Depression is one of the most common mental disorders in the United States, and the leading cause of disability worldwide. Even with such prevalence, the current standard treatment options for depression aren’t significantly effective or reliable. When it comes to antidepressants, over 60% of individuals with depression have to try multiple medications before finding one that works, and many don’t find relief from any medications.
Patients with depression should always couple medication with psychotherapy and the development of healthy thought patterns and emotional response techniques. However, finding relief day to day is still important, and medication or treatment that makes daily life easier can help individuals implement healthy habits. The need for more effective depression treatments is extremely important, but the options beyond antidepressant medication are slim and not well known.
One alternative treatment option for treatment-resistant depression is TMS or transcranial magnetic stimulation. Although it isn’t widely known, TMS has been used in the clinical field for over 35 years, and there is no significant scientific evidence that it is a TMS became FDA-approved to treat depression in 2008, and now some insurance companies will cover some or all of the treatment cost depending on the individual’s treatment history. Additionally, as research grows, TMS is being discovered as a promising treatment for a variety of other conditions, including PTSD, OCD, anxiety, bipolar disorder, and some forms of chronic pain.
What is TMS?
Transcranial magnetic stimulation in a non-invasive process that involves sending magnetic pulses onto the scalp. These magnetic signals are transmitted through the skull and activate neurons in your brain. TMS was first developed in 1985 and has been used ever since as a tool to measure motor conduction times and neural excitability in clinical trials. It is extremely safe and offers minimal side effects. As a treatment for mental health conditions, the magnetic pulses can be targeted to a specified area of the brain. When treating depression, the region of the limbic system known to be involved in depression and emotional regulation is targeted. There are multiple types of TMS:
- Single-pulse TMS or sTMS: Transmits a single magnetic pulse at a fixed frequency.
- Repeated-pulse TMS or rTMS: Transmits multiple magnetic pulses consecutively at a fixed frequency.
- Paired-pulse TMS or ppTMS: Transmits two magnetic pulses consecutively at a fixed frequency.
- Theta burst stimulation or TBS: Transmits magnetic pulses at a frequency that mimics individual brain waves and promotes neuroplasticity. Also known as Express TMS due to its shortened administration time, taking only a few minutes rather than the full 30 minutes like standard TMS methods.
How Do We Know TMS Is Effective?
Looking at clinical research, a number of sham-controlled trials have shown that TMS significantly reduces depression symptoms on average compared to placebo. There have been many repeated studies showing the effectiveness of TMS to alleviate symptoms and severity of depression in a clinical setting; some researchers have conducted reviews of the existing literature, showing a scientific consensus that TMS can show meaningful results even within 2 weeks. Longer-term studies have suggested that treatment periods of 4-6 weeks offer more reliable results.
Moving beyond clinical trials, we also have evidence that TMS is effective in treating depression in the real world. Researchers conducted a naturalistic observational study in 2012, observing real patients with Major Depressive Disorder receiving TMS treatments from currently practising TMS clinics. Their first observation was that the methods and practices used by the TMS clinics strongly aligned with the methods found to be most effective in clinical studies. They also observed that the rates of effectiveness in reducing depression symptoms were strikingly similar to previous results of controlled scientific studies. This shows us that TMS really does work in the real world for real patients. Overall, TMS was effective for about 60% of the patients observed in the study. Beyond that, almost 40% of the individuals achieved full remission or were completely relieved of symptoms.
While each individual may start to respond to treatment at a different time, on average patients start to experience relief about halfway through the treatment. TMS is unique from traditional antidepressants in that many patients experience relief for months or even years after the treatment. Unlike standard medications, TMS has the potential to offer lasting symptom relief and doesn’t promote reliance on a substance.
What is TMS treatment like?
Typically, a TMS clinic will construct a personalized treatment plan that suits your needs and schedule. However, a standard TMS treatment involves 5 sessions per week for 6 weeks, for a total of 30 sessions. Each session usually lasts around 20-40 minutes, allotting time to calibrate the machine and time for a health professional to monitor your response to the treatment. After the initial 30 sessions, additional booster sessions can be scheduled to ensure the treatment is effective and promote lasting results.
During each TMS session, you can comfortably sit and pass the time by reading, listening to music, or watching TV. The most common side effects reported are a mild tapping or tingling sensation on the scalp while the machine is on, or a general sensitivity that quickly subsides once the treatment is over. Some patients report a temporary mild headache or lightheadedness, and often these side effects subside after a few treatment sessions.
The biggest health risk involved with TMS is the risk of seizure, which is extremely small (less than .001%). For this reason, individuals with a predisposition to seizure, epilepsy, a history of head injury, or other neurological issues may not be recommended for TMS. You also can’t receive TMS treatment if you have metal implants of any kind, due to the interaction with the magnetic signals.
What else can TMS treat?
As mentioned before, TMS is gathering a lot of attention from clinical scientists, and research is constantly being conducted to determine the efficacy of TMS in treating a multitude of other mental and physical ailments. Patients can now receive TMS at a certified clinic for anxiety, OCD, PTSD, smoking cessation, chemobrain, and some types of chronic pain, such as migraines.
As the research continues and alternative treatments for depression become more widely known, TMS will likely become a more accessible treatment option for those struggling with treatment-resistant depression and other conditions. Certified TMS clinics offer personalized treatment plans that incorporate a variety of therapy and treatment methods to suit individual needs and to help treatments like TMS be as effective as possible.