私がうつ病になったらTMSで治療をします。精神科医がぶっちゃけて語ります。

Good evening. I'm Takahiro Haga, a psychiatrist. Today's video might not get many views. However, I believe it will be one of the most useful videos I've made so far. Today, I'd like to talk about TMS. TMS stands for repetitive transcranial magnetic stimulation. Simply put, it's a treatment method that uses magnetism applied from outside the head to generate a weak electric current in specific areas of the brain, regulating brain function. It's a treatment method that has shown effectiveness for depression and is covered by insurance in Japan. However, and this is very important, even though it's covered by insurance, there are very few facilities that actually offer TMS under insurance. There are only a limited number of facilities nationwide. And in most cases, hospitalization is required to receive it under insurance. In other words, even if you think, "If it's covered by insurance, I should be able to get it easily," it's not that simple in reality. First, I want to make something very clear. I have no affiliation with any companies or clinics that offer TMS. I don't receive any referral fees. I don't receive any profit from recommending TMS. With that in mind, today I would like to discuss TMS as an option from a neutral, yet quite positive, perspective. The reason I am focusing on TMS is because antidepressant treatment inevitably has side effects. Antidepressants are an effective treatment. Of course, we use them for patients who need them. However, taking medication can cause side effects such as weight gain, dry mouth, constipation, drowsiness, gastrointestinal symptoms, and autonomic nervous system dysfunction. Many patients find taking medication itself difficult. Antidepressants are thought to work by regulating neurotransmitters such as serotonin and norepinephrine in the brain, and by restoring neuroplasticity through BDNF, etc. This is a very important effect. However, since they are oral medications, they don't act solely on the brain. They affect the entire body. Therefore, unpleasant side effects such as gastrointestinal symptoms, autonomic nervous system symptoms, and weight gain can occur. On the other hand, TMS applies magnetic stimulation from outside the head. By generating a magnetic field, it induces a weak electric current near the surface of the brain. It does not directly pass electricity through the brain. One treatment using strong electric currents is modified electroconvulsive therapy, or mECT. While highly effective, it requires general anesthesia, muscle relaxants, and is generally performed in a hospital setting. It's a crucial treatment for severe depression, conditions accompanied by psychotic symptoms, and urgent situations. In contrast, TMS (Transcranial Magnetic Stimulation) uses much weaker stimuli. The stimulation primarily targets the left dorsolateral prefrontal cortex. The prefrontal cortex is deeply involved in reason, judgment, and emotional control. In depression, it's believed that the network between emotionally involved areas like the amygdala and emotionally regulating areas like the prefrontal cortex malfunctions. Therefore, the basic idea behind TMS is to stimulate the left dorsolateral prefrontal cortex to enhance its function. This approach seems quite logical. Instead of circulating medication throughout the body to regulate neurotransmitters, it directly stimulates the brain region thought to be affected by the dysfunction. Of course, it's not a panacea and doesn't work for everyone. Nevertheless, it's a very appealing treatment approach. The side effects of TMS are quite different from those of drug therapy. With TMS, side effects may include discomfort at the stimulation site, scalp pain, headache, muscle pulling sensation, and fatigue. Rarely, there is a risk of seizures, so it is necessary to carefully assess the indications and perform the treatment under safety management. However, generally speaking, it is different from treatments that broadly affect the body's metabolism, digestive system, and autonomic nervous system, such as antidepressants. Traditionally, TMS protocols involved 10Hz stimulation for 30 to 40 minutes. Recently, shorter protocols have emerged, with some where the stimulation itself is completed in just a few minutes. Of course, including examination and preparation, it will take a little longer, but the treatment itself is relatively short. If an outpatient environment is available, it is a treatment that can potentially be received without significantly disrupting daily life. So, how often is it performed? Generally, as an initial acute treatment, it is often performed 5 times a week for about 6 weeks, totaling around 30 sessions. After that, maintenance may be continued as needed, at a frequency of once a week or so. In other words, this isn't a one-time treatment. To stimulate the brain's network and maintain the condition, a period of intensive treatment followed by maintenance therapy may be necessary. T...