What is TMS therapy? TMS stands for Transcranial Magnetic Stimulation. It is a noninvasive procedure that uses magnetic pulses to treat depression.
This procedure is not experimental. It was approved in the U.S. by the FDA for depression treatment in 2008. The treatment is done on an outpatient basis in a doctor’s office or clinic. Indication for this treatment is usually for adult patients who still struggle with depression despite trying several antidepressants and counseling.
Depression is the leading cause of disability in the U.S. among people ages 15 to 44 years. There are many antidepressants available for the treatment of depression. Even though many of these medications are helpful for treatment, they, however, do not help everyone.
Some studies show that as much as two-thirds of people with depression do not get enough relief from the first antidepressant they try. Also, trying subsequent medications is less likely to help than the prior one.
Given this, it is essential to have other options outside of medications. Some other treatment modalities for depression include counseling, botanicals, Electroconvulsive Therapy, Spravato, and of course, TMS.
Electroconvulsive therapy (“shock therapy” or ECT) has been used for many years for treatment-resistant depression. Despite the negative connotations to ECT, it remains an available treatment for depression. Indeed, it is still the most effective treatment for severe depression.
Unfortunately, ECT has many side effects, including memory problems. As a result of this, many people are reluctant to try ECT, even though it is effective. TMS, therefore, makes for an excellent alternative treatment for severe depression.
So, what is TMS?
TMS is a noninvasive procedure that uses recurring magnetic pulses to stimulate specific regions of the brain to improve the symptoms of depression. The treatment involves using a TMS machine to generate magnetic pulses that stimulate the brain cells. In most cases, TMS is used when an individual has tried a few antidepressants. Because TMS involves using repetitive magnetic pulses, it is called repetitive TMS or rTMS.
TMS involves applying magnetic fields to specific parts of the brain that affect your mood. Unlike ECT, transcranial magnetic stimulation does not require anesthesia. Another considerable advantage is the tolerability of TMS. In addition, it has minimal side effects compared to medications and ECT.
It is unclear exactly how TMS works. For depression treatment, the magnetic pulses stimulate the left side of the brain. They pass through the skin and bone to stimulate the brain cells. This process helps the brain cells release brain chemicals that make depression better. The three main brain chemicals are dopamine, serotonin, and norepinephrine.
Unlike ECT, which uses electrical energy, TMS treatment involves magnetic pulses. Even though this may sound scary, it is generally not a painful process. Though some people describe pain during the process, tolerance is fairly good. Besides, adjustment of the machines is possible if there is some discomfort.
The TMS and MRI machines are similar in that they both use magnetic pulses. There are no major concerning short and long term side effects.
During a TMS session, an electromagnetic coil is placed on your head. For depression, this placement is on the left side, close to your forehead. Some treatment centers may provide off-label treatment for other disorders like anxiety and post-traumatic stress disorder. In this case, coil placement is different from depression treatment.
TMS does not require sedation or a recovery period. It also does not come with the memory problems seen with ECT. It is a reasonably safe treatment.
We know TMS helps with depression treatment, but what else is TMS used to treat? The answer to this question depends on the country. The use of this procedure varies somewhat depending on the location. In some European countries, there are several other uses for this treatment modality.
In the U.S., there is ongoing research with transcranial magnetic stimulation and other medical disorders. There will likely be more indications soon. There are many current researches, as well as off-label treatments.
The response rate for this procedure is about 60% to 70%. This value means that nearly two-thirds of people who did not benefit from medications feel better with transcranial magnetic stimulation. Out of this number, about one-third achieve full remission – meaning their depression goes away completely.
Note, however, that this improvement may not be permanent. Depression is a chronic illness; therefore, there will likely be ups and downs. Some people may feel well for many months before they relapse. Individuals can have another round of treatment if they develop symptoms of depression again.
What does the TMS procedure involve? This process involves the following steps:
There are two essential regions of the brain that come into play during transcranial magnetic stimulation. These are
TMS is not a cure for depression. It is a treatment procedure that helps your depressive symptoms. What this means is that your symptoms may come back again. On average, some people feel well for about a year. It may be shorter or longer for others. Unfortunately, about 30-40% of people do not respond to treatment at all.
It is important to remember, however, that depression is due to many factors. These include chemical, biological, social, and psychological reasons. As a result, your lifestyle choices, relationships, and coping skills affect your depression, in addition to your genetics.
Thus, using the improvements in your mood, drive, and energy after transcranial magnetic stimulation is essential. You can apply these positive changes to start therapy and improve your lifestyle. Exercising, improving your diet, and more social connectedness will help keep you mentally stable.
There are different types of transcranial magnetic stimulation machines. Even though they look different with some variations in how they work, they are quite similar. These machines all produce magnetic pulses for treating depression. Some examples are:
There is no need to bother about what kind of machine your healthcare provider uses. All these machines produce focused magnetic pulses, and as such, improvements in symptoms of depression.
TMS has minimal side effects. It is a noninvasive procedure that does not require sedation, surgery, or placement of electrodes. Even though most people tolerate this procedure very well, some issues may occur.
Side effects are rare. When they do occur, however, they tend to be mild to moderate. Also, they usually go away quickly and decrease as you have more sessions.
An advantage of TMS machines is that the settings can be adjusted to help with these side effects. In cases of a headache, over-the-counter pain medications usually help.
It is rare to have any severe side effects with TMS. Some possible problems which may arise are:
Note that this treatment is not necessarily a replacement for medications. The advice is to continue to take your medications. However, some people who are not on medications still do quite well with this treatment.
There are not many reasons to avoid Transcranial Magnetic Stimulation. The significant issues to look out for are:
TMS treatment is usually not done if you have the following magnetic metal objects:
Most patients with braces or dental fillings can have this treatment as the materials are non-magnetic.
Depression is the leading cause of disability in the U.S. among people ages 15 to 44 years. Antidepressants and counseling are first-line treatments for depression. However, other types of treatment may be necessary. Inadequate response and side effects to primary modalities for depression are reasons to consider other therapies. ECT, Spravato, and TMS are some alternatives.
TMS is a noninvasive treatment that uses magnetic fields to treat depression. In the United States, there is approval for the treatment of major depressive disorder and obsessive-compulsive disorder. It is different from ECT (shock therapy), which uses electrical energy.
There is no sedation during treatment. Work and normal activities resume after each treatment. A full session consists of 36 treatments – done five days a week for six weeks, with a slow taper over another three weeks. The first session lasts about an hour, but subsequent treatments are about 20 mins long.
The primary reasons to avoid doing TMS are a history of seizures, and metal implants in the head, neck, or chest area. There are different types of TMS machines, but they mostly do the same thing. Headaches, dizziness, and scalp pain are the most common side effects, though uncommon.
It is an outpatient treatment in a doctor’s office. There are many TMS treatment centers, and there is likely one around you.
Though this procedure is a great treatment for depression, it is not a cure. Your depression may recur even after TMS therapy. On average, some people tend to be stable for about a year before they begin to go downhill again.
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