Transcranial magnetic stimulation, or TMS, is a cutting-edge therapy primarily used for major depression. It’s a noninvasive procedure that uses an electromagnet to stimulate neurons in a specific part of the brain. It has been shown to alleviate depressive symptoms in many people who have tried medication and therapy without success.
While methods for treating depression are always improving, medication and therapy don’t work for everyone. Many people feel like they don’t get adequate relief from medications or that they can’t tolerate the side effects.
For people with major depression that doesn’t respond to other treatment, the last resort has typically been electroconvulsive therapy, or ECT. ECT is an effective treatment for major depression and it’s much safer than it used to be, but it also has some drawbacks. One drawback is that ECT is given under general anesthesia, which carries additional risk and expense. ECT also may have some negative side effects, including confusion, memory loss, nausea, headache, muscle pain, and jaw pain.
TMS, on the other hand, does not require anesthesia and is typically done as an outpatient procedure in sessions lasting about 40 minutes. Patients uaually don’t feel any kind impairment between sessions. Because TMS precisely targets one area of the brain, it’s much more comfortable than ECT and has fewer adverse cognitive and physical effects. TMS stimulates nerves, including those innervating the muscles in scalp. As a result, some people feel tension in the scalp or a slight headache after a session, although most people describe a TMS session as a tapping on the scalp.
Despite its safety and comfort, TMS is very effective. The first large-scale study of TMS as a treatment for depression found that about 30 percent of people who received the treatment felt complete relief from depressive symptoms, compared to only five percent who received a sham treatment. Since this study, which appeared in 2010, other studies have confirmed the effectiveness of TMS, finding that it eliminates or reduces symptoms for more than half of particpants. TMS is currently being studied for treatment of other mental health conditions as well, but so far it has only been approved by the US Food and Drug Administration for the treatment of depression.
Someone undergoing TMS will typically have to be treated five days a week for several weeks. The sessions last somewhere between thirty minutes and an hour. Because TMS doesn’t cause cognitive impairment, it can easily be done as an outpatient procedure, but it might be more convenient to undergo TMS as a part of an inpatient treatment program.
The procedure itself is simple. You will sit in a comfortable chair and the doctor or technician will locate the correct position for the device by locating the appropriate “landmark” in your brain. This landmark is the motor cortex. When you twitch slightly, the doctor or technician knows the intensity of the stimulation is right, and a slight adjustment will be necessary to find the right location. The electromagnet delivers quick pulses over regular intervals, which most people experience as a light tapping. After the session, you can just get up and go. It may take several weeks for you to notice relief of depressive symptoms, so don’t worry if you don’t feel better right away.
As with antidepressant medication, exactly how TMS works is not completely understood, although the picture gets clearer every day. We know that a part of the brain called the dorsolateral prefrontal cortex plays a role in depression. This part of the brain is in the very front and is responsible for executive functions such as attention and working memory. Brain scans have showed a correlation depressive symptoms and weak activity in this area of the brain, particularly on the left side. For whatever reason, this part of the brain in depressed patients isn’t adequately engaged. TMS essentially jumpstarts the neurons in this region of the brain. The strong electromagnetic current activates neurons just as you would activate your own motor neurons if you were to smile or open a door.
The reason TMS treatments have to be repeated every day for several weeks is the same reason your piano teacher told you to practice every day. If you just stimulate the neurons once and leave them alone, they just go back to normal. Repeated stimulation gradually causes them to become more active and connect with other regions of the brain. By repeating the procedure every day for weeks, your dorsolateral prefrontal cortex gradually learns to be active again cooperate with other parts of your brain.
As a relatively new treatment, TMS is still evolving. Every year, we learn more ways to make it more effective. TMS is also much more versatile than medication or ECT, which means there is a lot of room for optimization. For example, research has found that different shaped coils produce differently shaped magnetic fields, which have different effects on the brain. Pulse rates and interval times are easy to adjust and seem to affect how people respond to treatment.
It’s likely that TMS will be approved for treatment of other conditions in the near future. There are currently trials studying TMS for pediatric depression, obsessive-compulsive disorder, post-traumatic stress disorder, and bipolar disorder. TMS may also be useful in treating pain and rehabilitation from neurological disorders.
If you’re struggling with depression, The Dawn Medical Rehab and Wellness center can help. We are one of Thailand’s most respected addiction treatment and wellness centers. TMS is just one of the cutting-edge treatment modalities we use to provide personalized care to treat addiction, depression, anxiety, PTSD, and executive burnout. See our contact page to reach us by phone or email.