Transcranial Magnetic Stimulation (TMS) for Depression

young man with depression sitting on the floor

Transcranial Magnetic Stimulation or TMS is a non-invasive electronic stimulation of the brain using magnetic impulses. The treatment, which was approved by the FDA for depression in 2008, works by changing neuron activity in the brain with the intent of improving mood regulation. If you or a loved one have been recommended to TMS, you’re probably wondering what it is, how it works, and if it really works.

The answers to all of these are complex. Most people are never recommended to TMS. Instead, first-line treatments for depression are behavioral therapy or psychotherapy and antidepressants.

What is TMS?

Transcranial Magnetic Stimulation involves a series of 30–40-minute sessions, 5 days a week. Here, patients sit in a chair with a magnetic coil that sends pulses of magnetic energy through the brain. These pulses change neuron activity related to mood and mood regulation. It’s thought to activate regions of the brain that decrease neuron activity during depression, working to alleviate that depression. In addition, TMS increases cerebral blood flow and could improve synaptic plasticity, which could improve the efficacy of therapy.

Treatment normally lasts for 4-6 weeks, meaning patients receive 20-30 sessions total, consisting of 400-1200 minutes of actual treatment total. Studies testing the efficacy of these treatments show results as high as 4 times that of the placebo. In addition, with studies showing that TMS patients showed significant improvements in self-rated tests – with 30-40% remission rates.

Essentially, transcranial magnetic stimulation can be significantly effective for patients. However, for many, it’s also a large investment, as you have to go to a clinic every day for up to 6 weeks. In addition, there are medical risks, including headaches, seizures, and neurogenesis, a symptom where fewer neurons are produced in the brain.

In addition, with most studies following up on TMS patients after a year, it’s highly likely that you’ll need ongoing treatment to maintain efficacy over a period of 4-5 years.

Who Gets TMS?

Transcranial Nerve Stimulation is almost never prescribed before first-line treatment options. This means that the only people who receive the treatment are those who have failed to see benefits from antidepressants and from behavioral therapy.

However, in some cases, TMS may be used to complement behavioral therapy. For example, if you’ve had a history of treatment for depression with poor effect, your doctor may recommend therapy with TMS. In other cases, you may get therapy, antidepressants, and TMS.

TMS is a second-line treatment in part because it is so new. The treatment was first FDA approved in 2008, but we don’t entirely know why it affects the brain in the way it does. In addition, equipment and treatment facilities are expensive and difficult to access – meaning that TMS is out of reach for many patients.

Finally, TMS is only effective with consistent treatment. If patients do not continue to go to the clinic daily for 4-6 weeks, the treatment has significantly reduced results. With many people being unable to travel to a clinic at that frequency, transcranial magnetic stimulation often simply isn’t available for patients to use.

You cannot qualify for TMS if you have facial tattoos with magnetic ink, deem brain stimulators, stents, or metallic implants in your eyes or ears. Some technicians will recommend avoiding TMS if you have any implants in the skull, however, you can use TMS with braces.

In addition, you’ll be recommended away from TMS is you have epilepsy or another history of seizures, struggle with alcohol use disorder, have a brain tumor, use ecstasy or another psychedelic, use cocaine, or have recently had a stroke.

man with depression during his therapy

What Is a Transcranial Magnetic Stimulation Session Like?

When you go into a TMS session, you’ll be asked to remove anything that might interfere with magnets. This includes credit cards, keys, earrings, wallets, electronic devices, etc. From there, your technician will take tests, measure your head to properly fit the coil, and will do a motor threshold test. Here, they check how much power is needed to make your thumb twitch during a pulse, which varies by person. Then, they will hold a magnetic coil against the scalp or forehead.

The machine clicks each time it emits a magnetic pulse, which is the same type and intensity as that used in an MRI. You don’t feel anything, and you will not feel any pain. Most people find it uncomfortable to sit still for the full 20-30 minutes, but you will get used to it over the course of the treatment. In addition, your fingers and toes may twitch each time the coil pulses.

Treatment itself can vary in frequency, pulse pattern, pulse frequency, and even the strength of the magnet. What you get will in-part depend on the technology available in your area. However, for the most part, it depends on what your doctor or clinician thing are a best-fit for you.

After treatment, you’ll be able to return home the dame day, with no waiting period.

Are There Side-Effects or Risks?

TMS has multiple side-effects including some uncommon ones. Most people experience headaches and lightheadedness after sessions. In addition, you’ll experience discomfort at the magnet site. Finally, most people experience tingling and spasms or twitching in the face muscles for a few hours after treatment. If you have a lot of symptoms, your doctor may reduce the level of stimulation or recommend an over-the-counter medication.

A small percentage of people experience more serious side effects including seizures, hearing difficulties, and mania. For this reason, it’s important to assess your history of and risk of both mania and seizures. Persons with schizophrenia, bipolar disorder, and epilepsy should not generally use TMS.

Getting TMS Treatment

If you’re struggling with other forms of treatment, you can talk to your doctor about the possibility of getting TMS treatment. Here, your doctor may recommend that you take other therapy or try another medication first. That’s in part because many people try to use quick solutions to mental health disorders, and TMS runs that risk. It’s also because TMS is expensive, time-consuming, and not suited for everyone. You’ll therefore be recommended into a more accessible treatment with longer-lasting results.

At the same time, TMS is an FDA approved treatment, it does work, and it has very positive results. If your doctor approves TMS, you have the time, and your insurance is able to pay for it, TMS is safe, effective, and a good alternative to traditional treatment for depression

If you or you loved one need help with mental health treatmentdrug rehab, or alcohol rehab Compassion Recovery Center is here to help. Contact us to ask about our mental health programs and how we can support your specific requirements as you move into treatment.

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