Transcranial Magnetic Stimulation (TMS) therapy sounds intimidating. The name alone is a mouthful and the visual it creates—skulls and magnets—is potentially alarming. But in reality, TMS therapy is neither intimidating nor alarming. It’s a treatment for treatment-resistant depression that has been FDA approved since 2013. It might sound “woo-woo,” but there’s real science behind it and real people who have benefited from it.
What Is TMS Therapy?
TMS therapy is a noninvasive form of brain stimulation used when frontline treatments, including antidepressants and psychotherapy, prove ineffective for a patient. The treatment is delivered by a device that generates “highly concentrated, magnetic fields which are rapidly switched on and off.”
An electromagnetic coil is placed over the area of the brain that we know is involved in depression. The coils create repeating magnetic fields which can generate electrical activity in the nerve cells, stimulating the target area, as well as other connected areas of the brain.
Treatment sessions typically last 30-40 minutes, but can vary in length. Most patients receive treatment five days a week for four to six weeks, and many may continue for another few weeks to taper off the treatment.
What To Expect At The First Treatment?
TMS therapy is prescribed by a TMS physician, but the treatment is usually administered by a TMS technician. During the first session, the physician determines the patient’s initial motor threshold. This is done “by administering several brief pulses” and determining “the minimum amount of power necessary to make the patient’s thumb twitch.” The motor threshold is used to personalize the treatment settings and figure out what amount of energy is needed for brain cell stimulation.
Treatment begins once the coil is placed based on all the patient’s measurements. Patients will hear loud clicking sounds and may feel tapping. Patients may begin to experience relief after one session, though for most, relief becomes noticeable after the third week of treatment, or even not until the sixth week of treatment, in some cases.
Who Would Benefit From TMS?
TMS therapy is appropriate for folks for whom antidepressant medications proved inadequate. “50% to 60% of people with depression who have tried and failed to receive benefit from medications experience a clinically meaningful response with TMS,” according to Adam P. Stern, MD, director of psychiatric applications at Beth Israel Deaconess Medical Center’s Berenson-Allen Center for Noninvasive Brain Stimulation.
TMS therapy would not be appropriate for patients with metal in their heads, including aneurysm clips or coils, stents in the neck or brain, metallic implants, shrapnel or bullet fragments in or near the head, facial tattoos with metallic or magnetic-sensitive ink, or any other metal object in or near the head. Braces and dental fillings are excluded from this list and considered safe during treatment.
What Are The Side Effects?
TMS is noninvasive, which means it’s not surgical, and non-systemic and targeted, which means it does not affect other areas of the body like a medication might. TMS doesn’t require anesthesia or a hospital stay. It’s generally “well tolerated” and typically patients can drive home and return to their usual activities after.
The most common side effect reported in about half of patients is headache, usually mild. The headache can be treated with over-the-counter medication and usually lessens over the course of treatment. A smaller number of patients may experience hearing troubles due to the noise produced by the device, but this is likely a temporary effect—and patients are generally advised to wear ear plugs while receiving treatment.
The most serious side effect of TMS therapy is seizures. But it’s important to note that this risk is “exceedingly low.” As a result, patients who are prone to seizures or who suffer from epilepsy, a history of head injury, or other serious neurologic issues, should exercise caution when deciding whether TMS is right for them.
Are The Effects Permanent?
Unfortunately, the results of TMS are not permanent. However, many patients find that they feel better for a little more than a year after treatment. Many may choose to return for additional rounds of treatment at that time.
Is TMS appropriate to treat anything else?
The FDA has recently approved TMS therapy for adult patients with obsessive-compulsive disorder (OCD). The therapy has also been studied and is showing promising results for treating PTSD, neuropathic pain, and fibromyalgia. The FDA recently cleared the treatment for short-term smoking cessation in adults.
Depression is one of the most common mental conditions in the United States and can impair a person’s life as much as any other chronic disease. TMS is just one tool researchers and clinicians are developing to help folks suffering from depression. The treatment is FDA approved, safe, and largely effective. It’s not a miracle treatment—no treatment is yet—but it is a giant leap in the right direction for many patients.
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