What is TMS?
Transcranial Magnetic Stimulation (TMS) is a safe, non-invasive treatment for people ages 18 years and older who have been diagnosed with major depressive disorder. It is ideal for patients with treatment-resistant depression who have not found relief from other treatments, such as psychotherapy and antidepressant medication.
Cleared by the FDA in 2008, TMS delivers highly focused magnetic fields to stimulate underactive nerve cells in the brain to relieve depression symptoms. In a study by the National Institute of Mental Health, two-thirds of TMS patients experience either full remission of their depressive symptoms or experience a significant improvement. TMS offers a safe and effective out-patient treatment with little to no side effects.
How does TMS work?
Studies using PET scans have demonstrated that a depressed brain receives less oxygen and glucose fuel than a nondepressed brain. The result is less activity in the brain’s frontal lobe and limbic system, the area that controls mood and higher-level functioning. Over time, this decrease in activity leads to changes in the brain that reinforce neuronal pathways and patterns that can cause a person to feel depressed.
During TMS treatment, a magnetic coil is placed on a patient’s head. It delivers a pulsed electromagnetic field to the brain’s prefrontal cortex similar to the technology used in a magnetic resonance imaging machine (MRI).
The magnetic pulses are able to pass through the skull and into the brain, stimulating the neurons in that area. Once stimulated, these neurons then send messages to other neurons, setting off a chain reaction of activity all the way to the limbic system deep inside the brain.
Repeated treatments work to retrain the brain to create new pathways that can alleviate symptoms of depression. Where a single positive thought can reinforce a particular pathway once, TMS reinforces this pathway 100,000 to 150,000 times over the course of treatment.
How does TMS differ from ECT?
Electroconvulsive Therapy (ECT) works by sending electric currents to the brain in order to trigger a brief seizure and affect changes in brain chemistry. ECT is an in-patient hospital procedure that requires general anesthesia, a day or two of recovery, and can result in short- and even long-term memory loss.
TMS is different in that it is an out-patient treatment that is performed while a patient is awake. Patients can drive themselves to and from their appointment and there is no recovery time after treatment.
What does TMS feel like? What are the side effects?
During TMS treatment, patients are awake and can talk to friends or family, read, and even nap. Patients may hear a clicking sound and feel a tapping sensation on the area of their scalp where the electromagnetic coil is placed. This sensation is the coil working to stimulate the muscles and nerves under the skin. Patients have described treatment as annoying or uncomfortable, but not painful.
Some patients report feeling a mild headache after treatment. There is no recovery time after treatment, and patients can return to work and normal activities right after a session, even driving themselves to and from their appointment.
What is the course of treatment?
An average TMS treatment series includes 30-36 treatments spaced out over six to nine weeks. Each out-patient treatment lasts about 19 minutes. For the first six weeks, treatment is administered five days a week. After treatment number 30, most TMS providers will recommend tapering treatments for the last six visits over a period of three weeks.
What is brain mapping?
Brain mapping, also known as cortical mapping, is the process of pinpointing the left dorsolateral prefrontal cortex (DLPFC,) a spot located above the left temple where TMS treatment is applied. Before your first treatment session, your TMS psychiatrist will conduct a brain mapping procedure to determine this location as well as the power or “dose” appropriate for you.
When will I experience results? How will I know TMS is working?
Every patient responds differently to TMS, and the measurement of its success is a deeply personal one. On average, patients may notice a change at about four weeks of treatment. This can include having more energy, improved sleep and appetite, feeling less depressed or more engaged in activities. Often, family members or friends will be the first to notice positive changes.
Should I still take my medications during TMS treatment?
Yes. Patients should still follow the treatment plan prescribed by their psychiatrist. In general, it is recommended that patients continue their medication and work with their mental health provider regarding their medication regimen.
When can I begin treatment?
Talk with your doctor to determine whether TMS is right for you. Most insurance carriers will provide coverage for TMS only after patients have undergone trials of psychotherapy and medication without success. Mental health providers can refer you to our services by calling (916) 437-5170, emailing TMSinfo@cpsych.com or sending a fax to (877) 917-3450.