How Effective Is TMS Therapy? Transcranial Magnetic Stimulation and Treatment Insights

TMS, or Transcranial Magnetic Stimulation, can be an effective therapeutic treatment for depression in some people. This type of treatment generally involves the stimulation of different areas of the brain using a magnet for 20 to 40 minutes. Sessions are typically scheduled five times per week for four to six weeks, and the effects can last for six months to one year depending on the individual’s health and the severity of the disorder, among other factors. Another depression treatment option may be therapy, which can be finished in person or online.

Addressing treatment-resistant depression

Depression can be a serious mental health concern that tends to affect everyone differently. Depression encompasses several depressive disorders, including major depressive disorder, seasonal affective disorder, and persistent depressive disorder. Additionally, other mental health conditions can be comorbid with depression or feature depressive symptoms, such as bipolar disorder, anxiety disorders, and substance use disorder. 

For this reason, depression often goes undetected, which can exacerbate symptoms. Despite more than 300 million people living with depression worldwide, many aspects of depression may not be entirely understood, and treating depression can be difficult. 

Depression treatments

Depression treatments—which typically consist of antidepressant medication, therapy, or a combination of both—are thought to be effective for up to 90% of individuals. Sometimes, however, those who attempt to treat depression through traditional methods struggle to reduce their symptoms for various reasons (e.g., adverse effects of antidepressant medications). For these individuals, symptom relief may be possible through brain stimulation therapies, which are therapeutic treatment methods that stimulate nerve cells through medical devices.

Brain stimulation therapies

Common brain stimulation therapies include electroconvulsive therapy and vagus nerve stimulation (which active the brain and vagus nerve, respectively, through electric currents) and transcranial magnetic stimulation, or TMS (which activates the brain through magnetic pulses). TMS is a non-invasive brain stimulation treatment that can be used when individuals with depression are not responding to other therapeutic treatments.  

Transcranial magnetic stimulation (TMS) therapy

TMS, or repetitive Transcranial Magnetic Stimulation (rTMS), can be a depression treatment that generally uses a magnetic force to alter the patterns of your brain to decrease the symptoms of depression.

To engage in brain stimulation, a professional may begin by placing a magnetic coil against the side of the patient's head. Practitioners may then apply a series of pulses within the magnet to stimulate the nerve cells of the brain involved in mood control.

Because the procedure is non-invasive (meaning there is no direct reach to the brain via surgery), TMS is normally considered a safe, therapeutic treatment for depression without any dramatic or alarming risks.

That being said, there can be some mild side effects brought on by magnetic stimulation (TMS) sessions, which can include headaches, lightheadedness, facial tingling or numbness, and discomfort during the procedure. 

Headache

Due to the stimulation of activities in the brain, you could feel a tingling sensation on your head or dizziness. However, it is only mild and temporary.

Scalp discomfort 

When you undergo TMS therapy, you may feel scalp soreness at the site of stimulation. But it is often tolerable. 

Tingling or twitching

Stimulation can cause sensations in the face, scalp, or other areas.

Dizziness 

Some people may experience lightheadedness during or after treatment.  It would be best if you had someone with you during this therapy.

Fatigue

You may feel tired and lethargic after the session. Make sure to take a rest after the therapy. 

Seizures 

Some people also experience seizures, which are usually triggered by magnetic pulses.

Hearing issues

TMS therapy produces a tapping sound during the procedure, which can cause temporary hearing discomfort.  You must speak to your therapist if you experience this.

Qualifications necessary to administer treatments

Only a qualified TMS therapist should administer transcranial magnetic stimulation (TMS). This is because, while generally considered safe, repetitive TMS may still pose some risks and should be monitored by a professional for the safety of the patient.

This therapeutic treatment type is not usually taught as a regular part of earning a psychology certification and is considered a specialty. The following is a list of further qualifications to practice transcranial magnetic stimulation:

• Professionally licensed to practice TMS therapy
• Specialized training from accredited  TMS-specific programs
• Certification from a recognized TMS provider or organization
• Practical experience in administering TMS therapy and working with patients undergoing the same therapy
• A strong understanding of conditions that TMS targets such as depression, anxiety, and more
• Commitment to staying updated on the latest research regarding TMS
• In some cases, therapists must work under the supervision of a licensed psychiatrist, particularly when using TMS to treat more complex cases

Session overview

There can be some variation within the practice of TMS, but the basic mechanism is generally the same: a magnet is placed against the scalp—traditionally, near the forehead—and magnetic pulses are delivered.

Before a TMS therapy

Initially, a practitioner may administer TMS therapy to determine a patient's pain tolerance and comfort level, and then move on to "mind mapping" to make sure each session is targeting the correct area of the brain. Once a therapeutic treatment plan has been established, appointments typically last between 20-40 minutes.

During a TMS treatment session

During a TMS treatment session, the patient is usually placed in a comfortable chair and given earplugs to deaden some of the sound emitted by the magnetic machine. The magnet is typically activated for a few seconds. When activated, the patients may hear a clicking or tapping sound and feel a similar sensation against the skin.

After a TMS treatment

After a TMS treatment, you may feel slight discomfort such as a tingling sensation on your scalp or a headache as an effect of the magnet. However, this side effect is only for a brief moment and will go away on its own without medication.

How often do TMS sessions have to occur?

Most practitioners recommend regular treatment with TMS, which usually means five therapy sessions per week for a four- to six-week period. Therapeutic treatment can veer outside of this standard but usually requires at least this great a time commitment. Improvement in symptoms can take several weeks, but some patients report feeling changes as early as the first treatment.

Once therapeutic treatment has concluded, patients typically go on to use traditional, therapeutic treatment methods, such as talk therapy or medication, to maintain the results of TMS.

The cost of TMS can be difficult to discern, as it is still considered somewhat experimental by some insurance companies. For this reason, many patients are only able to undergo insurance-covered treatment after traditional methods have not worked; TMS is often not covered as a primary therapeutic treatment option.

Does insurance cover TMS treatment costs?

In some cases, TMS therapy may not be covered by insurance. Out-of-pocket costs for this treatment could range from $400 to $500 per session. Fortunately, many insurance companies allow doctors and clients to lobby for declined therapeutic treatment options.

How effective is TMS for depression?

TMS therapy generally has a 30% success rate, which can place it just below traditional antidepressants, which typically see a 50% success rate. Individuals who seek TMS therapy and treatment that experience improved symptoms are usually instructed to continue seeking regular "maintenance" therapy.

Although the exact efficacy of TMS therapy is not known, as it is still viewed as a fledgling practice, some studies have shown that it can demonstrate consistency in treating patients with depression. Additionally, as discussed below, TMS therapy can be used to treat certain other mental health conditions.

TMS therapy is thought to be an efficacious treatment for people experiencing various types of mental illness. If you’re seeking care for depression or another mental health condition, a qualified healthcare professional or therapist can determine the best course of therapy or therapeutic treatment. 

Nevertheless, transcranial magnetic stimulation treatment is ideal for individuals struggling with treatment-resistant depression. It also helps with anxiety and PTSD, as determined by a licensed healthcare provider.

Clinical trials suggest that repetitive transcranial magnetic stimulation treatment or TMS therapy can effectively reduce symptoms in those experiencing treatment-resistant depression. Additionally, there is evidence that this form of deep brain stimulation can lead to improvements in obsessive-compulsive disorder. Researchers have also found that TMS therapy can help individuals quit smoking. 

One of the reasons TMS therapy is gaining popularity may be its nature as a non-invasive, therapeutic treatment. Though this might be great for some patients, others can be considered poor candidates for TMS therapy. These can include individuals with pacemakers, stents, aneurysm coils, metallic implants in the upper body, monitoring tools inserted in the head or neck, bullets or shrapnel in the upper body, or tattoos using metallic ink.

Since transcranial magnetic stimulation uses electromagnetic energy for treatment, it could cause injury to people with implants. You can speak with your provider for alternative options with the same effectiveness rate as transcranial magnetic stimulation.

Tourette syndrome, schizophrenia, and more

Transcranial magnetic stimulation or TMS is generally not an ideal match for patients seeking to treat Tourette syndrome, schizophrenia, post-traumatic stress disorder, or obsessive-compulsive disorder. Instead, TMS can improve depression and major depression disorders specifically.

Lack of insurance coverage

Since TMS therapy may not be covered by insurance as a first-line treatment in some cases, it may be helpful to try other methods before implementing TMS. You may also want to ask your insurance provider what, if any, requirements need to be met before TMS is covered. Try to explore alternative treatments first to determine if TMS is truly necessary.

Online counseling for depression

Fortunately, research shows that online therapy can play a significant role in reducing depression and anxiety symptoms. For example, one study found that online therapy could be even more effective than traditional in-person sessions, with 100 percent of participants in the online group showing continued symptom reduction three months after therapeutic treatment.