updateFrom the Nation’s First Comprehensive Depression Center

U N I V E R S I T y O F M I C H I g A N

DEPRESSION CENTER

T H E M I C H I G A N D I F F E R E N C E ®

WHAT’S INSIDE

Learn More About Repetitive Transcranial Magnetic Stimulation

(rTMS)

~Center Welcomes New

Depression Center Consultation Clinic

~Not Too Late

to Support the Prechter Challenge

~Overcoming Treatment Resistant Depression

~New Titles in the

UMDC Reading Corner

~Upcoming Events

~

The Psychiatric Neuromodulation Program is pleased to announce that

repetitive Transcranial Magnetic Stimulation (rTMS) has arrived at the University of

Michigan. rTMS was approved in autumn 2008 by the FDA, and is the newest addition

to available treatments in the Department of Psychiatry and Depression Center. The

University of Michigan was a clinical trial site for this innovative treatment option and

it was the first approved site for rTMS in the State of Michigan.

How Does rTMS Work?rTMS is specifically approved for patients with treatment resistant depression,

especially those who cannot tolerate medications. It uses a magneticcoil to induce

modest electrical activity in the brain, non-invasively and without anesthesia. rTMS

is an outpatient procedure that allows patients to go about their normal daily routine

immediately following treatment.

continued inside

New Major Depression Treatment Option Now Offered at the Center

Pictured are U-M Depression

Center members Steve Taylor, MD,

the Co-Director of the Psychiatric

Neuromodulation Program and

Iva Grasso, BSN, MSW, the Clinic

Coordinator of the new Depression

Center Consultation Clinic. They work

together facilitating patient consultations

for the Clinic and Dr. Taylor oversees the

new rTMS therapy for the Depression

Center and Department of Psychiatry.

WHAT’S INSIDE

Learn More About Repetitive Transcranial Magnetic Stimulation

(rTMS)

~Center Welcomes New

Depression Center Consultation Clinic

~Not Too Late

to Support the Prechter Challenge

~Overcoming Treatment Resistant Depression

~New Titles in the

UMDC Reading Corner

~Upcoming Events

~

The Psychiatric Neuromodulation Program is pleased to announce that

repetitive Transcranial Magnetic Stimulation (rTMS) has arrived at the University of

Michigan. rTMS was approved in autumn 2008 by the FDA, and is the newest addition

to available treatments in the Department of Psychiatry and Depression Center. The

University of Michigan was a clinical trial site for this innovative treatment option and

it was the first approved site for rTMS in the State of Michigan.

How Does rTMS Work?rTMS is specifically approved for patients with treatment resistant depression,

especially those who cannot tolerate medications. It uses a magneticcoil to induce

modest electrical activity in the brain, non-invasively and without anesthesia. rTMS

is an outpatient procedure that allows patients to go about their normal daily routine

immediately following treatment.

continued inside

New Major Depression Treatment Option Now Offered at the Center

Pictured are U-M Depression

Center members Steve Taylor, MD,

the Co-Director of the Psychiatric

Neuromodulation Program and

Iva Grasso, BSN, MSW, the Clinic

Coordinator of the new Depression

Center Consultation Clinic. They work

together facilitating patient consultations

for the Clinic and Dr. Taylor oversees the

new rTMS therapy for the Depression

Center and Department of Psychiatry.

SUMMER 2009

U-M Depression CenterRachel Upjohn Building4250 Plymouth Road

Ann Arbor, MI 48109-2700800-475-6424

www.depressioncenter.org

New Depression Center Consultation Clinic Now OpenThe University of Michigan Depression Center Consultation Clinic (DCC) was recently established to help referring Michigan physicians treat patients with depression, including difficult-to-resolve episodes of depression and bipolar disorder. Consultations are performed by Depression Center faculty psychiatrists and

psychologists who have decades of experience in treating patients with complex clinical symptoms and are internationally recognized for their clinical and research expertise. The comprehensive assessment of patients takes a multidisciplinary approach with a focus on evidence-based treatment

options that stem from psychopharmacology considerations, medication management, psychotherapy, family therapy, exercise, nutrition, sleep interventions, and new advancements in neuromodulation. Each of these potential treatment options is weighed in the formulation as final recommendations are conveyed. The Depression Center Consultation Clinic is a new service offered by the University of Michigan Department of Psychiatry and the Depression Center. This consultation is provided

solely by senior faculty members and is available primarily to provide diagnostic and treatment recommendations to referring physicians, rather than to deliver ongoing care for all. The fee structure for this consultation is based on the amount of consultation time. A consultative report and communication with the referring physician and patient are provided by the senior faculty psychiatrist. Please visit www.depressioncenter.org for more information on the new Depression Center Consultation Clinic.

Depression and bipolar disorder are not to be taken lightly. They can cause individuals and their families anguish, frustration and inflict huge tolls on our communities and businesses with lost productivity and absenteeism. Science is helping and there are bright sides. Clinical depressions are treated quite effectively and have good recovery rates when detected early and there are new advances for those who do not respond promptly. The latter topic is featured in this newsletter.

An estimated 25 – 30% of depressed and bipolar individuals have syndromes that don’t respond promptly to “first-line” treatments. These more-persistent syndromes are often referred to as Treatment Resistant Depression (TRD) or Treatment Resistant Bipolar Disorder (TRBD). Our goals at the Depression Center are to match the right treatment option(s) with each individual patient—so-called “personalized treatment”—and to convey to depression sufferers and their

families everywhere that new options for care are becoming available. These advancements are emerging from our own research and from collaborators elsewhere, such as our 15 partners in the National Network of Depression Centers (www.NNDC.org).

Reflecting these advancements, the Depression Center and Department of Psychiatry are proud to announce the launching of our Depression Center Consultation Clinic (DCC) to evaluate, diagnose, and make treatment recommendations for referrals with depression, including those with TRD and TRBD. We also are pleased to announce the addition of our new repetitive Transcranial Magnetic Stimulation (rTMS) device, recently approved by the FDA for selected individuals who have not responded to prior traditional antidepressant treatments.

Treatment advances would not be possible without funding. Therefore, I would like to acknowledge the outstanding support of the Noble Foundation of Wooster, Ohio, a major partner of the Depression Center in establishing innovative clinical programs for treating patients with TRD. Recognizing the struggle of people affected by recalcitrant mental health problems, the Noble Foundation has made a significant contribution to the development of new screening and outcome assessment tools, and new treatment strategies like those discussed in this issue of our newsletter. We thank them on behalf of all the patients and families who will benefit from their generosity.

Merci,

John F. Greden, M.D.

From Our Director

d e p r e s s i o n c e n t e r u p d at e | s u M M e r 2 0 0 9

What Does rTMS Treatment Involve?

Delivery of rTMS treatment is a two-step process: the first step includes treatment planning and the second step is the actual treatment delivery and follow-up care. After a thorough consultation with a psychiatrist, patients undergo a simple

procedure to adjust the rTMS therapy to the patient before formal treatments begin.

Following consultation and treatment calibration, patients come to the clinic for treatment sessions five days per week for four to six weeks during the course of therapy. A session lasts approximately one hour, which includes positioning the rTMS coil against the head and delivering stimulation for about 40 minutes. Patients sit awake and relaxed in a comfortable chair with the rTMS device stimulating

the brain every 30 seconds. Only electromagnetic energy enters the body with this treatment—no medications, no anesthesia, no probes or leads.

rTMS has been approved by the FDA for TRD, and third party insurance payers, such as Blue Cross and Medicare, are determining whether it will be covered under their plans. Some third party payers have approved

the treatment on a case-by-case basis, and self-pay is an option for other patients. A course of treatment includes approximately 25 treatment sessions; some patients may require extended courses and/or follow-up treatment.

How to Find Out More About rTMS?

Thanks to the generosity of many enthusiastic doners, the Heinz C. Prechter Bipolar Research Fund at the U-M Depression Center met the challenge of an anonymous donor to raise $500,000 to qualify for matching funds in the same amount. In addition, we are making good progress toward the $1 million challenge presented to us by the World Heritage Foundation-Prechter Family Fund. With less than $500,000 left to go, we are getting close to meeting our goal. If we are successful, when leveraged by these challenge grants, donor gifts of $1.5 million will contribute $3 million to the Heinz C. Prechter Bipolar Research Fund.

These funds will be used by the Depression Center to search for the specific genes that make a person vulnerable to developing bipolar disorder and will also help target the most effective treatment options possible for each individual based on his or her personal genetic background. Please help us reach our goal so we can not only meet this generous challenge, but make real progress in the search for answers to bipolar disorder.

Not Too Late to Help Meet the Heinz C. Prechter Bipolar Research Challenge Grants

DONATEPlease consider making a matching gift to the Prechter Bipolar challenge. visit www.prechterfund.org for a secure online giving form or call courtney Metzger at 734.764.6161. Please hurry, the challenge ends in december 2009.

Mrs. Waltraud Prechter (center) with her son Paul Prechter and his wife Paige and A. Alfred Taubman (right) at the recent Saks Fifth Avenue fashion show in support of the Heinz C. Prechter Bipolar Research Fund at the U-M Depression Center. More than 200 guests and friends of the Prechter Fund attended the event, learned about the work of bipolar expert Dr. Melvin McInnis and enjoyed fashions by Italian designer, ETRO. The event raised over $145,000 for bipolar research and will be matched dollar for dollar by the World Heritage Foundation-Prechter Family Fund.

$ 1,026,392

goal$ 1,500,000

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rTMS continued

FACTS ABOUT rTMSApproved in Fall 2008 by the FDA as a treatment option for treatment resistant depression

~New treatment option for patients who are unable to tolerate or can’t find successful pharmacological therapies.

~Noninvasive treatment that can be done in an outpatient facility

Very few side effects, however it should not be given to anyone with a history of epilepsy or seizures

~Covered by some third party insurance payers; otherwise, is a self-pay program

~Maintenance treatments may be necessary following a full course of treatment

If you would like more information about rTMS, please visit the rTMS specialty page of the Department of Psychiatry Web site at www.psych.med.umich.edu/tms/ or call 734.764.0231 with questions.

DISCLOSURE: Dr. John Greden, Executive Director of the U-M Depression Center, has consulted for compensation, but has not participated in treatment studies for Neuronetics, manufacturer of products for rTMS. The U-M Department of Psychiatry has received financial support from Neuronetics for studies of rTMS.

reg Williams, Ph.d.

Overcoming Treatment Resistant Depression

Psychiatric neuromodulation provides new options for those with TRD

These new techniques are sometimes referred to as “neuromodulation” or “neurostimulation” because they stimulate or modulate brain function. We have known for decades that electroconvulsive therapy (ECT) is a remarkably effective treatment. It is currently one of the safest treatment options for patients with severe brain illnesses. ECT can have side effects, so the search has been on for additional approaches.Two newer forms of neuromodulation have shown promise in treating those with TRD and are available at the University of Michigan Depression Center. These are vagus nerve stimulation (VNS) and repetitive transcranial magnetic stimulation (rTMS). Another neuromodulation therapy, deep brain stimulation (DBS), is being studied at the University of Michigan.

The Center’s overall mission is to prevent development of TRD and TRBD but it is reassuring to know that new options are being developed should these disorders occur.

Depression and bipolar disorder are brain diseases that are distressingly common, affecting one in five Americans. For an unfortunate few, both can become chronic and persistent.

Treatment Resistant Depression (TRD) and Treatment Resitant Bipolar Disorder (TRBD) are terms that are sometimes used to

refer to those depressions that have not responded to at least two or three courses of adequate medication or psychotherapy. TRD and TRBD generate enormous burdens for depressed individuals and their families, rack up large financial costs, produce more physician visits and hospitalizations, increase difficulties functioning in the workplace, and create higher rates of suicide. The University of

Michigan Depression Center is dedicated to finding better answers for individuals with TRD and TRBD.

Only one-third of depressed individuals are symptom-free or in remission after the first course of antidepressant treatment. After treatment with a second antidepressant, only about one-quarter of those who haven’t yet responded go into remission. Additional successes can be achieved with each new course of adequate treatment, but the prolonged symptoms take a toll. TRD and TRBD are challenging opponents so new approaches are needed.

Suicide Prevention Plan for WaShtenaW county: KicK-off eventMonday, September 14, 2009

The Washtenaw Suicide Prevention Collaborative presents a kick-off event to launch the Suicide Prevention Plan for Washtenaw County. Learn about efforts to prevent suicide at the national, state, and local level, and how you can get involved to help spread the message that suicide is preventable. The event is from 12 pm-2 pm at Washtenaw Community College in the Morris Lawrence Building. Lunch will be served for those who pre-register. For registration and more information, please visit www.washtenawALIVE.org.

out of the darKneSS coMMunity WalKS Sunday, September 20, 2009

The Depression Center is pleased to support the American Foundation for Suicide Prevention’s (AFSP) annual Out of the Darkness Community Walks. By participating in these events, thousands of walkers nationwide raise money for AFSP’s vital research and education programs to prevent suicide and save lives, increase national awareness about depression and suicide, and assist survivors of suicide loss. There are several Michigan walks including “Ann Arbor” on Sunday, September 20, 2009 at 12 pm in Gallup Park.

You can find the complete list of all of the Community Walks, including the one in your area, on the AFSP Web site: www.outofthedarkness.org

Bright nightS: “neW hoPe for dePreSSion: StiMulating the Brain” tuesday, September 29, 2009

On Tuesday, September 29, 2009, the Depression Center’s Bright Nights Community Forum series presents a program focusing on new strategies

and techniques for treating very severe, or “treatment resistant” depression. The forum will be led by Steve Taylor, MD, Co-Director, Psychiatric Neuromodulation Program and Associate Professor, Department of Psychiatry, University of Michigan Medical School. A panel of experts will be on hand to answer questions.

Co-sponsored by the Depression Center and the Ann Arbor District Library, the Bright Nights public forums provide an opportunity for community members to obtain up-to-date information on a variety of topics related to depression. The quarterly series allows for discussion and Q & A between audience members and expert panelists.

Bright Nights forums are held from 7 to 8:30 pm in the Multi-Purpose Room of the downtown Ann Arbor District Library at 343 S. Fifth Avenue.

Seventh annual todd ouida lecture on childhood anxiety and dePreSSion Wednesday, September 30, 2009

The Seventh Annual Todd Ouida Lecture on Childhood Anxiety and Depression is scheduled for Wednesday, September 30, 2009 from 10:30 am-12 pm in the Garden Level Auditorium of the Rachel Upjohn Building. This year’s speaker is Dr. Joan Asarnow, Professor of Psychiatry and Biobehavioral Sciences, UCLA. The title of her talk has not yet been released.

Save the date! Second annual StateWide Suicide Prevention conference november 11-13, 2009

“Sustaining Hope, Saving Lives: Suicide Prevention Across the Peninsulas”November 11-13, 2009Lexington Lansing Hotel (formerly the Sheraton Hotel), Lansing. Online registration will begin in September at www.macmhb.org

Depression Center

Listed below are recommended books on the topic of treatment resistant depression. You can find these books, and many other resources, at the FRIENDS Depression Education Resource Center, located in the east atrium of the Depression Center building.

Out of the Black Hole: The Patient’s Guide to Vagus Nerve

Stimulation and Depression Charles E. Donovan III

Lifting Depression: A Neuroscientist’s Hands-On

Approach to Activating Your Brain’s Healing Power

Kelly Lambert

The Mindful Way Out Through Depression: Freeing Yourself From Chronic Unhappiness

Mark Williams

Treatment of Recurrent Depression

John F. Greden, M.D.

Undercurrents: A Life Beneath the Surface

Martha Manning

Upcoming Events

FOR MORE INFORMATIONabout featured book selectionswww.depressioncenter.org/

ResourceCenter

UMDCREADINGCORNER

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Information about depression is available online. Please visit our Web site at www.depressioncenter.org.

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Executive Officers of the University of Michigan Health System

Ora Hirsch Pescovitz, M.D., Executive Vice President for Medical Affairs; James O. Woolliscroft, M.D., Dean, U-M Medical School; Douglas Strong, Chief Executive Officer,

U-M Hospitals and Health Centers; Kathleen Potempa, Dean, School of Nursing.

The Regents of the University of Michigan

Julia Donovan Darlow, Laurence B. Deitch, Denise Ilitch, Olivia P. Maynard, Andrea Fischer Newman, Andrew C. Richner, S. Martin Taylor, Katherine E. White, Mary Sue Coleman (ex officio).

The University of Michigan, is a non-discriminatory affirmative action employer. © 2009 The Regents of the University of Michigan

Published 4x/yr by the University of Michigan Depression Center.

The University of Michigan Depression Center gratefully acknowledges the support of the Friends of the University of Michigan Hospitals and Health Centers for their generous gift which provides for the publication of UPDATE, and for recognizing its value in spreading our message of education, advocacy, and hope toward conquering depression and bipolar disorder.

For more information about Friends or to learn about volunteering at a Friends gift shop, contact: Sandy Del Favero at favero@umich.edu or 734-936-5975, or visit Friends online at www.med.umich.edu/friends/.