Todd Hutton, MD

We are all beginning to see the light at the end of the pandemic tunnel, but it is important to realize that this welcoming glow will not magically erase the emotional toll of COVID-19. This pandemic blew in like a hurricane, leaving us all shaken and bruised. Now as the storm loses steam, we’re relieved to see it subside, but we’re left in its devastating aftermath, grappling with how to deal with both the short and long-term effects of its trauma. Not only has there been a loss of life, there have been many other losses as well. Symptoms of depression often rise after a 

, and I, like many clinicians, believe a second wave – a mental health pandemic – is here.

The disease of depression is known to impact more than 17.3 million American 

, and research indicates the number of adults experiencing symptoms of depression in the U.S. has tripled because of 

. In fact, it is estimated that over 1 in 4 U.S. adults now report such 

.Treating depression can be tough, so it is critical that people have knowledge of 

their treatment options available to them.It can be life changing.

While COVID-19 has exacerbated symptoms for patients who were already struggling with depression, it has also meant new diagnoses, particularly in those who have experienced intense social isolation and loss, even if they don’t have a medical history of the disease. As depression rates continue to rise across the board, 2020 Census Bureau data reveals cases are rising most in younger adults, those who are more likely to be single and living 

. This is something I’ve witnessed in my own practice. 

Studies have also found that 24% of those who had actual COVID infection developed a psychiatric disorder in the 6 months following their infection, and this was the first psychiatric diagnosis for 36% of those 

. These rates are higher than what would be expected in people with similar illness such as the flu, and there is speculation that the infection itself may have its own neuropsychiatric effects.

We sometimes classify depression as either exogenous or endogenous, but both are equally treatable. Exogenous depression is triggered by external stressors, like COVID-19, whereas endogenous depression seems to come out of the blue and is considered primarily biological. Sometimes exogenous depression can be overlooked due to the seemingly situational origin of symptoms.We have certainly seen a rise in patients suffering from exogenous depression brought about by pandemic-inflicted circumstances like interpersonal loss, opportunity loss, and economic hardship.But dismissing these symptoms as situational and not worthy of treatment creates a problem for patients in need.

Do not Assume Pandemic Depression Will Disappear with a Vaccine

Stress can lead to brain changes that underlie depression, and such changes will remain long after vaccines roll out. Since cases are expected to rise, it is important that we not only listen, but actively screen for depression so diagnosis and treatment are not delayed. To facilitate this process, we should lean into available screening tools at our fingertips, like the Patient Health Questionnaire (PHQ-9), a common tool used to screen, diagnose, monitor, and measure the severity of 

. A patient can easily complete the PHQ-9 prior to their appointment or even in the waiting room, and it can be quickly scored by clinicians.

Once we accept that cases of exogenous depression are likely to remain even after protocols lift, the conversation can shift to the importance of discussing all treatment options with patients.

The reality is that drug therapy simply does not work for all patients – and it is important that we shift our thinking to consider TMS (Transcranial Magnetic Stimulation) sooner in the patient 

. It is a safe and effective treatment option for adult patients struggling with either exogenous or endogenous depression and has minimal systemic side effects. 

I’ve supported thousands of patients through depression – many of whom were among the estimated 6.2 million who do not benefit from antidepressant 

- with TMS therapy, an FDA-cleared, insurance covered, non-invasive treatment that uses MRI-strength magnetic pulses to stimulate specific areas of the brain associated with mood.

After 12 years of treating depressed patients with TMS therapy, my practice is one of the larger providers in the country. We have administered more than 100,000 treatments across 12 locations, and as we navigate this mental health pandemic, I’d urge you to keep these best practices top of mind.

With TMS, we are seeing better response and remission rates than patients experience on their second, third or fourth antidepressant. In fact, research indicates the likelihood of remission drops in depressed patients who are unresponsive to multiple antidepressant 

. This makes TMS an especially appealing option for those struggling with chronic and persistent depression, as well as first episodes.

In conclusion, current depression rates within the U.S. are increasing to staggering levels. As the hurricane of COVID passes, we are left dealing with its devastating impact on mental health in America. To fight this new pandemic, physicians must increase screening efforts and raise patient awareness of safe and effective treatments beyond drug therapy. Physicians would be wise to mitigate the damage by teaching patients about non-drug treatment options like TMS early on. The sooner the better for everyone.

Dr. Todd Hutton is the Medical Director at 

. Dr. Hutton is a board certified Psychiatrist and a Distinguished Fellow of the American Psychiatric Association. He is an Adjunct Clinical Professor of Psychiatry at the USC Keck School of Medicine where he teaches residents in Psychiatry. Dr. Hutton completed his advanced TMS Therapy Fellowship at Duke University Medical Center. He was also elected the 

Articles

Dr. Todd Hutton gives tips for how to best handle the ongoing mental health crisis.

As One Pandemic Ends, My Tips on How To Navigate This Next One

As it often presents with nonspecific symptoms, depression is a very serious condition that can, sadly, become all too easy to overlook. However, major depression is a real health issue in our country that 

affects more than 16 million adults in the US

 at all stages of life—from celebrities to everyday people like you and me.

Unfortunately, sufferers aren’t always proactive about seeking the help they might need, even those with access to the best of care. This is partly because of the stigma associated with mental health, and partly because people with depression lose hope that they can be better.

As we embark upon the notoriously gloomy winter months, it’s more important than ever for health practitioners across the board, not just psychiatrists, to be on the lookout for signs and symptoms of depression in their patients, and to be prepared to provide support as soon as possible. This means remaining open to exploring the wide variety of available, safe and effective treatment options for sufferers, like transcranial magnetic stimulation (TMS).

I’ve seen firsthand the effect that mental illnesses like depression can have on individuals as well as their families and loved ones, and far too often I’m confronted with patients who have been suffering for far too long without relief. While psychiatry is my specialty, I value the collaborative role of physicians and know that it is when we work together to align on the best course of action that we see the best success with our patients, and this is particularly true in the case of patients suffering from depression. My work has led to wonderful relationships with professionals across specialties and it is this type of synergy and shared expertise that most often results in happier, healthier patients, whose well-being have been placed front and center.

Typically, doctors prescribe talk therapy, antidepressants, or a mix of both for depressed patients. These treatments work for many people, but unfortunately, not all. In fact, in any 

, only a minority of patients achieve full remission, and as trials of antidepressant medication increases, so can side effects and the potential for treatment failure. Of course, there are off-label options for consideration, but as doctors, we should first focus on proven options that are safe and effective—such as TMS. At my practice, I’ve seen great results with NeuroStar Advanced Therapy.

NeuroStar was the first TMS device to receive US Food and Drug Administration (FDA) clearance in 2008. 

, 58% of patients significantly responded to treatment, and 37% achieved complete remission of their depression symptoms with NeuroStar. Among people followed for 12 months after acute treatment, 

Despite these promising statistics and results, a common misconception is that TMS treatments are last-resort options when all else fails—but this isn’t the case. The American Psychiatric Association 

 TMS as a second-line treatment and unlike electroconvulsive therapy (ECT), TMS is non-invasive and allows patients to continue their regular daily activities immediately following treatment sessions.

It’s a great option, and one my patients prefer, as it’s 

 often seen with antidepressant medications.  TMS shouldn’t be brought into play in the fourth quarter of the game. I’ve seen in my own practice the positive impact it can have and urge other doctors across specialties to consider TMS therapy earlier in our patients’ treatment plans, in the hopes that we can shorten the length of their suffering.

Patients don’t have to settle for living in a fog, merely getting by as they try to function with their depression. With therapy like NeuroStar, remission from depression can be achieved when medication fail and doctors on the front lines of care need to be aware of this so they can be armed with all the tools available to help their patients. There are a variety of resources available for doctors to address mental illnesses like depression, and it is our duty as clinicians to empower our patients and help them in their fight against depression. My recommendations on steps physicians can take to help best meet the needs of patients include:

Be open with patients and ask about symptoms of depression. Be mindful of their mental health history and encourage these important conversations.

Know how to initiate screenings, if applicable. The US Preventive Task Force recommends that 

adults over the age of 18 be screened for depression

. The recommendation is for clinical practitioners to implement screening with adequate systems in place. This means they should have systems and staff to ensure patients are screened, appropriately diagnosed and treated with care or referred to a setting where they can receive adequate care.

Have a strong and trustworthy referral network of mental health professionals.

If appropriate, consider TMS as a viable treatment offering.

Why TMS Works for My Patients & Practice 

My practice is now solely focused on TMS therapy because I have seen its impact. My first patient was a nurse who failed to respond to dozens of medications, but had full remission with TMS. Since then, I have seen many patients seeking out TMS therapy who are partial medication responders.

These patients are better on their medications in that they may be no longer suicidal and can function, but they are hardly satisfied with their quality of life. Their doctors had given up on trying to get them to full remission. These patients would seek out TMS on their own, and many were able to reach the remission that they were seeking. As we learn more about TMS, our techniques and response rates have improved. In my practice now, we see 56% of our patients get to remission (as per depression scale scoring) and 72% achieve response (as per 50% reduction on a depression scale).

As doctors, we have an incredible opportunity to heal those who are not well and transform lives. With that role also comes the responsibility to advocate for our patients, especially when they aren’t in a position to advocate for themselves. Sometimes this means adjusting our viewpoints on viable treatment options and thinking outside of the box to consider new or alternative methods that will set them on the path to recovery.

As professionals, let’s continue our work to break the stigma of depression, and open our minds to treatment options that will help us give our patients the fighting chance we know they deserve.

Todd Hutton, MD, is the medical director at Southern California TMS Center, a board-certified Psychiatrist, and a Fellow of the American Psychiatric Association. He is an Associate Clinical Professor of Psychiatry at the USC Keck School of Medicine where he teaches residents in Psychiatry, and is on staff at Huntington Memorial Hospital in Pasadena, CA. 

The piece reflects his views, not necessarily those of the publication.

Healthcare professionals and researchers interested in responding to this piece or contributing to MD Magazine® can reach the editorial staff 

Physicians on the front lines of care should be empowered to consider alternative treatment options for patients in significant need.