WHAT IS TMS THERAPY?
Transcranial magnetic stimulation (TMS) is a noninvasive form of depression therapy. The treatment involves the use of magnetic pulses sent to the brain to help stimulate neural activity. TMS can be used on its own, in combination with one or more therapies, or in lieu of other treatments. The history of TMS dates back to the late 1700s when scientists discovered that nerves serve as electrical conductors and support muscle contraction. In 1976, scientists in the United Kingdom stimulated nerves using short magnetic field pulses. Their work was later expanded by Dr. Anthony Barker and the Sheffield Department of Medical Physics and Clinical Engineering. Barker and his team created a machine that could stimulate the cerebral cortex, a thin layer on the outer portion of the brain. They used electromagnets to stimulate neurons in the brain, without disrupting neural activity or causing pain. This provided the basis for TMS used for depression therapy today. TMS for depression therapy has been studied extensively over the years. More than 3,500 papers have been published relating to the use of TMS to help patients cope with depression, post-traumatic stress disorder (PTSD), and other mental health disorders. In 2019 deep tms energy was also FDA cleared for the treatment of OCD.
WHAT SHOULD I EXPECT AT TMS THERAPY?
TMS therapy is performed in a doctor’s office. A patient is first seated in a comfortable chair, and a TMS device is placed on their head, near the left temple. Next, the TMS device gently sends magnetic pulses to the brain; the pulses are sent roughly 3 cm below the skull and stimulate neural activity in regions of the brain that are believed to be responsible for mood regulation. The total treatment time for TMS is approximately 20 minutes. After a therapy session, a patient can leave the doctor’s office and go on with their regular day.
THE TMS THERAPY PROCESS
1. Pulsed magnetic fields generate small electric currents in the brain’s prefrontal cortex
2. The electrical charge inside neurons becomes less negative and more positive; this drives the release of neurotransmitters, which transmit messages between neurons and from neurons to muscles
3. Neuronal pathways activate remote areas of the brain’s limbic system
4. Blood flow and glucose metabolism increase in areas of the brain that were previously underactive; this is believed to help improve mood and reduce depression
WHAT OCCURS AT FIRST TREATMENT SESSION?
The first TMS therapy session involves measurements so that the TMS coil can be safely and comfortably placed on a patient’s head. At the session, the patient’s motor threshold (amount of power necessary to make the patient’s thumb twitch) is measured; this is done by administering brief magnetic pulses. Each patient’s motor threshold varies, and it must be measured to establish personalized therapy settings.
Once the patient’s motor threshold is determined, the TMS coil is placed above the brain’s front portion. Next, TMS therapy is administered, at which time the patient may hear clicking sounds and/or feel a gentle tapping sensation under the coil.
During a TMS treatment program, therapy sessions are conducted five days a week, for six weeks. The patient’s motor threshold is not checked at every session, but the threshold may be reevaluated if there is a concern that it has been altered due to a change in medication and/or other conditions.
HOW IS TMS TREATMENT DELIVERED?
TMS therapy does not require patients to be hospitalized, nor does it require sedation and/or anesthesia. Patients are awake and aware during TMS, and there is no downtime after therapy.
WILL TMS DISRUPT MY BRAIN FUNCTION OR CHANGE MY PERSONALITY?
With TMS, medical clinicians target specific portions of a patient’s brain for treatment. This ensures the therapy does not affect a patient’s memory or cause impaired thinking, and it does not alter personality in any way. While TMS may help reduce symptoms of depression, it may also help patients sleep well and improve their ability to function, think clearly, and perform everyday activities.
IS TMS THERAPY SAFE?
TMS therapy is generally safe and well-tolerated. TMS therapy has very few side effects when compared to antidepressants, electroconvulsive therapy (ECT), and other depression treatments. In 2008, TMS was FDA-approved to help patients coping with treatment-resistant depression. TMS has also been CE-approved in Europe to help patients dealing with bipolar disorder, chronic pain, obsessive-compulsive disorder (OCD), PTSD, and adult attention-deficit/hyperactivity disorder (AD/HD).
IS TMS THERAPY EFFECTIVE?
The results of TMS therapy vary. Patients may achieve long-lasting relief of depression symptoms with a TMS treatment program; others may require additional therapy sessions later.
Research highlights the effectiveness of TMS in patients who experience depression symptoms. Some studies indicate TMS therapy can deliver a response rate of up to 70%. In addition, research has shown that over 40% of depression patients who receive TMS report no further symptoms after treatment.
HOW SHOULD I PREPARE FOR TMS THERAPY?
A medical evaluation is required before a patient undergoes TMS therapy. As part of the evaluation, a patient needs a physical exam and psychiatric assessments.
During a medical evaluation, patients should notify their doctor if they:
• Are pregnant or are considering becoming pregnant
• Have metal or implanted medical device in their body
• Are currently taking any medications, herbal supplements, and/or vitamins
• Have a history of seizures
• Have a family history of epilepsy
• Are currently dealing with or have dealt with bipolar disorder, psychosis, or other mental health disorders
• Have experienced brain damage from an illness or injury
• Are currently dealing with other medical conditions
• Have previously received TMS
TMS therapy is only recommended if it is believed to be safe and effective to help a patient manage their depression symptoms.
WHAT SHOULD I EXPECT DURING A TMS THERAPY SESSION?
A TMS therapy session requires approximately 20 minutes to complete each day. During the treatment session, a patient is seated and can watch TV or read a book and relax.
After each TMS session, a patient can resume their normal activities.
WHO PERFORMS TMS THERAPY?
A trained and certified technician administers TMS therapy. The technician is required to complete an extensive training program and possesses both technical and interpersonal skills.
Technicians know how to use TMS technologies properly. They also support patients throughout TMS therapy and help them achieve optimal treatment results.
WHAT ARE THE SIDE EFFECTS OF TMS THERAPY?
TMS therapy does not require anesthesia, medication, or electrical shocks that can cause intolerable side effects. The therapy does not cause weight gain, vomiting, nausea, and other side effects associated with antidepressants.
Discomfort after TMS treatment is nonexistent or minimal. Patients may report no discomfort after TMS sessions, or only slight headaches for the first few.
HOW DO I KNOW IF TMS THERAPY IS WORKING?
Patients may experience the following results during TMS therapy:
• Improved sleep quality beginning in the first week of treatment
• Ability to concentrate better as early as the second week of treatment
• Gradual reduction in depression symptoms
• Feeling “more normal” than before approximately one to four weeks into treatment
• Complete disappearance or reduction of depression symptoms after six weeks