when they changed this approval to 1 failure of medication. Although anyone can pay for the treatment out of pocket. Research shows that taking fewer medications before TMS can reduce the number of side effects of these medications, and increase the success rate of the TMS treatment.


Success Rate Using TMS With Major Depression

Repetitive transcranial magnetic stimulation, known as rTMS, may produce long-lasting changes in electro-cortical function. According to researchers, the pulses are thought to increase blood flow and encourage the growth of connections between brain cells. TMS can also cause the release of the neurotransmitters dopamine, serotonin and norepinephrine, which are chemicals that help send signals between cells. The magnetic field is about the same strength as that of a magnetic resonance imaging (MRI) scan.

Midtown Psychiatry Experience With TMS

At Midtown Psychiatry and TMS Center, Dr White has been using TMS to help people with Major Depression since 2014. She has seen a success rate of  54% percent for patients who’ve tried TMS at her office that have seen improvements in their depression symptoms.

“For the people who do see an improvement, it can be life-changing, as many of those patients have suffered from Major Depression for years,” Dr. White says. The success stories of those helped using TMS can be seen in the note cards that Dr. White has posted on a bulletin board in her office.

The results Dr. White has seen in her office are similar to studies announced at the American Psychiatric Association meetings, which report that 53 percent of patients with medication-resistant depression who were treated with TMS reported no or mild depression following six weeks of treatment, according to results.

The TMS patients achieved better results than depressed patients who tried a different medication after failing to improve from past medication. Among patients trying a new medication, 38 percent saw improvements, according to study results.

However impressive the studies are, the studies and Dr. White caution that TMS does not work for everyone. In more serious cases of major depression, intensive outpatient treatment or hospitalization may be required.


TMS For Other Conditions

Research is ongoing into whether transcranial magnetic stimulation, or TMS, can help people with autism, schizophrenia, tinnitus, and a host of other conditions involving the brain. Although the FDA has approved TMS only for medication-resistant depression, the treatment has been approved in Europe for bipolar disorder, post-traumatic stress disorder, chronic pain, obsessive-compulsive disorder and adult ADHD, according to


Integrative Treatment And Major Depression

Dr. White uses what she calls Integrative treatment, which, after a comprehensive evaluation, may include a combination of various therapeutic modalities such as relaxation, psychotherapy, yoga, medication, meditation, exercise, TMS therapy, nutritional supplementation, herbal medicine, vitamins, dietary changes, light therapy, and others. If you find yourself experiencing any of the symptoms of a major depressive disorder, you should seek assistance from a medical professional. Thankfully, in recent years, there is much less of a stigma for a major depressive disorder, and there is plenty of in-depth information available about depression online that you can discuss with your doctor.


What Our Patients Are Saying About TMS Treatment At Midtown Psychiatry

We have a bulletin board in our office which has note cards posted from people who have experienced TMS treatment in our Houston TMS Psychiatrist Office. Here are a few:

“As someone who has struggled with depression on and off my whole life and struggling with another long term episode I was excited to find a new treatment. After completing the TMS treatment I’ve been able to climb out of that depressive state and start doing the things I need to do to continue to enjoy my life. I would recommend the treatment.”

“My experience with TMS was very helpful. I went from being tired all day and not finding much pleasure in life to seeing hope for the future.”

“TMS help with my depression symptoms better than any medication ever has with no side effects. I would definitely recommend TMS to those suffering from depression and/or anxiety.”




You can hear from some of our patients as they discuss the real impact of TMS on their lives by watching Dr. White in a television video interview about TMS.


About Midtown Psychiatry & TMS Center

Midtown Psychiatry and TMS Center was created to provide the best possible mental health care available. With each patient, we strive to identify and treat the underlying causes of distress and symptoms of anxiety, depression, and other mental health issues. We work closely with patients and their families to create a treatment plan that addresses any imbalances we find. This may include addressing nutritional, lifestyle, and other core imbalances. Our treatment team, directed by Dr. Daniela White, MD, is dedicated to providing the best in diagnosis and treatment possible for a wide range of psychiatric issues, using an integrative treatment approach that improves the quality of life for our patients.

To that end, Midtown TMS and Psychiatry Center works in partnership with our patients and their families, advising them on options for treatment, such as psychotherapy, medication, TMS therapy, nutritional supplementation, vitamins, dietary changes, light therapy, yoga, meditation, exercise, herbal medicine, and others.

To learn more about TMS and our integrative treatment approach–make an appointment using the button or form on this page or call us directly at 713.426.3100.





Can Antioxidants Help Treat Depression and Anxiety?

Antioxidants Depression and Anxiety

When it comes to stress-induced psychiatric disorders, anxiety and depression are the most common. I see this often in my practice. We know that stressful life events can produce a state of vulnerability to depression and anxiety in some people. The mechanisms that contribute to vulnerability of mental illness is an area which needs further study. Although promising research has been done in the past few years that indicates that there are biochemical changes that occur in the body as a result of stress that can be addressed.  For patients suffering from stress-induced psychiatric disorders, it is essential to understand the role of antioxidants on stress-induced psychiatric disorders so a plan can be created and implemented to help cope with the effects of stress.


Stress and Nutrition

Research has shown that stress places a demand on the body in terms of nutrition. During a period of stress, it has been discovered that there is an increase in adrenal production and mobilization. There is also an increase in vitamins and minerals, such as vitamin C, vitamin E, magnesium, potassium, and micronutrients, This further accelerates the metabolism of proteins, fats, and carbohydrates which produces quick energy that is needed to overcome the stress response.


Antioxidants and Stress

To combat the biochemical changes which occur as a result of stress, there is something researchers call “antioxidant defence” in the biological system. The research on this states that “primary defence is by enzymatic antioxidants such as superoxide dimutase, glutathione peroxidase, catalase, nicotanamide adenine diphosphate, glutathione transferase and glutathione reductase, while secondary defence is by the non-enzymatic antioxidants such as vitamin E (alphatocopherol), vitamin C (ascorbic acid), β-carotene, minerals, and trace elements like zinc.” This indicates that stress and vitamins are related and we need to replace any vitamins that are depleted in order to maintain healthy functioning.


What Are Antioxidants?

The term “antioxidant” was originally used to refer to a chemical which prevented the consumption of oxygen. We now use the term “antioxidant” to describe small molecules that interact with free radicals and neutralize them ensuring proper function of all physiological functions of the body. Free radicals and oxidants can play a dual role as both beneficial as well as toxic compounds. As such, they can either have a helpful or harmful effect on the body. Free radicals are continuously generated by our bodies through internal processes, exposure to different external pathogens or stress. The best sources of antioxidants come from richly colored fruits and vegetables. Different colors characterize different types of antioxidants.


Green Vegetables

Brightly colored green vegetables such as kale, broccoli, peas, zucchini celery, collard greens, asparagus, Brussel sprouts, and spinach are rich in lutein and zeaxanthin, antioxidant nutrients deposited in the retinas of your eyes. It is believed that eating an adequate amount of these green vegetables can help prevent the vision loss caused by macular degeneration.

The cabbage family is rich in B vitamins, needed to properly convert glucose to ATP.


Yellow and Orange Vegetables and Fruits

Carotenoids are yellow and orange vegetables and fruit, such as butternut squash, carrots, pumpkin, yellow and orange bell peppers, and sweet potatoes. The body converts carotenoids to the nutrient vitamin A which benefits your skin, bones, immune system, vision, bones, and heart.


Red Vegetables

Red vegetables also contain flavonoids called anthocyanins, which have properties of antioxidants and may help your memory, boost immunity, protect urinary tract and reduce your risk of disease. These include vegetables such as radishes, beets, red onions, and tomatoes. Many foods with natural red pigments also contain lycopene, which is an antioxidant phytonutrient which may help protect against cancer of the prostate.


Purple and Blue Vegetables

Purple and blue vegetables such as purple cabbage, purple onions, eggplant, purple peppers, and purple potatoes contain phenolic flavanoids and ellagic acid which are anti-inflammatory compounds. Eating these color vegetables may improve cognitive function, prevent some types of cancer, and reduce your risk of cardiovascular disease.


Oxidative Stress, Free Radicals and Illness

Researchers believe that a balance must be maintained between free radicals and antioxidants within the body for healthy functioning. If this balance is not maintained, the free radicals may exceed the body’s ability to neutralize them, which can change different proteins, molecules, DNA, lipids, and carbohydrates, resulting in illness. Antioxidants must be present in the body in order to stabilize the reaction by-products (free radicals), otherwise, it is believed that they damage the cellular tissue.

We get these needed antioxidants from our food. We know that if we eat a diet which is lacking proper nutrients our mitochondria cannot properly process glucose. This results in free radical by-products which can cause ongoing damage to cells and proteins. This, in turn, may accelerate the aging process, increase the risk of auto-immune diseases, degenerative diseases, cancer, and other illnesses.

The term of oxidative stress refers to this imbalance between the free radicals that become excessive to the antioxidants defenses, resulting in molecular changes and eventually illness.


Oxidative Stress and Mental Health

Oxidative stress has been shown to be an important contributor to inflammatory conditions, and in recent years has been implicated in the underlying mechanisms that result in depression and anxiety. One of the proposed pathway in developing depression has been the increased oxidative stress which pairs up with inflammatory mechanism leading to cellular aging, and possibly depression and anxiety. Studies that look at the common factors that underlie depression, cellular aging, cancer and dementing illnesses seem to find the oxidative stress a common denominator.


Alternative Treatment and Depression

There is an ongoing research in finding “out of the box” modalities to help in the treatment of depression, and most of the alternatives to the traditional pharmacological treatment try to address the inflammation through moderate exercise and a noninflammatory diet. A diet that has anti-inflammatory properties is rich in flavonoids or  ‘nutraceuticals. ’  These seem to have good antioxidative properties, and are primarily found in brightly-colored fruits and vegetables. Others kinds are also found in food, the vitamins such as vitamin C (ascorbic acid), Vitamin E (tocopherols), or B carotenes.


Research On Antioxidants, Anxiety and Depression

In a study exploring the role of antioxidants in generalized anxiety disorder (GAD) and depression, it was observed that patients with GAD and depression had significantly lower levels of vitamins A, C, and E in comparison to healthy controls. The study results reported that after dietary supplementation of these vitamins for a period of 6 weeks, a significant reduction in anxiety and depression scores of patients was observed (P<0.001). A significant increase in the blood levels of antioxidants was observed in patients (P<0.05) except that of vitamin E in the group of depressed patients.


The Reality of Diets

We know that while the amount of antioxidants needed could be obtained through good nutrition, it would be necessary to eat between 6-10 servings of fruits and or vegetables daily. Oftentimes, that is not possible.  Therefore, we recommend supplementing with good multivitamin/antioxidants called nutraceuticals which gives you a better chance of ensuring that you are getting enough antioxidants and helps with good absorption and bioavailability.


Diet and Illness

Although further study on the effects of nutrition is needed to maximize the potential of nutrition on health, the research, to date, demonstrates clearly that diet can play a huge role in preventing or ameliorating illness. As can be seen from the research detailed above- having a diet rich in different colored vegetables, and supplementing with nutraceuticals can be a great start in getting the antioxidants your body needs.


Below is a list of references that can help you in your journey to feeling good both physically and mentally.  Click here to schedule a mental health consultation.



Role of antioxidants in generalised anxiety disorder and depression.

Gautam M, Agrawal M, Gautam M, Sharma P, Gautam AS, Gautam S.
Indian J Psychiatry. 2012 Jul;54(3):244-7.


“Minding My Mitochondria: How I overcame secondary progressive multiple sclerosis” By Terry Wahls, MD


Dr Wahls’ super-nutrient paleo diet, that reversed her Multiple Sclerosis


Phytochemical and Pharmacological Profile: A Review. … Lobo, V., A. Patil, A. Phatak, and N. Chandra. 2010. “Free Radicals, Antioxidants and Functional Foods: Impact on Human Health.” Pharmacognosy Reviews 4 (8): 118–126.


Free radicals, antioxidants in disease and health.

Pham-Huy LA1, He H, Pham-Huy C.
Int J Biomed Sci. 2008 Jun;4(2):89-96.


Depressive and Anxiety Disorders Showing Robust, but Non-Dynamic, 6-Year Longitudinal Association With Short Leukocyte Telomere Length.

Verhoeven JE1, van Oppen P1, Révész D1, Wolkowitz OM1, Penninx BW1.
Am J Psychiatry. 2016 Jun 1;173(6):617-24. doi: 10.1176/appi.ajp.2015.15070887. Epub 2016 Mar 4.


Homocysteine and Depression: What You Need To Know

Ask your psychiatrist if Homocysteine could be contributing to your depression…

homocystein and depression

What is HCY?

Homocysteine (HCY) is an amino acid that is destructive to cell integrity and DNA, and is a risk factor for the development of vascular and neuropsychiatric pathologies.

HCY has been linked to cardiovascular diseases, but when it passes the blood-brain barrier, it contributes to other chronic disorders such as depression, dementia, bipolar disorder, schizophrenia, and acute events, like strokes.

Where do these amino acids come from? HCY is not obtained from the diet – it’s not present in a naturally occurring protein. An amino acid found in a normal diet, called methionine, is broken down to either cysteine (a ‘good’) amino acid or homocysteine (the ‘bad’ form).

What causes HCY Toxicity?

The mostly commonly suggested mechanisms are oxidative injury, direct vascular damage, impaired methylation and impaired DNA synthesis. Another possible mechanism is the possibility of a heightened the inflammatory process, which is associated with depression.

Causes for elevated HCY can be genetic, epigenetic, and environmental and lifestyle-related.

The most common causes of elevated HCY:

  • smoking
  • excessive alcohol consumption
  • lack of exercise
  • obesity
  • some medications
  • psychological stress

Exercise helps distribute the HCY more evenly throughout the body, facilitating metabolism.  Poor vitamin intake makes it impossible for the metabolism of homocysteine to a ‘good’ form (cysteine). Decreased magnesium levels also slows down the metabolism of HCY. Lipid lowering medications or anticonvulsants impair the HCY metabolism as well. Genetic predisposition, like a mutation in the MTHFR enzyme can also decrease the ability of the body to metabolize HCY efficiently (TT and CT are the most variants shown to be associated with depression).

Why and how is this important for the treatment of depression?

Based on the theory of impaired metabolism of HCY, the low monoamines levels (serotonin, dopamine, norepinephrine) are related to the lack of important coenzymes that are necessary for the metabolism of HCY and the synthesis of neurotransmitters.

The coenzymes necessary for the HCY reduction are fully metabolized B vitamins. If a patient with depression is genetically predisposed to not be able to metabolize them (such in CT and TT variants of MTHFR) then they will have high levels of HCY, which may cause a higher level of inflammation and neurotoxic effects on the brain.

How can we individualize the treatment of depression?
  1. Check for the MTHFR mutation. Although it is not the only etiological factor, it can suggest a polymorphism contributory to the inflammation and depression.
  2. Supplement treatment with antidepressants by adding metfolate at 15 mg/day. Depression has been associated with reduced metfolate. Supplementing can help the HCY metabolism, reducing its toxic effects on the brain.
  3. Supplement with complex B vitamins and other necessary micronutrients. Maximizing methylation with reduced complex B and micronutrients necessary in the metabolism of HCY. Many patients can benefit from this supplementation even in the presence of HCY and because they are safe, they should be more largely used as a routine addition to the antidepressant treatment.

If you like this article on Homocysteine and Depression, or have questions, schedule your first session by calling us at 713.426.3100.


  1. Homocysteine and Neuropsychiatric Disease: Angela Pana, MD, Psychiatric Ann. 2015;45(9):463-468.
  2. Inadequate Homocysteine Metabolism: A theory of Depression, Andrew Farah, MD. Psychiatr. Ann. 2015;45 (9): 469-472.
  3. Theory into Practice-Addressing the Homocysteine Basis of Depression. Andrew Farah, MD Psychiatr. Ann. 2015;45(9):473-477.


Depression and Inflammation: What You Need To Know

Ask your psychiatrist if inflammation could be contributing to your depression…

depression and inflammation

In the last few years there has been an increased interest in the link between depression and inflammation. More and more research has been done to understand depression better and find other ways to combat it besides using antidepressant medications. Depression is the most widely spread cause of disability in the world, and these medications do not always work for everybody.


Inflammatory Disorders and Depression

One of the many things pointing to the relationship between depression and an inflammatory process is the fact that depression is frequently associated with other inflammatory disorders such as autoimmune diseases, cardiovascular disorders, diabetes and cancer.

Another important finding is that inflammatory markers are associated with major depressive disorder (MDD). One in five persons with cardiovascular diseases experiences MDD. Up to 70% of patients with autoimmune disorders experience MDD. About 15-20 % of cancer patients also have depression. Diabetes doubles up the rate of depression. Many meta-analyses studies show that individuals with MDD have significant increase in inflammatory markers like TNF-alfa and IL-6.


Stress and Inflammation

Since depression can develop in the absence of other inflammatory diseases, one theory is that stress (acute and chronic) is associated with the increased availability of proinflammatory citokines. Psychological stress can activate inflammation; however, depressed patients have difficulty controlling the body’s inflammatory response to stress. When the inflammatory pathway is initiated, a cascade of reactions results that decreases the serotonin level and boosts the glutamatergic response; thus creating depressive symptoms.


How Does This Apply to Depression Treatment?
  1. This medication helps decrease immunotherapy-induced depression, reduce the inflammatory response, and lower the pro-inflammatory factors.
  2. Stress Management. Managing stress effectively and proactively decreases inflammation.
  3. Healthy Diet. A diet rich in vegetables, fruits and Omega 3 is helpful in reducing inflammation.
  4. Exercise. Aerobic exercise has a well-documented impact on reducing inflammation and acts as one of the best destressors.

If you like this article on Depression and Inflammation, or have questions, schedule your first session by calling us at 713.426.3100.

  1. Depression and Inflammation: Examining the link: Maria Almond, MD, MPH Current Psychiatry, vol 12, no 6, 25-32.

Can Exercise Help Depression?

Physical Activity and Lifestyle Changes as Adjunctive Treatment for Mental Illness

exerciseanddepressionWhen it comes to helping people cope with depression, the most commonly recommended treatments for most are usually either therapy alone, or counseling combined with prescription medications. These forms of treatment are often effective in helping people to manage the symptoms.

Research on Depression: What Works?

However, research on depression, anxiety, and exercise shows that the psychological and physical benefits of exercise can also help reduce symptoms of depression and anxiety, and even help people manage other conditions such as diabetes, high blood pressure, and arthritis.

A study by S. Rosenbaum et al. published in the Journal of Clinical Psychiatry (Sept 2014) showed that physical activity reduced depressive symptoms in people with mental illness. Physical activity has been researched more in recent years showing that when incorporated in a holistic approach to the treatment of mental illness it has the result of augmenting the action of the antidepressants, and speeding up the response to treatment.

What I See In My Practice In Patients With Depression

While some studies suggest that exercise can be a substitute to the pharmacological treatment, what I found in my clinic is that only a certain subset of patients with depression respond to physical activity only; those with depression that is milder in severity. However for moderate to severe depression I find that the addition of exercise to the medication regimen and other changes in lifestyle, make the recovery more robust and sustainable.

Physical Activity Defined

Physical activity was defined for the purpose of the above study as ‘any body movement that is produced by the contraction of the skeletal muscles that increases body energy expenditure’ and exercise as ‘a subset of activities that is planned, structured, and deliberate’. The simplest form of regular exercise that could still make a change in the treatment of depression is walking at a brisk pace, for at least 25 minute a day for a minimum of five days per week.

Challenges for People With Depression

People who struggle with depression know that what may seem to be a simple task, taking a walk, or working out, becomes a difficult one. Especially those with moderate to severe depression, due to the fact that some of the common symptoms include: lack of initiative, decreased energy, difficulty making decisions, thoughts of life not being worth living, etc. These symptoms make taking that first step toward regular exercise extremely difficult.

More Challenges Seen In Depression

Another common form of resistance for those with depression is the reluctance to initiate a change, even one that could potentially be helpful. I hear a recurrent complaint of ‘the lack of time’. For the depressed patient in the midst of their depression, it becomes increasingly difficult to attend to the required activities of going to work, attending to the children, cleaning the house, and taking care of themselves. Usually, they are the last ones to take care of themselves, especially if they are feeling mentally tired and physically exhausted.

Ways to Break Through The Challenges of Depression

Get Support and Encouragement


Rather than add exercise as one more task to add to the ‘to do list’, what I find the most helpful is to ask the patient to rely on a friend or a family member to support and encourage them to set a goal and start working towards it.

Schedule Exercise; Start Small And Build

Usually, I recommend people start with just allocating 10 minutes a day in their daily schedule for ‘exercise’. Even for a short distance of 100 yards is enough to start, but keep the mind aligned with a final goal of walking 25 minutes at a brisk pace every morning, if possible. I ask them to start with this small step, dividing the main goal into smaller ones that are more easily attainable. Accomplishing a small task becomes rewarding, and initiating it is less overwhelming. What I found is that when the window of time allocated for exercise exists in one’s schedule, increasing the amount of time or the intensity of the exercise is easy to adjust in a stepwise approach.

Take Time For Yourself

We all know that we can best help others if we take care of ourselves- so it is important that we make the time for ourselves a priority. Walking is really helpful in increasing the sense of planning, and actually doing something for one self which is extremely healing for the depressed patient who perceives him/herself as not worth it, a burden, and contemplating death.

Take Time To Reconnect With Others

Walking can also provide distraction from our negative thoughts- especially when done with a companion. It helps create a sense of connection with people and with our surroundings as well.

Physical Effects of Exercise

When done at a fast pace, exercise increases the heart rate high enough to provide aerobic benefits, including the production of the endorphins that often help you feel happier and more relaxed. When exercising regularly, people also begin feel better about their appearance which can boost confidence and improve self-esteem. And most importantly, exercise improves your chances of living a longer and healthier life.

Holistic Approaches to Treatment; Other Ways to Manage Depression

In addition to exercise, I encourage my patients to consider other lifestyle changes that can help manage depression. These include healthy nutrition practices, getting good sleep, increasing their social support, and practicing stress reduction techniques. I will talk more about these practices in future articles. So to answer the question can exercise help depression, yes it can, but also explore other options to maintain improvement in mood, energy level, and overall health.

Contact us to learn more about can exercise help depression and treatment options by calling us at 713-426-3100.




Another Treatment Option for Depression

Inadequate Treatment for Depression


depressed womanOut of 14 million people struggling with depression in the US alone, 4 million of them are inadequately treated. Depression is the second major cause of disability on a global scale, and will become number one by 2030. People who struggle with depression frequently take medical leave of absence, or if they cannot take time off they increase their presenteeism, going to work but functioning very poorly, under the level expected, and with reduced productivity.

Case Study

Kara: Symptoms And Medication

When Kara, 22, first came to her evaluation at the office she was primarily concerned about her lack of motivation. She said that she had lost herself and that she lost her drive. She had struggled with depression for many years and she has been treated with different antidepressants that either would work temporarily or would not help at all.

Impact of Depression

She was not able to work, and she was now living with her mom, after giving up her last job. She would spend most of the day in bed, not finding the energy to venture out of the house. One of the symptoms associated with her depression was extreme anxiety which limited her ability to socialize. In the past, she used to be surrounded by friends and was a social butterfly, but now, because of her depression, she would avoid taking her friends calls, and if she did- she would always back out of social commitments. She was not able to go to work, and her dreams of becoming a teacher one day where getting further from becoming reality. Her concentration was impaired, and the anxiety created a problem in terms of handling the customers at work, pushing her towards taking a medical leave of absence.

Transcranial Magnetic Stimulation (TMS) Therapy

Her psychiatrist eventually referred her for TMS therapy after Kara tried three different antidepressants, as well as different combinations of them and two augmentation strategies. She decided to come to Houston for treatment, because TMS therapy was not available in her town. When we first began working together, her psychometric scales for depression and anxiety were in the high levels, her score on HAM-D (Hamilton Depression Scale) was 23, in the high range of severity.

Before and After Treatment With TMS

At the conclusion of treatment, Kara felt that her anxiety was practically gone, and her energy returned to normal levels that she had not experienced in years. Her HAM-D depression level in the last week of treatment was 7, showing a remission rate. Two years later, in May of this year, she sent us a picture from her college graduation. She went back to school and made her dreams a reality; finally accomplishing what it seemed two years ago was impossible for her.

The True Cost of Depression

When looking back on her story, one cannot help but wonder what she would have lost, or not accomplished without successful treatment. When medication is not effective, and symptoms remain, so much is lost. Relationships suffer, career aspirations are not realized, work and income are adversely affected. When medications are not effective- seeking help with treatments such as TMS therapy, are worth the time and investment in restoring one’s life back to its full potential. Kara, at 22, because of her depression and anxiety, felt that her life was at a dead end. She was paralyzed by anxiety, fear and depression and therefore not able to follow her calling or provide for herself. Two years later, she has been able to gain control over her life, and has reached her goal of becoming a teacher.

If you like this article on another treatment option for depression, or have questions, schedule your first session by calling us at 713.426.3100.

When Medication Doesn’t Work For Depression: The Transcranial Magnetic Stimulation (TMS) Option

When Medication Doesn’t Work For Depression: The Transcranial Magnetic Stimulation (TMS) Option

Alternatives To Depression Medication: The Transcranial Magnetic Stimulation (TMS) Option

*Mary, a lovely, poised, 28 year old woman, had a long history of depression, going as far back as she could remember, starting in middle school. She did not remember a clear trigger for feeling so sad and tired, that she had to lay down after returning from school. Nothing really happened to start it, and her sadness crept in slowly. Several family members were suffering from depression and were taking medications, and her grandmother committed suicide.


Her physician at the time started her on Serafem, considering that her predisposition to depression was inherited therefore would respond to medications. It had limited effectiveness. Later in her adult life she had two episodes of postpartum depression, and continued to feel easily irritable, sad, discontented with herself, and lacked the initiative and energy to do things that she used to enjoy.

When she first presented to the clinic she felt that she tried so many medications without any relief and felt skeptical of another trial. Her psychometric scales for depression and anxiety were in the range of severe intensity. She had difficulties concentrating, was afraid she might lose her job, and she felt most of the time lethargic and tired. Prior to trying TMS, she had tried six other medications, each of them for at least 24 months. She took them regularly but did not experience significant relief.


The TMS Option: An Alternative to Depression Medication

During the consultation we had with her, and her mother who accompanied her, we explained why TMS could be a good alternative to the medications. TMS acts locally in that part of the brain that is responsible for the symptoms of depression, the Pre Frontal Dorso Lateral Cortex (PFDLC). Unlike medications, which circulate through the entire system binding to receptors located in different organs therefore creating side effects, TMS does not have systemic adverse reactions. TMS creates electrical currents through a pulsating magnetic field that can reach inside the brain at about 1.5-2.5 cm deep.

At the beginning of the treatment she experienced some mild discomfort at the area of application. She met with me weekly to discuss her progress and during the first two weeks she expressed her worries that if this treatment fails, she had no other hope left. When she felt for the first time that her mood became lighter and she had the energy to do the things she wanted with her family over a weekend, she was surprised. On Monday when she returned for the treatment she said that she was afraid to believe that it could be a real relief.

TMS Treatment Results

As the time progressed, so did her improvement. At the end of the treatment, she felt “really good’, like she hadn’t in a long time. Mary said that for the first time in many years she was able to relax enough to enjoy the entire weekend. She also reported that in situations that other times would ‘freak her out’ she was able to keep her cool, and not feel anxious. She felt able to return to work and handle the situations as they arise, feeling more comfortable setting limits and stopped blaming herself in situations that were clearly not her fault. At 6 months after finishing the treatment she continued to be in remission.

To learn more about  Transcranial Magnetic Stimulation (TMS)   as one of the alternatives to depression medication, or to make an appointment to see if Transcranial Magnetic Stimulation (TMS) is a good option for you- contact us at 713-426-3100.

*Please note that some of this information, age, sex, exact diagnosis was modified to protect the identity of my client, however, the impact, or effect of the treatment is the actual experience of the client.

Alternatives to Depression Medication

Alternatives to Depression Medication: Use TMS When Medication Doesn’t Work

When Antidepressants Are Not Tolerated: Transcranial Magnetic Stimulation (TMS) Is The Only Option


VK was a *56 year-old woman who was deeply depressed when she came to our clinic. A few months earlier, her mother, whom she had a very close connection to, passed away from cancer. VK had been taking an antidepressant called Pristiq to manage her depression, was also in weekly therapy, but she was extremely sad, crying ‘at the drop of a hat’, very anxious, unable to drive on her own, and not looking forward to the upcoming Holidays, which were always her and her mother’s favorite time of the year. She had thoughts of ‘life is not worth living’ since she could not imagine a reason to continue living without her mother.

We tried different antidepressants and combinations of medications, but besides having side effects she was not seeing a response in the severity of her depression. TMS treatment was suggested as one of the best treatment alternatives to depression medication after a few months. Because she considered the therapy as new and because of the cost- she did not feel it was an option that she was willing to try at that time.

Almost two years after her initial visit, after trying Pristiq, Wellbutrin, Buspar, Lyrica, Saphris, Abilify and a couple of other augmentation techniques, she came one day with her husband for a consultation on considering TMS.

Her husband’s support convinced her that she should try TMS, regardless of comparatively high cost of the treatment procedure. Among the barriers in the treatment with TMS are the patient’s inherent belief that there is no hope, that it is not worth the expense, or that they are a burden for the family. These thoughts and beliefs are triggered by the depressive disorder itself, by the cognitive dissonance that defines the illness.

When VK started TMS therapy, her psychometric scales for depression and anxiety were all in the ‘severe’ range. In the first three weeks of treatment, her anxiety grew because she was not seeing the results that she hoped for immediately. When she showed up for treatment without her husband, we knew that she was doing better, since she was able to drive on the freeway by herself. A few sessions later she realized that the improvement was noticeable. At the end of the treatment, her psychometric scales were all showing remission of symptoms.

Today, 2 years later, VK has picked up a new hobby, quilting, that she has now mastered at a high level. She is also able to drive to the nearby town to take quilting lessons, was invited to become an instructor, and thoroughly enjoys Christmas and shopping again. VK said in her last interview that TMS was the best investment she ever made for her health.

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*Please note that some of this information, age, sex, exact diagnosis was modified to protect the identity of my client, however, the impact, or effect of the treatment is the actual experience of the client.

If you like this article on alternatives to depression medication, or have questions, schedule your first session by calling us at 713.426.3100.

Major Depression Treatment and TMS

Major Depression and TMS: Stories From The TMS World

SG is a 53 year old woman, very successful professionally who has been treated for depression for many years and had a hard time taking the antidepressants. Some of them made her feel confused and some of them made her gain weight. She felt torn between taking medication to feel better and struggling with the side effects. At one point she was taking more than five medications for what was considered a refractory to treatment depression. Eventually she found that taking only Wellbutrin helped her to feel better, without feeling ‘medicated’. However her mood was never back to how it was prior to those four episodes of the depression that started occurring in her twenties. She had to give away some of her hobbies, because of the lack of pleasure in doing them, her drive was lower, and she was more fearful of trying new things. She felt that sleep was a good way of not thinking about how life used to be, therefore had a difficult time getting out of bed in the morning.

When her daughter brought her in for the TMS (transcranial magnetical stimulation) evaluation, to discuss the procedure, its pros and cons, she was already reluctant to try something new. The depression itself makes people feel like burdens on their families, and the cost of the procedure made her feel guilty about even considering it. Her negative pattern of thinking made her believe that most likely the results will be null, and on top of everything she felt that ‘at her age’ what else can she expect from life. She was also fearful that the TMS might make her depression worse.

Eventually the family convinced her to give TMS a try and she accepted. For the first two and half weeks she didn’t notice any difference and her guilt and doubt about accepting the treatment increased. We reassured her that most people start to see a response around the third week of the treatment.

Towards the end of week three she was still apprehensive about starting the weekend, but Monday she came back and said that the weekend wasn’t bad at all. For the first time in many years she got out of bed and did things without ‘having to push herself to do it’. She didn’t have to convince herself to go and shop for the groceries; she just got out of the house, did the shopping and even enjoyed it. She started cooking for the family and, for the first time she started thinking about gardening again. Not only did she notice an improvement but the family also noticed the change as well. She started waking up earlier in the morning without dragging around the thought of a new day. She started bringing her book and read during her sessions.

At the end of her thirty sessions of TMS the psychometric scales used to track her progress showed marked improvement, to what is considered remission of symptoms. She continued to take Wellbutrin as a maintenance medication, and her mood remained stable at a higher level of functioning than before.