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Transcranial magnetic stimulation (TMS): Hope for stubborn depression


Major depression is one of the most common mental illnesses facing Americans. For some, the disorder can be effectively treated by conventional approaches, like talk therapy and antidepressants. For others, however, their symptoms persist through several different treatments, affecting their quality of life.

New, alternative methods of treatment can offer hopes for these people. Transcranial magnetic stimulation (TMS) is a new approach that has been pioneered over the past few decades. Today, it's becoming a more conventional approach for treatment-resistant depression.

Here's how transcranial magnetic stimulation works, and how it can help people with depression when other methods of therapy have failed.

On this Blog:


What is Transcranial magnetic stimulation (TMS)?

Transcranial magnetic stimulation is a therapeutic approach to depression that uses magnetic devices to stimulate nerves in regions of the brain associated with mood regulation. The technique is typically only used when other methods to treat depression haven't been effective.

During an average TMS session, a TMS practitioner uses an electromagnetic coil device to send a series of magnetic pulses to a patient's brain. It's often called rTMS, or repetitive TMS because the practitioner will send these signals repeatedly throughout each session. The average session usually lasts between 30 to 60 minutes.

Results can be felt immediately. Many patients, however, will need several weekly sessions over three to seven weeks before experiencing significant relief from their symptoms.

In most cases, TMS doesn't require anesthesia. The therapy also very rarely causes serious side effects — most commonly, patients report headaches during or after treatment. People can typically drive themselves to and from TMS sessions.

TMS is sometimes confused with electroconvulsive therapy (ECT, or sometimes "shock therapy"), the traditional approach to treatment-resistant depression. Unlike ECT, however, TMS doesn't appear to affect memory or cognition negatively


Can TMS be used to treat depression?

Like many depression treatments, it's not fully understood why TMS improves symptoms. Right now, psychologists believe the mood benefits associated with TMS may be due to improved activity in regions of the brain that are affected by depression.

In any case, TMS has been found to be an effective method in managing the symptoms of treatment-resistant depression.

One of the most extensive trials on TMS found that 47 percent of patients with treatment-resistant depression responded positively. Of those, nearly one-third experienced a full remission of their depression. While these results aren't always permanent, the mood benefits associated with TMS usually persist for many months after the end of treatment. On average, patients will experience more than a year of improved symptoms after completing a series of TMS sessions.

Patients who find that the effects of TMS have worn off can undergo further sessions, which almost always provide similar improvements. Follow-up rounds of TMS typically require fewer sessions than the initial treatment. While TMS is a relatively new approach to treatment-resistant depression, some patients have been receiving regular TMS follow-ups for as long as a decade. So far, there is no evidence that it becomes less effective over time.

Because it's rare for patients to have adverse reactions to TMS, their symptoms rarely or never worsen following or during treatment.

There's also a limited but growing body of evidence that suggests TMS may be useful in treating mental illness other than depression, like pediatric depression, bipolar disorder, and PTSD. However, TMS isn't approved yet for treating these conditions — future research is necessary.


Transcranial magnetic stimulation for patients with major depression

Many Americans, unfortunately, have to deal with the struggles of major depression. While some people can find relief in traditional therapeutic approaches, like talk therapy and antidepressants, others don't.

Fortunately, treatments like TMS have been shown to help those with major depression that hasn't responded to other forms of treatment. The approach has been found to be effective for more than half of all patients with treatment-resistant depression.

The effects of TMS don't last forever but can be sustained with follow-up sessions. People who respond to TMS the first time almost always respond well to future treatment.

This means that for many, TMS may be an effective, long-term approach to treatment-resistant depression. This is good news for anyone suffering from the crippling effects of this mental health disorder.




Risks of TMS

Repetitive TMS is a noninvasive form of brain stimulation. Unlike vagus nerve stimulation or deep brain stimulation, rTMS does not require surgery or implanting electrodes. And, unlike electroconvulsive therapy (ECT), rTMS doesn't cause seizures or memory loss. It also doesn't require the use of anesthesia, which puts people in a sleep-like state.

Generally, rTMS is considered safe and well-tolerated. However, it can cause some side effects.

Common side effects

Side effects are generally mild to moderate and improve shortly after a session. Side effects decrease over time with more sessions.

Side effects may include:

  • Scalp discomfort and pain.

  • Headache.

  • Tingling, spasms or twitching of facial muscles.

  • Lightheadedness.

Your health care provider can adjust the level of stimulation to reduce symptoms. Or your provider may recommend that you take a pain medicine available without a prescription before the procedure. In some people who get frequent headaches or migraines, TMS triggers headaches, so treatments might need to be stopped.


What you can expect

 Repetitive TMS is usually done in a health care provider's office or clinic. It requires a series of treatment sessions to be effective. Generally, sessions are carried out daily, five times a week, for 4 to 6 weeks.

Your first treatment

Before treatment begins, your health care provider will need to identify the best place to put the magnet on your head and the best dose of magnetic energy for you. Your first appointment usually lasts about an hour.

During your first appointment, the "mapping" process is performed. Here's what you can likely expect:

  • You'll be taken to a treatment room, asked to sit in a reclining chair and given earplugs to wear during the procedure.

  • An electromagnetic coil will be placed against your head and switched off and on repeatedly to produce stimulating pulses. This results in a tapping sensation on your head and a clicking sound, followed by a pause.

  • The coil will be moved around your head and the magnetic energy adjusted to find the location that causes the fingers or hands on the other side of your body to twitch. Once the location is found, a second process of finding the "motor threshold" occurs. Strong and weak pulses alternate to determine how much energy is needed to move your fingers or thumb during at least half of the attempts.


During each treatment

The coil placement and dose are usually done only once. This occurs during the first treatment. For all later treatments, the magnet is moved to the treatment position using measurements from the first treatment.

Here's what to expect during each treatment:

  • You'll sit in a comfortable chair, wearing earplugs, with the magnetic coil placed against your head. The treatment location of the coil is different from where the coil makes your fingers or thumb move.

  • When the machine is turned on, you'll feel and hear rapid tapping on your scalp. The pattern will be a few seconds of tapping followed by a pause. The pattern will repeat. You may have scalp discomfort and even some pain during the tapping, but not during the pauses. You'll remain awake and alert during the procedure.

  • Depending on the type of stimulation pattern used, the procedure will last 3.5 minutes or 20 minutes. The latest stimulation type is called "intermittent theta burst stimulation" and requires only 3.5 minutes. The original rTMS pattern took 37 minutes, but it can be performed in 20 minutes now.


After each treatment

You can return to your normal daily activities after your treatment. You might have a headache for a short time afterward. Between treatments, you can usually expect to work and drive.


If rTMS works for you, your depression symptoms may improve or go away completely. Symptom relief may take a few weeks of treatment.

The effectiveness of rTMS may improve as researchers learn more about techniques, the number of stimulations needed and the best sites on the brain to stimulate.

You Are Not Alone

Reach out to Grace Health Services today to discover a path forward, tailored to your unique needs and circumstances. Whether you're seeking therapy, counseling, or specialized mental health services, our dedicated team is here to guide you every step of the way.


Let’s get you the care you deserve!

​Our certified providers at Grace Health Services in VA & D.C. are dedicated to understanding and treating a variety of mental health challenges. Drawing from both modern research and years of hands-on experience, we aim to provide nothing but the finest care from the moment of diagnosis.

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