Transcranial Magnetic Stimulation (TMS)

Transcranial Magnetic Stimulation (TMS) is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain, helping to alleviate symptoms of depression. TMS is especially beneficial for patients who have not responded to traditional medications or therapies. This treatment can offer long-lasting improvements, and many patients experience a significant reduction in their depression symptoms, often after completing a full course of treatment.

What is Transcranial Magnetic Stimulation (TMS)?

Transcranial Magnetic Stimulation (TMS) is an FDA-approved, non-invasive treatment primarily used to address major depressive disorder (MDD) and other mental health conditions. Particularly beneficial for individuals who have not responded to antidepressant medications, TMS works by using magnetic pulses to stimulate nerve cells in the brain, specifically targeting the prefrontal cortex. This area is crucial for mood regulation. By stimulating this region, TMS can help alleviate depressive symptoms and improve overall mental well-being, offering a safe and effective alternative treatment.

How Does TMS Help with Depression?

In individuals with depression, certain regions of the brain, particularly the dorsolateral prefrontal cortex, are often underactive. TMS addresses this by delivering repetitive magnetic pulses to these underactive areas, boosting neuronal activity and increasing the release of neurotransmitters such as serotonin, dopamine, and norepinephrine. This process helps restore normal brain function, reduce depressive symptoms, and improve mood over time, providing an effective solution for those who haven’t found relief from other treatments.

Treatment Prognosis

Approximately 75% of patients who undergo TMS report a positive response to the treatment, experiencing significant improvements in mood and a reduction in depressive symptoms. The treatment has been found to be effective for individuals who have not responded well to traditional medications, providing hope for those facing persistent mental health challenges.

The First Session: Motor Threshold Testing

The first TMS session begins with a motor threshold test, which typically lasts about one hour. This test helps determine the appropriate intensity of stimulation for each patient. The provider places the TMS coil on the scalp and delivers brief magnetic pulses to locate the motor cortex. The goal is to identify the minimal stimulation required to cause a visible movement in the patient’s hand or fingers, known as the motor threshold. This threshold ensures that the stimulation intensity is personalized for optimal effectiveness.

TMS Treatment Protocol

The standard TMS treatment protocol involves 36 sessions spread over 9 weeks, with each session lasting 20-30 minutes. Patients remain awake and alert throughout the session and can resume normal activities immediately afterward. The treatment schedule typically starts with five sessions per week for the first six weeks, followed by three sessions in week seven, two sessions in week eight, and one session in week nine. This gradual tapering helps maximize the treatment's benefits while minimizing potential side effects.

Risks and Side Effects

TMS is considered a safe and well-tolerated treatment, though some mild side effects may occur. The most common side effects include mild headache or scalp discomfort, which usually resolves after a few sessions. Other potential side effects may include tingling, twitching, or spasms in facial muscles, lightheadedness, or temporary sensitivity to the clicking sound of the machine (earplugs are provided). While rare, there is a slight risk of seizures, typically in patients with a history of seizures or epilepsy.

Contraindications: Who Should NOT Receive TMS?

TMS is not suitable for everyone. It should be avoided by individuals with metal implants near the head (such as aneurysm clips, deep brain stimulators, or cochlear implants), those with implanted medical devices (such as pacemakers or insulin pumps), and individuals with severe neurological conditions that may increase the risk of seizures. TMS is also contraindicated for individuals with a history of seizures, brain aneurysms, hemorrhagic stroke, mania, or psychosis.

What to Expect During and After TMS Treatment

Improvements in depressive symptoms may begin after 2-3 weeks of treatment, although some patients notice changes sooner. The long-term benefits of TMS can last for months or even years, although maintenance sessions may be necessary for some individuals. One of the key advantages of TMS is that it does not involve medications, meaning it avoids many common systemic side effects associated with antidepressants, such as weight gain, insomnia, fatigue, or sexual dysfunction.

TMS Treatment Flow

The TMS treatment process begins with a contraindication questionnaire followed by a complimentary pre-assessment and medical clearance. Afterward, the motor threshold test is conducted, and the patient begins the 36-session treatment protocol. After completing the sessions, a follow-up appointment is scheduled to evaluate the progress and determine if further maintenance sessions are needed. This comprehensive approach ensures that the treatment is customized and effective, leading to long-term mental health improvements.

Covered by insurance, TMS offers a safe and effective option for individuals struggling with treatment-resistant depression. It requires no sedation, and each session is painless, making it an attractive alternative for those seeking non-invasive treatments. TMS is a powerful tool in helping patients regain control over their lives, especially when other treatments have been unsuccessful.