As a psychiatrist who has been treating patients for more than 10 years, the most common condition that I come across is clinical depression (also known as Major Depressive Disorder). For decades, patients have been typically treated with traditional methods using medications and/or psychotherapy, however some patients do not always respond well due to side effects or lack of substantial improvement. Although there are other alternative treatment strategies available to treat clinical depression, I am excited to tell you about TMS (Transcranial Magnetic Stimulation). TMS has been FDA cleared since 2008 to treat depression that hasn’t responded well to antidepressants. In the past few years, many insurance companies are now offering coverage for this safe and effective alternative to antidepressants. TMS involves no drugs or sedation, no electrical shock, and is a completely non-invasive in-office procedure.
In simple terms, Transcranial Magnetic Stimulation uses a magnet to activate the brain. It was first developed in 1985 and studied as a treatment for depression, psychosis, anxiety, and other disorders like OCD and PTSD. Unlike electroconvulsive treatment (ECT), in which electrical stimulation is more generalized, TMS can be targeted to a specific site in the brain. Scientists believe that focusing on a specific site in the brain reduces the chance for the types of side effects usually associated with ECT.
For FDA approved protocols for depression, the TMS course happens every weekday, a little over 6 weeks for a total of 36 sessions. The patient will come to the office and sit in a comfortable chair similar to the kind seen in a dentist’s office. Each session usually lasts about 20 minutes.
An electromagnetic coil is held against the top of the head near an area of the brain that is
thought to be involved in mood regulation. Short electromagnetic pulses are administered through the magnetic coil. The magnetic pulses easily pass through the skull, and causes small electrical currents that stimulate nerve cells in the targeted brain region. Because this type of pulse generally does not reach further than two inches into the brain, the clinician can select which parts of the brain will be affected and which will not be.
The magnetic field is about the same strength as that of a magnetic resonance imaging (MRI)
scan. Generally, the patient feels a slight knocking or tapping sensation on the head as the pulses are administered.
Before the procedure, patients are asked to remove any magnetic-sensitive objects (such as jewelry, credit cards). Patients are recommended to wear earplugs during treatment for their comfort and hearing protection, as it produces a loud clicking sound with each pulse like an MRI machine.
During the first session, several measurements are made to ensure that the TMS coil will be properly positioned over the patient’s head. The TMS physician then measures the patient’s motor threshold, by administering several brief pulses. The motor threshold is the minimum amount of power necessary to make the patient’s thumb twitch, and varies from individual to individual. Measuring the motor threshold helps the physician personalize the treatment settings and determine the amount of energy required to stimulate brain cells.
Not only has the FDA approved TMS for Major Depressive Disorder, it is now approval to treat Obsessive Compulsive Disorder, migraines, and smoking cessation.
There are some contraindications for TMS which include the following:
• Patients with any type of non-removable metal in their heads (with the exception of braces or dental fillings), should not receive TMS.
• Aneurysm clips or coils
• Stents in the neck or brain
• Deep brain stimulators
• Electrodes to monitor brain activity
• Metallic implants in ears and eyes
• Shrapnel or bullet fragments in or near the head
• Facial tattoos with metallic or magnetic-sensitive ink
• Other metal devices or object implanted in or near the head
Side effects/Adverse Effects
• Discomfort at the site on the head where the magnet is placed.
• The muscles of the scalp, jaw or face may contract or tingle during the procedure.
• Mild headaches or brief lightheadedness
• Temporary ringing in ears
• It is possible that the procedure could cause a seizure, although documented incidences of this are very rare as in less than 1 in 10,000.
TMS can be used in cooperation with medications and talk therapy. Sometimes the benefits of TMS will enable a patient’s current psychiatric medications to work better. Other patients may be able to lower doses of medications or even is some cases be able to titrate off psychiatric medications completely. The benefits of TMS can last 6 months or longer. There are times when a TMS course will have to be repeated in case the first round of treatment benefits wears off.
If you or a loved one are interested in learning more about this alternative treatment for depression, please feel free to contact our psychiatric office where a free consult can be arranged by calling (256)739-4910 Ext 7486 and asking to speak with our TMS Coordinator, Rachel Turner.
Santosh Pillai, D.O.