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Transcranial magnetic stimulation (TMS) – A new cure for chronic depression

What is TMS therapy? How does it work?

Introduced in 1985, transcranial magnetic stimulation (TMS) is a brain stimulation therapy that helps treat psychiatric disorders like depression. TMS is a non-invasive treatment where doctors use magnetic fields to stimulate a targeted area of the brain to reduce symptoms of depression.

When should you try TMS therapy?

According to the National Center for Biotechnology Information, 30% of patients experiencing depression don’t respond to traditional treatment like medication and talk therapy. If you have been diagnosed with depression, and your symptoms have not improved through these traditional methods, you may be a good candidate for this painless brain stimulation therapy.

What should you do before receiving TMS treatment?

1. You have to do a few lab tests and a physical exam.

2. You’ll need a psychiatric evaluation.

3. You should inform your doctor of any medications you are taking

4. Your doctor will ask about your medical history, such as:

  • if you are pregnant or planning to get pregnant
  • have any medical implants
  • have been diagnosed with any other mental health conditions
  • have a brain tumor or injury
  • often experience severe headaches or migraines

TMS therapy for depression – How does it work?

SC WW blogpost - late night thoughts

Step 1: You will sit in a reclining chair with a footrest. The physician will keep a pillow around your head to make you feel comfortable.

Step 2: You will wear a cotton cap with a mark on the treatment spot.

Step 3: A certified physician will keep the electromagnetic coil secure against your scalp.

Step 4: The electromagnetic coil will stimulate specific nerve cells in your brain which control mood and depression.

Step 5: The magnetic pulse activates parts of the brain that have decreased activity due to depression.

Step 6: The stimulation helps to reduce your depression symptoms.

Do you need someone to go with you to the appointment?

You can visit the mental health clinic and go back home alone.

TMS therapy is not painful. You will not need to be sedated.

What are the four different types of TMS therapy?

Traditional TMS therapy: This is the primary form of TMS therapy given to patients with Major Depressive Disorder. Traditional TMS therapy uses low-intensity magnetic pulses to stimulate nerve cells of the brain that control mood.

Deep transcranial magnetic stimulation (dTMS): dTMS involves a non-invasive brain stimulation technique. The magnetic stimulation is delivered to the deep brain areas.

In deep TMS therapy, physicians use different H-coils to stimulate up to 4cm beneath the skull.

Repetitive transcranial magnetic stimulation (rTMS): During an rTMS treatment session, the patient receives a series of brief, repeated and highly focused magnetic pulses called a pulsed magnetic field. These pulses stimulate brain cells in treating MDD.

The treatment session lasts for about 19 to 37 minutes while patients recline in a comfortable chair. The patient remains awake and aware during all TMS treatment sessions. There is no medication necessary during treatment, and the patient generally experiences mild side effects.

The treatment usually consists of five sessions per week for six weeks. Most patients will experience a lift in symptoms around the tenth session after two weeks of rTMS.

Intermittent Theta Burst Stimulation (iTBS): iTBS is an express 3-minutes and 9 seconds session. iTBS uses a unique, higher frequency magnetic pulse that enables faster delivery of the magnetic stimulation therapy.

iTBS, the accelerated form of TMS, consists of:

1- Routine protocol: five sessions per week for six weeks.

2- SAINT protocol: 10 sessions of 10 minutes per day with 50-minute intersession intervals for 5 days

3- Intense modified protocol:

Week 1: 3 treatment days, 3 sessions per day (9 total).

Week 2: 2 treatment days, 3 sessions per day (6 total).

Weeks 3 and 4: 1 treatment day, 3 sessions per day (6 total) for 4 weeks. 15-minute intervals between sessions.

Can you use TMS therapy for other mental health disorders?

TMS therapy is not only an effective treatment for depression, but it can also treat a variety of other mental health disorders.

Generalized anxiety disorder: When medication and psychotherapy don’t achieve positive results, TMS therapy can treat generalized anxiety. It helps to reduce anxiety symptoms by controlling nerve cell activity in the prefrontal cortex.

Obsessive-Compulsive Disorder (OCD): According to the National Center for Biotechnology Information, individuals with OCD often have hyperactivity between the striatum and prefrontal cortex. TMS treatments can reduce the hyperactivity and OCD symptoms.

Schizophrenia: Schizophrenic patients often have auditory hallucinations. Magnetic impulses are delivered to the overactive temporoparietal cortex, which is involved in language. This may help to reduce auditory hallucinations.

Alzheimer’s disease: According to the National Center for Biotechnology Information, TMS therapy may help to reduce Alzheimer’s symptoms by changing the neural connections between memory and learning.

Post-traumatic stress disorder (PTSD): TMS therapy is quite effective for PTSD. It helps to stimulate the prefrontal cortex, reduce fear, and panic.

Stroke rehabilitation: The magnetic impulses on the motor cortex help to promote motor recovery after a stroke. The motor cortex regulates voluntary movement.

Nicotine addiction: TMS therapy stimulates the prefrontal cortex. It also helps to trigger the release of dopamine, lowering nicotine cravings.

Severe pain: TMS therapy stimulates the motor cortex and neurotransmitters involved in pain. This can give you relief from chronic pain.

Multiple sclerosis: TMS treatment along with physical therapy can help to reduce spasticity. The stimulation helps to reduce muscle tightness and promotes body movement.

Side effects of other Depression treatment compared to TMS therapy?

Side effects
Medication Electroconvulsive therapy TMS therapy (mild)
Nausea Facial twitching
Loss of libido Heart rate may increase Neck pain
Insomnia or hypersomnia Blood pressure may increase Drowsiness
Gastrointestinal discomfort Memory loss Tingling sensation
Weight gain Muscle ache
Irritation Confusion

Can TMS therapy damage your brain?

Clinical studies on long-term exposure to TMS therapy have not found any evidence of brain tumors in patients as a result of the therapy. It also does not cause memory loss or a reduction in concentration.

What are the eligibility criteria for TMS therapy?

Failure (or side effects) of antidepressants: FDA recommends TMS for patients who did not experience positive results or had no response to one adequate antidepressant trial.

Most insurances such as Aetna, Cigna, Medicare, and Tricare require a trial of two antidepressants and psychotherapy (ex: 12 session of Cognitive Behavioral Therapy (CBT) for MDD).

Age: You should be at least 18 years old.

TMS therapy, Medication and ECT – A comparative study

What to consider ECT Medication TMS

TMS therapy is better than medication and ECT
Do you need to get hospitalized? Yes No No
Are there any significant side effects? Yes Yes No
Is it non-invasive? No Yes Yes
Is it painful? Not much No No
Is it FDA-approved? Yes Yes Yes
Is it effective? Response – 66 to 79%, Remission – 47 to 75% Response – 49 to 52%, Remission – 28% Response – 68 to 70%, Remission – 45%
Do you need sedation? Yes No No

How much does transcranial magnetic stimulation cost?

The cost of TMS therapy depends on several factors. To get an idea of the overall cost, fairhealthconsumer.org is a great place to start.

The FDA approved TMS therapy to treat patients in 2008. Health insurance plans provide coverage for TMS therapy, as well. This will help to ease some of the financial burden of your treatments.

Is TMS therapy covered by Medicare?

Medicare covers TMS treatments only when talk therapy and medication have not helped to reduce your depression and anxiety symptoms.

What is the average TMS success rate?

The average success rate of TMS therapy is between 58% to 67%. The success rate of our psychiatrists is 80%+.

Is TMS therapy safe? Is it suitable for everyone?

TMS therapy is safe. However, you should avoid it if you have stents, metal plates, facial tattoos, and coils in your body due to the strong magnetic fields released during rTMS.

FDA cleared TMS devices – A comparative analysis

MagVenture Brainsway Neurostar Magstim CloudTMS
rTMS Yes Yes Yes Yes Yes
iTBS Yes Not FDA approved Yes Yes Not FDA approved
OCD D-B80 H7 No No No

Written by, On Apr 24, 2021

Dr. Sonia Parikh, MD is an adult psychiatrist and cofounder of Savant Care, Inc. She is a TMS (Transcranial Magnetic Stimulation) practitioner and is accepting new patients for TMS.