Transcranial Magnetic Stimulation or TMS therapy, is an FDA approved treatment for depression that utilizes energy to stimulate the brain and facilitate improvements in depressive symptoms. The treatment utilizes short pulses of a focused magnetic field to stimulate nerve cells in the area of the brain thought to control mood. This brief and painless treatment is performed in a quiet, comfortable setting under the supervision of a psychiatrist and is administered while the patient is awake and alert.
1. How does it work?
“A 3 Tesla magnet, which is the same strength magnet used in an MRI, is placed over the area of the brain known as the dorsolateral prefrontal cortex. The powerful magnet sends pulses through the skull and causes depolarization of the neurons in the superficial cortex of the brain. Through neural pathways, the local stimulation causes functional changes in other brain regions and leads to improved cell communication and improvements in depressive symptoms,” said Asbach. “The electromagnetic coil is placed against the scalp and delivers pulses of magnetic field in 30 second intervals involving 40 pulses in a 4 second period with 26 seconds of rest. The magnetic pulses are not painful and feel/sound like a light tapping on the scalp.”
“I often describe the sensation to my patients as if someone were to lightly flick your head 4000 times in a 20 minute period. It may not be comfortable but it is not painful for most.”
2. How long does the treatment take? When can patients expect to see results?
“The first TMS treatment is called a mapping. At this appointment a medical practitioner and TMS technician will use a computer algorithm to identify the best location on the scalp for treatment. As a result of the mapping, your first treatment session usually lasts about an hour. Subsequent treatments are quicker and last anywhere from 20-30 minutes,” said Asbach.
“Patients receive treatments 5 days a week for 6 weeks or a total of 30 sessions. Patients commonly will start to see improvements in their symptoms about half way through the sessions, however sometimes improvements are not observed until later in the treatment process. The reason being that TMS is causing changes in neuron functioning and communication through the repetitive and sustained exposure to magnetic impulses which stimulate the cells and “wake them up.” This does not occur in just one session and requires continued exposure to the magnetic pulses,” Asbach continued.
3. What patient population does this therapy work best for?
The FDA has approved TMS for patients with treatment resistant depression. Treatment resistant depression is defined by the failure of two or more antidepressant therapies with adequate trial of dose and duration.
“TMS treatment of depression is covered by most insurance companies although some insurers require further medication failures and/or an adequate trial of counseling. TMS is not recommended for the treatment of depression within the context of Bipolar illness. Additionally, patients with a history of seizures are recommended to consult with their neurologist as TMS treatment has been reported in rare instances to increase the risk of seizure (in normal clinical use the estimated risk of seizure is 0.03% of treatments),” added Asbach.
4. What are some common misconceptions surrounding TMS that may hold people back from trying it?
A common misconceptions surrounding TMS is that it is an invasive procedure. Patients think that anesthesia is required or drastic alterations to their medication regimen. However, TMS is a non-invasive treatment that is done in the office. Patients are able to drive to and from their TMS treatments and often come to the office to receive their TMS treatment on their lunch break or on their way to work.
“If patients suffer from depression and have tried 2 or more medications without success, they may be good candidates to receive this innovative treatment,” said Asbach.
The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice. Readers should always consult with a licensed healthcare professional for diagnosis and treatment.