Mike Parker felt nothing, just a yawning emptiness. He did not want to get out of bed. He did not want to interact with his wife or play with his dogs. Diagnosed with depression, he tried medication but could not find any that was effective. He was hospitalized twice and had to quit his chef's job. 

"People think of depression as you're sad. You're not sad. You just don't have the will to live. You're just breathing. You don't want to eat. You don't want to get a shower," he said. "It's just a whole lot of nothing. A blank state of barely surviving." 

Then Mike tried a treatment called TMS, or transcranial magnetic stimulation. TMS is a noninvasive, outpatient procedure that uses a machine to stimulate nerve cells in the brain and improve the symptoms of depression. Parker recently completed six weeks of treatments offered by WellSpan Philhaven. 

"Within the first week, I could tell my mood had lightened a little bit," said Parker, 43. "After six weeks, I felt like a new person." 

Parker and his wife hosted family members over the holidays at their Berks County home. He actively participated in and enjoyed the visit, something he would not have been able to do without the treatment.  

"I made dinner, which I have not done in a while," he said. "We watched a couple of Christmas movies and had breakfast Christmas morning. It was good." 

Overall, 70 percent of patients treated with TMS at Philhaven have seen an improvement in their depression symptoms and 42 percent have had a complete remission of their symptoms. 

A different way to treat depression 

Depression is the leading cause of disability for people ages 15 to 44 in the U.S., according to the U.S. Centers for Disease Control. Medications and therapy are the first line of treatment, but they do not work for everyone, said Dr. Sehar Khokher, the associate medical director of WellSpan Philhaven who is trained to deliver TMS, which Philhaven has offered since 2019. 

Approved by the Food and Drug Administration, TMS is a part of a growing field of "neuromodulation" treatments that deliver electrical or chemical signals to targeted areas of the nervous system, acting directly on the nerves. Neuromodulation therapies include spinal cord stimulation to treat chronic neuropathic pain, deep brain stimulation for Parkinson's disease and other disorders, and vagal nerve stimulation for epilepsy. 

TMS treatments deliver targeted magnetic pulses to stimulate mood-controlling areas of the brain that are underactive in people who have depression, lessening or eliminating their depression symptoms. 

TMS also is showing promise as a treatment for other conditions. The creators of the particular type of TMS device used at Philhaven, called NeuroStar, are working toward approval for use in the treatment of tobacco addiction and for bipolar depression. TMS also is being investigated for the treatment of opioid or stimulant addictions, eating disorders, ADHD in children, and early dementia, among other conditions. 

For the treatment of depression, patients must have failed one trial (typically a six-week period) of antidepressant medication to qualify for TMS. The treatment is covered by Medicare and most private insurances. 

The process, and its results 

Patients receive a 30-minute treatment every weekday for six to eight weeks at one of the two Philhaven locations that offer TMS: the Mt. Gretna campus, in Lebanon County, and the Meadowlands office, in York. 

Patients sit in a chair during treatments. The treatment device has an arm with a small device that is situated just above the front of the head, but not touching it, and delivers the electrical impulses to a specific area of the brain. The patient is awake – in fact it is preferred they are talking, reading, or otherwise mentally engaged for maximum effect. 

"The treatment feels like a pencil eraser tapping on your head, for short bursts," Mike said. "It's not uncomfortable." 

About 60 percent of patients may need another round of TMS treatments. Mike was in this group. His treatment at Philhaven followed treatment he received four years ago in North Carolina, where he used to live. He was taking medication but started to feel depressed again and sought out another TMS provider. 

Khokher said the treatment can be "life changing" for patients, who often talk about having hope for the first time in a long period.  

She recalls a particular woman who had not left her house in years, due to her depression. By the second week of treatments, the woman was driving places and walking around the block in her neighborhood. 

"I don't think people realize how debilitating depression can be," she said. "We just manage depression. We don't cure it. I think this will change future treatment approaches and I think the technology will get a lot more sophisticated as time goes on and continue to evolve." 

For Mike, TMS "seemed like magic, like a switch had been flipped. My wife was thrilled. After the treatment was done, we started going outside and going on hikes. We bought kayaks. We started going to restaurants. We started living." 

He adds, "I am not the same person, in a very good way. It was night and day for me." 

For more information on TMS treatments at WellSpan, go here.