Pulses: A Q&A with Carlos Lowell, D.O.’90

Carlos Lowell, D.O.’90, is a board-certified psychiatrist in private practice in Sandusky, Ohio, and medical director of the TMS Institute of Ohio. He is the only osteopathic physician on the board of the Clinical Transcranial Magnetic Stimulation Society, an international organization of more than 1,000 members. He co-chairs the society’s education committee and serves on its PULSES faculty.

What Is TMS?

Transcranial magnetic stimulation is a non-invasive neurostimulation technique that uses magnetic fields to modulate brain activity. It involves applying a pulsating magnetic field to specific regions of the brain that can either enhance or inhibit neuronal activity, depending on the parameters used. An FDA-cleared neuromodulation treatment for depression since 2008, TMS is also FDA-cleared for major depressive disorder, obsessive compulsive disorder, smoking cessation, migraines and anxious depression. It is a standard and effective procedure that has given hope to patients across the country. By precisely targeting specific brain areas, TMS can help regulate brain circuits and alleviate symptoms. As an outpatient therapy with minimal side effects, it can be appealing for individuals seeking alternative treatments or who have had limited success with traditional approaches.

How Does It Work?

TMS uses small magnetic fields to stimulate or inhibit regions of the brain by electromagnetic induction through a small generator coil placed over the patient’s head. It delivers magnetic pulses to certain brain regions, producing changes in the activity of the brain cells. The frequency of pulse delivery influences whether brain activity is increased or decreased in the affected cells. This means the effects of TMS treatment can be long-lasting because it changes the patterns by which nerve cells and brain networks connect and communicate with each other.

TMS is a highly well-tolerated outpatient procedure that doesn’t require an anesthetic, as does electroconvulsive therapy. After TMS sessions, patients can resume their normal life activity, including driving. I’ve seen patients who’d been limping through life, having tried various medications, perk up right in front of me. Most improve within two to three weeks.

What Do You Want Other Health Care Providers To Know?

TMS utilizes basic osteopathic principles of the interplay of structure and function of the body. It causes functional changes that in turn alter the brain’s structure, resulting in strengthened connections at synapses that are enduring over time, rebalancing healthy functioning of brain structures and circuits. These functional and structural changes are well documented with functional magnetic resonance imaging and PET scans.

Primary care physicians treat the bulk of major depression cases. TMS can be a game-changer for serving these patients. Medical students and residents would benefit by understanding its basics as it advances. The therapy’s applications are expanding beyond psychiatry, too. Research has shown its positive application in pain management, post-stroke rehabilitation, Parkinson’s disease and substance abuse. TMS is also being used as a research tool to better understand brain function and functional neuroanatomy. I believe it’s going to be utilized across multiple specialties.

CTMSS offers excellent educational resources for medical providers on its website. I also recommend Transcranial Magnetic Stimulation: Clinical Applications for Psychiatric Practice by Richard Bermudes, M.D., Karl Lanocha, M.D., and Philip Janicak, M.D.

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