Repetitive Transcranial Magnetic Stimulation

TMS is a form of brain stimulation, also known as “neuromodulation,” that is used to treat depression by stimulating the brain using electromagnetic fields, completely non-invasively.

During TMS therapy, a device that generates a magnetic field is used to induce electrical currents in the brain. The device is placed over key areas of the head, and the magnetic field is administered in very short pulses, precisely targeting a part of the brain that regulates mood.

TMS treatments are an outpatient procedure, which means they are done in an office setting. Patients are seated in a treatment chair during treatments and remain awake throughout the procedure. Patients may go about their normal daily routines immediately following treatment. The typical initial treatment course consists of daily treatments over a 4-to-6-week period, for an average of 20-30 total treatments. Each treatment session lasts approximately 40 minutes.

TMS is a unique treatment for people with mild to moderate treatment resistance and/or medication intolerance, providing an intervention that may prevent the development of more severe treatment resistance.

Although numerous antidepressant medications and other treatments are available, many patients suffer multiple depressive episodes that are not well controlled with existing therapies. Approximately one out of three patients treated with conventional antidepressants do not find relief from depression symptoms. Many patients suffer intolerable side effects to commonly used antidepressants, such as nausea, diarrhea, insomnia, sedation, lack of emotion, and sexual problems.

TMS was approved by the FDA in 2008 to treat major depressive disorder, specifically for patients who have failed to respond to one previous, “adequate” trial of an antidepressant medication. “Adequate” means taking a medication at a sufficient dose and for a sufficient period of time. Many patients also have difficulty tolerating multiple medication trials. These are the patients who have been shown to respond best to TMS. Other patients with a more severe history of resistant depression may also respond to TMS, although patients with many medication failures may find greater improvement from other brain stimulation techniques such as ECT and VNS.

rTMS has been demonstrated to be an extremely safe, well-tolerated treatment. It does not require anesthesia or any other medication, and can be administered as an outpatient procedure. Although seizures are described as a potential side effect, and anyone with a history of epilepsy should not seek treatment, these are extremely rare. In the most recent clinical trial, involving over 10,000 treatments, no seizures were reported.

Common negative side effects include pain at the site of stimulation, which can be managed by adjusting device placement and settings. Pain was judged to be severe in only a very small number of cases. Other potential side effects also include muscle twitching during treatment sessions, post treatment headache, and toothache in some patients.

The first step for people considering TMS is to complete a formal evaluation with our Ambulatory Psychiatry clinic to determine whether the treatment is right for you. If you think you are a candidate for TMS, please speak with your psychiatrist or call our clinic.

During the call, please be prepared to provide a detailed history of all medications, psychotherapy, and any other treatments you have tried for depression. A clinic representative will answer your questions about TMS or help you set up a formal consultation. You should also contact your insurance provider to determine if TMS may be covered under your plan.