Since 9/11, more than 2.6 million Active Duty and National Guard soldiers have been deployed overseas. Epidemiological studies have demonstrated that over half of these Veterans have or will have clinical significant neuropsychiatric problems including Posttraumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI), depression, alcohol and substance abuse, and acute and chronic pain. While these VA Medical Centers provide excellent care, they often do not offer a full range of treatments for patients with neuropsychiatric problems, and especially those patients who do not respond to or cannot take antidepressants or other forms of treatment.
There is a great need for better treatments and effective therapy for Veterans suffering from severe depression. The UI Center on Depression and Resilience has launched a new pilot program offering repetitive transcranial magnetic stimulation (rTMS) therapy to Chicago-area Veterans suffering from severe depression. This program is unique in that none of the Chicago-area VA Centers currently offer rTMS treatment.
rTMS is a novel treatment for depression, and there are indications that it could effectively treat other psychiatric disorders such as PTSD and alcohol and substance abuse. The FDA approved rTMS in 2008 as a treatment to alleviate symptoms of treatment-resistant depression, when patients have not found relief from antidepressant medication. rTMS is particularly useful for treating depression that does not respond to other treatment methods and for treating patients who are unable to take antidepressant medications. Despite its effectiveness and fewer side effects compared to antidepressant medications, rTMS treatment is not currently available at any of the three Chicago-area VA Medical Centers.
Veterans are distinct from the civilian population because they are at higher risk for depression and have been repeatedly documented to be relatively resistant to treatment. Suicide rates are also relatively higher in Veterans, and comorbidity of MDD with other psychiatric disorders, such as PTSD, is very common. Depression and PTSD are highly prevalent and difficult-to-treat conditions in the Veteran community, and antidepressant medications may fail to alleviate these symptoms, particularly in Veterans. Veterans are also hesitant to take medications for depression and PTSD, citing concerns related to side effects, stigma, and the possibility to taking medication for years or a lifetime. Thus the need for alternative treatment strategies such as rTMS is paramount. Approximately 40% of Veterans receive care at a VA Medical Center, suggesting that the majority of Veterans choose and prefer alternative sources of care outside the VA. There is insufficient evidence that rTMS is effective and well-tolerated in Veterans, and thus studies are needed to determine the utility and safety of rTMS for depression specifically in Veterans.
As with any neuropsychiatric therapy, the goal is to give patients improvement in their quality of life. This program continues the UICDR’s mission to provide Veterans with the highest quality of services they both need and deserve.