Transcranial Magnetic Stimulation (TMS): How it works, what to expect, side effects & more.
What is Transcranial Magnetic Stimulation?Transcranial Magnetic Stimulation (TMS) was developed in 1985, and has been FDA-approved since 2008 to treat patients with depression who have not experienced satisfactory improvement from antidepressant medications. TMS is covered by most health insurance plans after the patient has tried 4 or more antidepressant medications and therapy without relief.
How does TMS work?This noninvasive, outpatient procedure uses repetitive pulsed magnetic fields similar to those in an MRI (magnetic resonance imaging) machine to stimulate the executive functioning center of the brain, called the dorsolateral prefrontal cortex (DLPFC), with an alpha frequency wavelength similar to what your brain naturally exhibits in a focused, relaxed and restful state. This alpha frequency can also be naturally increased through meditation, mindfulness, yoga and exercise. TMS helps the brain transition out of the brain’s default mode network (DMN), which typically involves perseverating on negative thoughts in someone who suffers from depression and anxiety. TMS improves executive functioning (memory focus, attention, learning) in any individual, though can be especially helpful in people who suffer from depression and anxiety, as studies show that these disorders have a negative impact on overall cognition.
Is TMS like electroconvulsive therapy (ECT)?While both procedures are effective in treating depression, TMS is very different from ECT. ECT is done under anesthesia. During ECT, electricity is introduced into the brain, sometimes injuring the brain. ECT can cause memory and concentration problems. During TMS therapy, the patient is awake and alert throughout the entire treatment. No sedation is necessary with TMS treatment, and patients may return to regular activities immediately following treatment. During TMS, electromagnetic waves are used to pulse the brain stimulating normal physiological reactions. No negative impacts on memory or concentration have been reported with TMS therapy.
How does TMS compare to antidepressant medications?People who have failed four or more antidepressants have less than a 10%, or 1 in 10, chance of improving if given another antidepressant. Those same people would have a 70%, or 7 in 10, chance of responding to TMS. TMS does not affect any other parts of the body except for the small part of the brain that TMS stimulates. Therefore, it has very few side effects. TMS is an especially good option for any depression and anxiety sufferers who are pregnant or breast-feeding, concerned about drug interactions, or wish to avoid taking pharmaceuticals. No sedation or anesthesia is needed, giving patients the freedom to drive themselves home or return to work after receiving TMS therapy. TMS treatments are generally given daily, five days per week for six weeks, followed by one treatment per week for the next six weeks. Treatments last 15 to 30 minutes. Some patients may see their depression go into complete remission with TMS therapy, while others may need occasional maintenance treatments after their initial treatment sessions are completed. Maintenance TMS protocols are generally not needed.
What are the side effects of TMS therapy?Side effects are typically mild to moderate and dissipate rapidly after the treatment session ends. Side effects may include:
- Scalp discomfort
- Seizures (extraordinarily rare)