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  • Writer's pictureDr Smolenski

TMS Relevant

Updated: Sep 19, 2019


Transcranial Magnetic Stimulation (TMS) is an FDA-approved treatment for people with depression who have not seen satisfactory improvement from anti-depressant medications.

Using pulsed magnetic fields, TMS treats depression by stimulating the part of the brain believed to be involved in mood regulation.

TMS Therapy is noninvasive (TMS is a not a surgical intervention. It does not require any sedation or anesthesia) and nonsystemic (it targets only the portion of the brain involved in emotional regulation. It is not like medications, which circulate in the bloodstream).

How does TMS work?

TMS is an outpatient procedure. The TMS technician applies a soft plastic coil to the patient’s scalp, sending magnetic pulses through the skull and 2-3 centimeters into the brain. The magnetic pulses stimulate specific parts of the brain with accuracy, ensuring only the tissue involved in mood regulation is targeted. The magnetic pulses used by TMS are so small they cannot be felt by the patient, and are similar to the ones used by a Magnetic Resonance Imaging (MRI) machine. When administered to the brain, these magnetic impulses produce a miniscule electrical current in the axon of neurons in the brain. The electrical currents cause the neurons in the brain to become active and lead to an increased release of neurotransmitters. Improved neurotransmission decreases depression. The typical course of treatment consists of 5 sessions per week over a 6 week period (30 treatments), followed by 3 weeks of tapering it (6 treatments) for a total of 36 sessions. Treatment sessions are 19 minutes in duration; most patients feel completely fine after sessions, and return to work or normal daily life.

Is TMS a good alternative for patients who cannot tolerate the side effects of antidepressant medications, or those for whom antidepressants have been unsuccessful?

Since TMS is not an oral medication it does not circulate in the bloodstream and cause unwanted side effects such as weight gain, dry mouth, or nausea. TMS has been cleared by the FDA for the treatment of patients with depression who have not had satisfactory improvement with antidepressant medications.

Does TMS therapy have any side effects?

The most commonly reported side effects during clinical trials were headache and scalp discomfort. These potential side effects were typically mild to moderate, and were less common after the first week of treatment. During clinical trials, less than 5% of patients treated with TMS discontinued treatment due to side effects. If necessary, headaches from TMS can be treated with over-the-counter pain medications. If the side effects persist, the strength of the TMS pulses can be temporarily reduced to ensure the comfort of the patient.

What are the potential risks of TMS therapy?

In clinical practices there have been rare reports of seizures. These instances of seizures were associated with the use of Wellbutrin and/or alcohol. To help mitigate this risk, patients are asked to stop the use of Wellbutrin before beginning TMS and to abstain from alcohol during the course of their TMS treatment. Rarely, patients may develop manic symptoms during TMS. The incidence of seizure with TMS is small and appears slightly lower than the incident risk reported for the use of current antidepressant medications.

Is TMS like electroconvulsive therapy (ECT)?

No. While both procedures are effective in treating depression, TMS is very different from ECT. During TMS therapy, the patient is awake and alert throughout the entire treatment. No sedation is necessary with TMS treatment, and patients are able to safely transport themselves to and from therapy. Patients are able to return to their daily activities immediately after TMS treatments. There were no negative impacts on memory or concentration reported with TMS therapy.

Is TMS therapy right for me?

While TMS therapy has been proven to be an effective treatment for depression, not all patients will benefit from it. Patients should be carefully monitored during the course of their treatment for worsening symptoms, suicidal thoughts or behaviors, and/or unusual behaviors. Families and caregivers should be involved in monitoring the TMS patient, and be able to notify the patient’s treatment provider of any sudden changes in mood or behavior. Patients should discuss with their doctor the potential risks and benefits of TMS therapy, and make the best treatment decision for them.

Is TMS covered by insurance?

TMS is covered by most health insurance plans after the patient has failed antidepressant medications.

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