Transcranial Magnetic Stimulation (TMS)
What is TMS?
-
It is a noninvasive treatment that uses magnetic fields to stimulate nerve cells in a specific spot (or spots) in the brain. The fields are directed at the parts of the brain where depression and anxiety stem from.
It involves repetitive magnetic pulses so it is also referred to as repetitive TMS or rTMS.
TMS was FDA approved in 2008 and addresses the source of the problem in the brain.
Continued research is taking place, but TMS is also believed to relieve symptoms for other disorders such as Bipolar Disorder, Obsessive Compulsive Disorder (OCD), Post-Traumatic Stress Disorder (PTSD), Alcohol use Disorder, Substance use Disorder, and memory loss.
-
An electromagnetic coil is placed on / near your forehead to a predetermined position by a Doctor. The electromagnet sends a pulse that stimulates nerve cells in the region of your brain that controls depression and/or anxiety.
People with depression and/or anxiety have reduced activity in those areas of their brains, so the electromagnetic pulses work to essentially “wake up” those parts of the brain. It works to stimulate activity where there is no or reduced activity.
-
Typical candidates are:
-People with depression and/or anxiety who have not tried other forms of treatment
-People with Major Depressive Disorder or treatment resistant depression and/or anxiety (meaning you’ve tried other forms of treatment such as anti-depressants, anxiety medication and/or therapy or counseling)
-People aged 18-70 years old are preferred. In some cases, adolescents may be eligible and individuals over 70 may be eligible.
Likely unqualified candidates:
-If you have a medical history of seizures or brain injury that could lead to complications.
-Medical implants that could break or malfunction after exposure to the magnetic energy.
-Age restrictions (mentioned above)
-
Common side effects include:
-Headache (after treatment)
-Discomfort at the site of stimulation
-Tingling or twitching of facial muscles (during treatment)
-Lightheadedness
-Fatigue (during the first week or so)
Serious side effects are rare and include seizures and mania. The consultant and Doctor will determine if you are at risk for any of these prior to treatment and if you are, will not allow you to receive treatment.
-
First, you will have a consultation where you will answer a series of questions at the treatment center with a consultant to determine your eligibility for treatment and insurance coverage.
Once scheduled to start, your first session will take about an hour to an hour and a half. You will meet with a doctor to answer additional questions to evaluate the level of depression and/or anxiety, determine the exact coil placement, determine the amount of magnetic energy needed, and then have your first session.
During regular sessions:
-You will sit in a reclining chair and the coil will be placed on your head to the previously determined location.
-The machine will start delivering stimulating pulses at the level of energy previously determined by the doctor (this can be changed during the course of your treatment based on your symptoms).
-You will feel a tapping sensation on your head where the coil rests.
-The sessions will last anywhere from 20-40 minutes depending on your treatment plan. You remain awake during treatment.
The full treatment plan typically is 30-36 sessions in 6-9 weeks. This usually is comprised of 1 session a day, 5 days a week for 6 weeks. Then 2 sessions a week for 3 weeks (the tapering period).
This is an outpatient treatment. You will be able to drive yourself to and from treatment.
You will meet with the doctor halfway through your treatment to assess how it’s going and if anything needs to be adjusted, and then you will have a post treatment follow-up with the doctor one month after treatment completion.
-
Approximately 60% of TMS patients go into full remission of their depression and/or anxiety symptoms.
Approximately 80% of TMS patients feel their symptoms have improved by at least 50%.
*Statistics are based on patients who complete the full treatment plan
Patients will also notice: Improved sleep, elevated mood, regained interest in things and activities, and decreased feelings of sadness.
Why TMS?
-
Important notes with antidepressants:
All antidepressants are required by the FDA to have a black box warning (the strictest warning for prescription medications) for suicide risk. Often times, suicidal thoughts can worsen with taking antidepressants.
Stopping antidepressant treatment abruptly or missing multiple doses can cause withdrawal-like symptoms (uneasiness, nausea, dizziness, lethargy, flu-like symptoms).
Many people have to try a number of different antidepressants to find one that works for them. With this - you are putting your body through the highs and lows of going on and coming off of medication.
If you stop taking the medication because you forget or don’t want to be on it anymore, the effects of the medication wears off. With any type of medication, your body flushes it out overtime. If you want results to last, you have to stay on the antidepressants.
With the TMS treatment, it targets fixing the actual source of depression and anxiety in your brain. It’s not messing with the chemical reactions in your brain, it’s ‘waking up’ your brain and teaching it how to properly fire neurotransmitters on it’s own - the way your brain is designed to.
Medication forces your brain to do something where TMS teaches your brain to do something. By teaching your brain how to properly function, it will be able to continue to work properly on it’s own after the 6-9 week period where with medication, you have to continuously take the medication to see results.
-
There are over two dozen different kinds of antidepressant medication.
The most common type of antidepressant is Selective Serotonin Reuptake Inhibitors (SSRI). SSRIs purpose is to change the level of serotonin in the brain and rebalance the chemicals. They block the reabsorption of serotonin which is supposed to allow neurotransmitters to send and receive chemical messages more effectively. The goal is that this would increase the mood boosting effects of serotonin and improve the symptoms of depression.
Common side effects:
-Digestive problems
-Nausea
-Dry Mouth
-Restlessness
-Headaches
-Insomnia / drowsiness
-Decreased sex drive
-Agitation
-Suicidal Thoughts
The next most common antidepressant is Serotonin-Norepinephrine Reuptake Inhibitors (SNRI). SNRIs are similar to SSRIs in that they work to block the reabsorption of serotonin, but SNRIs also block norepinephrine. The same goal applies here: to attempt to rebalance the chemicals in the brain to allow neurotransmitters to communicate more effectively resulting in reduced depression symptoms.
Common side effects:
-Heart palpitations
-Dry mouth
-Increased heart rate
-Digestive problems
-Changes in appetite
-Nausea
-Dizziness
-Restlessness
-Headache
-Insomnia / drowsiness
-Decreased sex drive
-Agitation
-
-
Visual comparison of the potential side effects for Antidepressants, Electroconvulsive Therapy (ETC), and Transcranial Magnetic Stimulation (TMS)