Star Tribune
Depression therapy has magnetic appeal across Minnesota
A magnetic therapy for persistent depression is in such demand in the Twin Cities that Allina Health has doubled its capacity with the opening of a new mental health center in Fridley.
While antidepressant medications and talk therapy are still the first options, Allina psychiatrist Dr. Bennett Poss said alternatives are needed for the growing share of patients who aren’t helped by those treatments alone. Transcranial magnetic stimulation has been an option in the U.S. for 15 years, but it emerged in the post-pandemic era as more people sought depression treatment and more research validated its potential.
“Evidence-wise, it’s one of those things that has actually panned out better or at least as advertised,” said Poss, who provides TMS at Allina’s Abbott Northwestern Hospital in Minneapolis. “There are so many things that look good in clinical trials and then they make it to patient care and they’re not so good.”
TMS involves magnetic coils that are placed on the scalp for around 30 minutes and direct pulses into the brain, usually at a golf-ball-sized target on the front left side that regulates mood. After one to two months of five-day-a-week treatments, about half of patients report some benefit and a third see remission of depressive symptoms, studies have shown.
Poss likened it to lifting weights or running, and he said that it stimulates a part of the brain that is underutilized in people with depression.
“We put it into use more than you would otherwise, and over time it causes some of the same changes you would actually see with exercise” to the body, he said.
More than 23% of Minnesota adults reported in 2022 that they had depression at some point, an increase from 15% in 2011, according to survey data from the Centers for Disease Control and Prevention. Minnesota in that timespan went from below the national average to at or slightly above it.
TMS is only recommended for a fraction of those patients who have been diagnosed with major depressive disorder, which is marked by severe and prolonged sadness and hopelessness. But clinicians said that is being diagnosed more as well.
“The cool thing about (TMS) is once people have received the treatment, and if they respond to it, they don’t have to continue it, necessarily. So it’s distinct in some ways from medication,” said Dr. Sophia Albott, who heads the University of Minnesota’s division of adult mental health.
The treatment has roots at the U, where Dr. Ziad Nahas was involved in clinical trials that persuaded the U.S. Food and Drug Administration to approve it in 2008 as a treatment for major depression in adults.
Albott said the magnetic therapy was originally limited to patients who had tried therapy and had no success, or had severe side effects, with at least four antidepressant drugs. The federal Medicare program recently expanded its coverage so that patients only had to try two drugs before being eligible for TMS, which partly explains the recent growth in Minnesota.
Coverage in Minnesota varies by insurance plan and employer. HealthPartners generally uses prior authorization in its plans to make sure patients have tried other treatments first, but Medica does not use that restriction.
Albott said she hopes it becomes more of a first-line therapy, though its time commitment will remain a barrier along with the roughly $10,000 cost shared between patients and insurers. Recent U research has tried to predict which patients respond best to TMS, whether it substantially increases interest in daily life and reduces suicidal impulses, and whether it can be expanded for use by adolescents and for neurological conditions such as stroke.
The treatment already has been approved for smoking and obsessive compulsive disorder, and some researchers believe it can treat the ear-ringing condition known as tinnitus, which also reportedly increased during the COVID-19 pandemic.
Becky Steffens, 39, of Coon Rapids, didn’t believe it would work, not after 15 years of dealing with depressive symptoms. Success at the U’s clinic for treatment-resistant depression came when her doctors switched sides and directed magnetic pulses into the right side of her brain. Research has found that some patients need stimulation on that side to regulate a different portion of the brain that fuels negative thoughts.
Treatment wasn’t easy because it disrupted work, was noisy and uncomfortable, she said. “It’s like a little bird is pecking on the same spot on your head over and over for like 50 minutes.”
It also wasn’t one-and-done success, as she needed two rounds and once-a-week maintenance treatments along with other depression therapies. But TMS gave Steffens several months of complete remission and reduced symptoms the rest of the time that allowed her to discover joys in life such as painting and volunteering.
“I’m able to have a baseline where I’m not necessarily, like, happy and joyful and everything is great,” she said, “but I’m not sad and stuck. I feel like it’s kind of a place where I’m able to have emotions, feel them and then come back to a baseline … and not get stuck in those negative sticky thoughts.”
Poss said there will be need for other treatments, including more extreme but highly effective electroconvulsive therapy that causes patients to go into seizures and “resets” their brains without depressive symptoms. But he said he is particularly optimistic about TMS now that it is gaining interest and access is expanding at Allina’s Mercy Hospital Campus in Fridley.
One person was killed and two were critically injured in a head-on collision on a western Wisconsin highway, officials said.
The crash occurred shortly after 11:30 a.m. Monday about 9 miles south of Turtle Lake on Hwy. 63, the Polk County Sheriff’s Office said.
An SUV driver heading south crossed over the center line and hit a northbound car, the sheriff’s office said.
The car’s driver was killed, and a passenger in the vehicle suffered life-threatening injuries, according to the sheriff’s office. The SUV driver also was critically injured, the sheriff’s office added.
Officials have yet to release the identities of any of the vehicles’ occupants.
Star Tribune
Experts working to end homelessness in Minnesota say Supreme Court ruling on Grants Pass v. Johnson will make their jobs harder
Organizations working to end homelessness in Minnesota warn that it’s going to get harder to move people living on the streets into permanent housing, after a recent U.S. Supreme Court ruling.
The high court ruled Friday that fining or jailing people for breaking anti-camping ordinances when there is no shelter available does not violate the Constitution. The decision gives local governments across the country the green light to cite and possibly arrest people living in homeless encampments or other public spaces.
“We know that this population in particular, with higher rates of significant mental health conditions, higher rates of substance use disorders, are facing a lot of barriers already,” said Stephanie Nelson-Dusek, a research scientist behind the Wilder Foundation’s triennial Minnesota Homeless Study. “Piling on more barriers is not a solution to ending homelessness.”
The Supreme Court reversed a lower court’s ruling on City of Grants Pass v. Johnson, which the National Homelessness Law Center called the most significant case on homelessness to be reviewed by the Supreme Court in 40 years. When advocates for the poor in Grants Pass, Ore., accused the city of using anti-camping laws to effectively banish its homeless population into other communities, Grants Pass petitioned the Supreme Court to defend its ability to close encampments and issue citations of nearly $300 that could escalate to larger fines of $1,250, a month in jail and a ban from city property if not paid on time.
“From 30 years of research, we know that people who are sleeping outside … have some of the most complex health needs of our homeless population, which can really limit the ability to get housing, especially in a competitive rental market,” Nelson-Dusek said. “The decision glosses over the bigger picture, which is that we do not have enough safe and stable housing. We don’t have enough shelter beds, or at least beds that are needed at the moment they’re needed, in areas throughout our state.”
Last October the study found that one-third of homeless adults in Minnesota had been turned away from a shelter in the previous three months, with two-thirds sleeping in a car, vacant building or on public transit as a result. Nearly half of homeless adults were on a waiting list for public housing, and another 10% couldn’t get on the waiting list because it was closed to new applicants.
The state of Minnesota filed a brief opposing the city of Grants Pass, asking the court to uphold homeless people’s right to sleep in public in lieu of shelter. Attorney General Keith Ellison’s office argued that was a “narrow” protection given that local governments would still be able to limit the size and location of encampments, and punish criminal conduct related to encampments such as littering, public drug use and defecation.
“There is overwhelming evidence, meanwhile, that criminalizing involuntary homelessness makes already difficult situations even worse,” the Attorney General’s brief said. “People who have been incarcerated are ten times more likely to be homeless than the general population. This statistic is unsurprising, given the many barriers between people with criminal records and the resources they need to obtain housing and employment. In addition, efforts to clear encampments often destroy the identification papers, cellphones, laptops, and other items that people would use to find employment or housing.”
The city of Grants Pass argued that it was practically barred from enforcing anti-camping laws against anyone because police officers couldn’t tell who wanted shelter but couldn’t get it, who refused shelter because it was not “adequate,” and what adequate shelter meant. Grants Pass has one shelter based in a Christian church that requires homeless people attend daily religious services in return for a place to sleep.
“Given the difficulties of administering a shelter-based approach, district courts applying [prior court rulings] have hamstrung cities in enforcing public-camping laws against anyone unless and until they have enough ‘secular shelter space’ for everyone — a near-impossible task, especially because the number of homeless people surpasses the shelter available in every major western city and continues to climb,” the city wrote in its petition.
In a 6-3 ruling Friday, the Supreme Court sided with the Oregon city, overturning a 2018 decision out of Idaho that limited western cities’ ability to sweep camps in lieu of providing adequate shelter. Writing for the majority, Justice Neil Gorsuch opined that fines and jail time were not “cruel and unusual” methods of punishment, regardless of the conduct being punished. For the minority, Justice Sonia Sotomayor wrote that the court had abdicated its role safeguarding the most vulnerable Americans.
Hennepin County is working with a national organization, Community Solutions, to achieve functional zero chronic homelessness — the state in which more people are helped into housing than losing it — by 2025. The goal is complicated by cities’ need to close encampments when they become too large and problematic for neighborhoods and demand for shelter beds outpacing supply.
Regardless of the many practical difficulties, fining and arresting people for trespassing on public land makes those challenges worse, Communities Solutions’ Chief Program Officer Beth Sandor said.
“There’s nowhere in America where arresting and fining people for sleeping on the street has led to reductions in unsheltered homelessness or an overall homelessness,” Sandor said. “Fees and fines make it harder for people to access employment, housing and social services … And so we hope the focus will really be on solutions rather than expensive ways to not solve homelessness.”
A U.S. parole commission has denied release for Leonard Peltier, a 79-year-old member of the American Indian Movement convicted of murdering two FBI agents during a shootout on the Pine Ridge Reservation in South Dakota.
Peltier, who has maintained his innocence during his 47 years in prison, appeared for a parole hearing last month at the federal complex in Coleman, Fla., northwest of Orlando. His next opportunity for parole is set for June 2039, said Kevin Sharp, his attorney.
In 1973, Native Americans led by the American Indian Movement occupied Wounded Knee, S.D., over Indian rights issues in a historic standoff with federal authorities. In 1974, two AIM leaders, Dennis Banks and Russell Means, went on trial in federal court in St. Paul. The trial ended when U.S. District Judge Fred Nichol dismissed the charges, citing government conduct.
The following year, Special FBI Agents Jack Coler and Ronald Williams were shot while driving separate cars in pursuit of a robbery suspect on the reservation. A gunman then shot and killed the agents at close range. The FBI said that gunman was Peltier. His supporters have long held that prosecutors only showed that he was present at the shootout, not that he fired the fatal shots.
“Our position is that you’ve got a conviction on a seriously flawed set of facts,” Sharp said in an interview last month. “You have a conviction that is seriously tainted with investigation and prosecutorial misconduct, yet Leonard has spent over half of his life in prison. Any additional incarceration is just retribution. It serves no purpose toward any idea of justice. You also have got a nearly 80-year-old man who spent nearly 50 years in prison. He has a serious health condition. The prison cannot take care of his health needs. They got their pound of flesh. It’s time to end this.”
FBI Director Christopher Wray submitted a statement urging the commission to reject Peltier’s parole.
“We must never forget or put aside that Peltier intentionally murdered these two young men and has never expressed remorse for his ruthless actions. … Granting parole for Peltier would only serve to diminish the brutality of his crime and further the suffering of the surviving families of Coler and Williams, as well as the larger FBI family.”
Star Tribune staff writer Randy Furst contributed to this story.
