The Basics of TMS

Anyone who’s ever experienced depression knows how truly debilitating the disorder can be and unfortunately, there’s no one-size-fits-all treatment for it.  Medications can help but they don’t work the same way for each person so the right one is often found only after much trial and error, trying this one and that to see which one has more positive results and fewer negative ones.   Still, for many, the right medication remains elusive. Along with psychotherapy, medications are considered the first line of attack in treating the symptoms of depression. Now, there’s a second line available: TMS.

TMS, or Transcranial Magnetic Stimulation, is a drug alternative for treatment of depression that uses magnetic fields to stimulate specific areas of the brain to lessen or eliminate the symptoms and is recommended to patients who have undergone other treatments, such as medications, that have failed.

TMS is administered through a coil which generates a magnetic field which when applied to the head, induces an electrical current in the brain.  By activating the neurotransmitters with a magnetic field, they may begin to function properly. Why? The connections in the brain are electrical and it is believed that depression is caused by electrical dysfunction in the dorsolateral prefrontal cortex.  By giving it a boost of electricity, it may begin to function more normally.

TMS is not Electroconvulsive Therapy (ECT or shock therapy).  Until recently, ECT was considered the most effective treatment for treatment-resistant depression.  Electrically stimulating areas of the brain is still widely used but not easily tolerated and many patients experience memory loss and cognition problems.

With TMS, those same areas are stimulated using an instrument much like an MRI machine which is non-invasive, doesn’t require sedation, and easier tolerated.  By stimulating the left frontal brain in this way, it normalizes the neuronal circuits in the area where depression occurs.

Side effects typically consist of a headache either during or after the treatment.  Rarely, seizures may occur so the treatment is not recommended for people with epilepsy, a history of seizures or any other neurological issues.

During the treatment, the TMS machine creates a highly concentrated magnetic field that is directed to specific areas of the brain, usually on the left dorsolateral prefrontal cortex which is the area in the brain that regulates mood and is usually less active in people with depression.  The magnetic field produces small electrical currents that stimulate neurons in the brain into releasing the neurotransmitters serotonin, norepinephrine, and dopamine. These are the same chemicals that are in antidepressants but the TSM treatment kicks your body into creating them naturally instead of orally ingesting artificial ones.

The treatments last from approximately 20 minutes, 5 days a week for 4-6 weeks.  The patient remains awake and alert during the procedure which means there is no downtime―the patient can go right back to work.

After the treatment, it may be possible to cut back on medications but this is something that the patient must discuss with his or her doctor.  The patient should also continue psychotherapy.

Treatment success has been high with TMS―as high as 67.7% having a positive response after a full year in a 2014 study and 45.1% experiencing remission. Because depression has a high rate of recurrence, permanent remission doesn’t always happen, but many who have remission after treatment can see relief from symptoms for often as long as a year.

TMS was approved by the FDA in 2008 which means most insurance companies will cover the treatment.  Currently, however, TMS is a treatment that is only available for patients who are 18 or older but it could be approved by the FDA in the future as a drug alternative for treatment of adolescents suffering from treatment-resistant depression.

TMS works when medications don’t.  It’s a drug-free solution that’s non-invasive and is done on an outpatient basis.