Transcranial Magnetic Stimulation And Depression: Is TMS An Effective Treatment?
If you or someone you know experiences symptoms of depression, you may have heard of a treatment called transcranial magnetic stimulation, or TMS. TMS can sometimes help with symptoms of depression as well as other brain-related conditions. There are some risks associated with the treatment, but when conducted safely and properly, it can yield some significant benefits in some patients.
What is transcranial magnetic stimulation (TMS)?
Transcranial magnetic stimulation (TMS) involves stimulating specific areas of the brain with a magnetic field. This is intended to stimulate the nerve cells that may contribute to symptoms of depression. A magnetic field is used to stimulate the brain in hopes of sparking a change.
Although TMS isn’t considered an invasive procedure and is relatively low risk, it’s typically reserved for instances where other traditional treatment options have not produced the desired results. Patients who don’t respond to psychotherapy, prescription medication, or other forms of treatment may be candidates for TMS. There are some risks associated with TMS therapy, but when conducted safely and properly, it can have some significant benefits for some patients.
Transcranial magnetic stimulation and depression: How TMS works
During most sessions of transcranial magnetic stimulation, a trained professional places an electromagnetic coil against the scalp, near the front of the head. Next, a pulse is passed through the scalp and into the brain. It's placed in this area to target the part of the brain that controls mood. Researchers believe that areas like this have decreased levels of activity in individuals who experience depression. By stimulating them into action, doctors may help patients experience relief from depression symptoms.
According to Harvard Medical School, more than 50% of individuals who didn’t experience relief from depression with medication experience a “clinically meaningful response with TMS.”
For this reason, you may want to speak with your primary care doctor or a mental health professional if this method of treatment sounds interesting to you. You can ask about any potential side effects of TMS and discuss alternative treatments if TMS isn’t right for you.
Risks and side effects of TMS
Because transcranial magnetic stimulation (TMS) is noninvasive and doesn’t involve anesthesia, it is generally considered safe. Most people don't have severe side effects, and the most common risks are typically minor. Still, there are some risks to be aware of, especially if you have any preexisting conditions.
TMS side effects
While TMS is generally well-tolerated, some people may notice mild, temporary side effects. These reactions often occur during or shortly after a session and usually resolve on their own. The following are some examples of side effects:
- Headache
- Discomfort of the scalp
- Lightheadedness
- Tingling or spasms in facial muscles
Online therapy for depression
Regardless of whether you pursue TMS, therapy will likely become a necessary part of your journey to relieve symptoms of depression. The benefits of therapy are numerous, especially with the rise in online therapy options. Being able to seek the care you need from wherever you are means that you don’t even need to get out of bed to find support. Even on your toughest days, an online therapist can be more convenient.
Therapy with a mental health professional as treatment
If you’re living with depression or symptoms related to it, you might find that online therapy is preferable to in-person options for more reasons than just flexibility. In fact, one literature review of 17 studies noted that online therapy may be more effective than in-person therapy when it comes to treating symptoms of depression. Another study found that online therapy was also effective for anxiety and bipolar disorder. TMS alone often isn’t enough to make symptoms go away and stay away in the long term, but with the support of a mental health professional, you may be able to see a more significant change in the way you feel and function.
Takeaway
What does transcranial magnetic stimulation do?
Transcranial magnetic stimulation, or TMS, is a non-invasive procedure that can stimulate nerve cells in the brain by using electromagnetic coils placed on the scalp. These coils generate magnetic fields in the form of pulses that activate specific regions of the brain associated with mood control, such as the prefrontal cortex. The reasoning behind this is that the activity in these parts of the brain is reduced in those experiencing certain mental health disorders, like obsessive-compulsive disorder and major depressive disorder. By stimulating these regions, a person may feel symptomatic relief and subsequent improvement in mental well-being.
Since it is a noninvasive form of brain stimulation, it does not require surgery, unlike deep brain stimulation, which involves surgery and implantation of electrodes. While undergoing TMS treatment, the patient remains awake and alert. There are different ways to perform TMS. The most commonly used are repetitive transcranial magnetic stimulation and deep TMS.
Transcranial magnetic stimulation and depression
Major depression, a serious mental health disorder, is characterized by a continuous depressed mood and loss of interest in activities. It may also cause sleep issues, GI problems, fatigue, guilt, and suicidal ideation. Although treatment sessions using talk therapy and medication are considered effective for major depression, some individuals may not show improvement in symptoms. The use of TMS, specifically repetitive transcranial magnetic stimulation, may help.
TMS sends repeated magnetic pulses to stimulate nerve cells and boost activity in brain regions that control mood; hence, it is called repetitive transcranial magnetic stimulation. This non-invasive, FDA-approved treatment may ease major depression symptoms, especially when other therapies fall short. A study published in the Depression and Anxiety Journal shows that both high-frequency stimulation to the left prefrontal cortex and low-frequency stimulation to the right prefrontal cortex are effective for major depression.
What are the pros and cons of TMS?
Transcranial magnetic stimulation can be effective for major depressive disorder. It is typically used when depressive symptoms do not improve with other depression treatments, including talk therapy and medication. TMS offers targeted relief for mood disorders with few systemic effects, but it isn’t without its limitations. Reviewing its main advantages and disadvantages can clarify whether it fits your treatment plan well.
Pros and cons
There can be a variety of advantages and disadvantages to brain stimulation therapies like TMS, including the following:
Pros:
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This procedure varies from other types of electrotherapy, like deep brain stimulation (DBS). One of the main differences between deep brain stimulators and TMS is the invasiveness of the procedures, as DBS involves making holes in the skull and directly implanting electrodes into the brain. Unlike ECT, TMS stimulation of brain cells does not cause memory loss or seizures. Repetitive transcranial magnetic stimulation (repetitive TMS) is considered safe but has side effects, which are generally mild to moderate. Common side effects are headache, lightheadedness, and scalp discomfort. Some doctors may recommend pain medicine to relieve the discomfort. It is crucial for individuals considering repetitive transcranial magnetic stimulation or deep TMS for treatment to talk to their doctors regarding its benefits and risks and determine whether the treatment is the right option for their condition.
Does TMS really work as a mental health treatment for anxiety?
Research suggests that TMS, a noninvasive procedure, may be an effective treatment for conditions like general anxiety disorder. In many cases, healthcare providers will only use TMS once more traditional approaches have proven to be ineffective. These traditional approaches often include psychotherapy (i.e., talk therapy) and medications. The success rate of TMS for anxiety can vary from person to person but may be as high as 75%. However, more research may need to be conducted to conclude its viability and effectiveness as an anxiety treatment. Besides anxiety, TMS may also be effective for other mental health conditions, such as depression and obsessive-compulsive disorder.
Does TMS rewire the brain?
While the phrase “rewire your brain” may be interpreted in a variety of ways, pulses of magnetic energy during transcranial magnetic stimulation (TMS) may be able to increase activity in certain regions of the brain, potentially affecting its function. This brain stimulation is done through the use of electromagnetic coils attached to the skin and scalp of the head. To establish the baseline of excitability, the doctors determine the motor threshold by stimulating the motor cortex. They then transfer the coil to the target brain region. Once attached, each magnetic coil will send pulses of magnetic energy into the dorsolateral prefrontal cortex, areas of the superficial cerebral cortex, and a variety of other regions. In doing so, TMS may relieve the symptoms of certain mental health disorders, such as depression and obsessive-compulsive disorder.
TMS and magnetic resonance imaging
Typically, TMS treatment uses MRI to guide the placement of the TMS coil. The fMRI also shows blood flow. Changes in blood flow can help evaluate functional connectivity, revealing how brain regions work together.
What is the success rate of TMS therapy?
The success rate for TMS therapy will vary depending on what neurological disorders are being addressed and the nature of a patient's previous medical history. According to the media and publishing division of Harvard Medical School, Harvard Health Publishing, approximately 50% to 60% of those who have tried medication-based treatments for depression (but have not received any benefit) have experienced a meaningful response with transcranial magnetic therapy (TMS).
In addition, one-third of these individuals experienced full remission from their depression symptoms, though these effects were not always permanent. However, patients who underwent TMS procedures often felt better for months after treatments before a recurrence of symptoms occurred. It's important to note that success rates may vary, and it may be beneficial to explore other studies or methods of treatment.
What is the success rate of TMS?
While success rates may vary, one study suggests that 30% to 50% of patients undergoing transcranial magnetic stimulation therapy will respond to the treatment, but may not achieve remission of symptoms. Several factors may influence whether a person responds to TMS treatment. For example, younger individuals, who could have a higher level of brain plasticity, may respond more often to TMS therapy than older individuals.
It's important to note that this is only one study, and further research may need to be conducted to draw more finite conclusions on the efficacy of TMS. This study also doesn’t consider the success rates of other forms of TMS, like deep transcranial magnetic stimulation or intermittent theta-burst stimulation. In addition, individuals who do not benefit from TMS may still find success with more intensive forms of electric stimulation, like electroconvulsive therapy.
Who should avoid TMS?
Although repetitive TMS treatment and deep TMS are used to help improve symptoms of patients with depression, transcranial magnetic stimulation isn’t suitable for everyone. The TMS coil generates magnetic pulses. It’s contraindicated for people with magnetic-sensitive implants or metal in their body, as well as those with certain neurological conditions like seizures or migraines.
TMS therapy exclusions
Individuals who are using certain medical devices may not be eligible for TMS therapy. These devices include:
Pacemakers
Medicine Pumps
Implanted stimulation devices
Aneurysm coils or clips
Implanted hearing devices (like cochlear implants)
Certain brain activity monitoring devices
Stents
Those who have shrapnel or other metals within their body may also not be able to undergo TMS therapy due to the magnetic fields produced by the procedure. In addition, patients with certain medical conditions may not be able to use TMS, such as those with a history of seizures or migraines. Also, according to the National Institute of Mental Health, rTMS treatment is not allowed for individuals under 15 years old.
Who is not a good candidate for TMS?
Those who have experienced success using antidepressants or other medications may not be good candidates for TMS therapy, as TMS is typically only used once a person has been determined to have treatment-resistant depression. However, this may not be true in all cases, as more recent research may indicate that TMS could be effective for treatment-resistant depression when used alongside antidepressants.
Another group that may not be eligible for transcranial magnetic stimulation (TMS) is those who are under the age of 18 or are experiencing certain medical conditions. These conditions can vary but often include those that cause seizures or require the use of implanted medical devices such as nerve stimulators, pacemakers, or defibrillators.
Who should not use TMS?
Even though repetitive transcranial magnetic stimulation has been found helpful for depression and other mental health conditions, it is not advisable for everyone. It may not be beneficial for individuals with embedded metal, implanted medical devices, bullet fragments, or tattoos with metallic or magnetic ink to use transcranial magnetic stimulation (TMS) or repetitive transcranial magnetic stimulation (repetitive TMS), because TMS and repetitive TMS procedures use electrically generated magnetic pulses, anything containing metal or devices that use electricity may be disrupted. This could result in objects moving around in the body or malfunctioning, which may cause injury; in some cases, these injuries can be fatal. Due to the potential risks, it's important to be open and honest with your physician before undergoing this or any procedure.
How many sessions does it take for TMS to work?
How many sessions a TMS patient has to undergo before the procedure has an effect may vary. According to the UNC School of Medicine, a typical course of TMS will last for six weeks, with five treatments (i.e., daily sessions) taking place each week. These treatments can last anywhere from 20 to 40 minutes and do not involve any cutting of the skin, surgery, or anesthesia. While individuals may feel symptomatic relief before the end of their TMS series, it is often recommended that they finish the full course of the rTMS treatment to experience the full effects of the procedure.
The cost of TMS can be a significant barrier for individuals seeking relief from treatment-resistant major depression. Without insurance, a TMS session can cost between $400 and $500. While treatment sessions can be costly, most insurance companies do cover them. However, coverage may depend on an individual’s insurance plan.
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