Depression is the leading cause of disability in the United States among people ages 15 to 44. While there are many effective treatments for depression, first-line approaches such as antidepressants and psychotherapy do not work for everyone. In fact, approximately two-thirds of people with depression don't get adequate relief from the first antidepressant they try. After two months of treatment, at least some symptoms will remain for these individuals, and each subsequent medication tried is actually less likely to help than the one prior.
What can people with depression do when they do not respond to first-line treatments? For several decades, electroconvulsive therapy (ECT or "shock therapy") was the gold standard for treatment-resistant depression. In fact, ECT is still considered to be the most potent and effective treatment for this condition, and it continues to be used regularly across the country. For many people with depression, however, ECT can be too difficult to tolerate due to side effects on memory and cognition. For those individuals and the many others who have had an inadequate response to medications and therapy alone, there is a newer treatment option called transcranial magnetic stimulation (TMS).
What is transcranial magnetic stimulation?
Transcranial magnetic stimulation, or TMS, is a noninvasive form of brain stimulation. TMS devices operate completely outside of the body and affect central nervous system activity by applying powerful magnetic fields to specific areas of the brain that we know are involved in depression. TMS doesn't require anesthesia and it is generally exceptionally well tolerated as compared to the side effects often seen with medications and ECT. The most common side effect is headache during or after treatment. A rare but serious side effect is seizures, and TMS may not be appropriate for people at high risk such as those with epilepsy, a history of head injury, or other serious neurologic issues.
Does TMS work?
Approximately 50% to 60% of people with depression who have tried and failed to receive benefit from medications experience a clinically meaningful response with TMS. About one-third of these individuals experience a full remission, meaning that their symptoms go away completely. It is important to acknowledge that these results, while encouraging, are not permanent. Like most other treatments for mood disorders, there is a high recurrence rate. However, most TMS patients feel better for many months after treatment stops, with the average length of response being a little more than a year. Some will opt to come back for subsequent rounds of treatment. For individuals who do not respond to TMS, ECT may still be effective and is often worth considering.
What is TMS therapy like?
TMS therapy is an intensive treatment option requiring sessions that occur five days a week for several weeks. Each session may last anywhere from 20 to 50 minutes, depending on the device and clinical protocol being used. When patients arrive, they may briefly check in with a technician or doctor and then begin the stimulation process. The technician will determine the ideal stimulation intensity and anatomical target by taking advantage of a "landmark" in the brain called the motor cortex. By first targeting this part of the brain, the team can determine where best to locate the stimulation coil as it relates to that individual's brain and how intensely it must "fire" in order to achieve adequate stimulation. Calculations are then applied to translate this data toward finding the dorsolateral prefrontal cortex, the brain target with the greatest evidence of clinical effectiveness and an area known to be involved in depression. Though one session may be enough to change the brain's level of excitability, relief isn't usually noticeable until the third, fourth, fifth, or even sixth week of treatment.
Can TMS help with other conditions?
TMS is being studied extensively across disorders and even disciplines with the hope that it will evolve into new treatments for neurological disorders, pain management, and physical rehabilitation in addition to psychiatry. There are currently large clinical trials looking at the effectiveness of TMS in conditions such as pediatric depression, bipolar disorder, obsessive-compulsive disorder, smoking cessation, and post-traumatic stress disorder. While promising avenues for research, TMS for these conditions is not yet approved and would be considered "off-label."
FAQs
There is some controversy around TMS therapy, with some people arguing that the long-term benefits have not been proven. However, the majority of research suggests that the benefits of TMS therapy do last for at least several months after treatment ends.
Does TMS really work for depression? ›
Does TMS work? Approximately 50% to 60% of people with depression who have tried and failed to receive benefit from medications experience a clinically meaningful response with TMS. About one-third of these individuals experience a full remission, meaning that their symptoms go away completely.
What are the negative effects of TMS? ›
Common side effects
- Scalp discomfort and pain.
- Headache.
- Tingling, spasms or twitching of facial muscles.
- Lightheadedness.
TMS may not work for everyone. There is a risk that clinical symptoms of depression would worsen if they are not adequately treated. In some patients, particularly those with underlying bipolar disorder or severe anxiety, TMS can be overly stimulating to the brain and induce worsening anxiety, panic, or insomnia.
Who should avoid TMS? ›
Aneurysm clips or coils, metal stents, and cochlear implants are all examples of implants that may exclude you from having TMS therapy safely. Ocular implants, deep brain stimulators, or any other medical implants containing metal may also jeopardize the safety and efficacy of TMS and your implants.
Who is not a good candidate for TMS? ›
You may not be a candidate for TMS if:
You have implants controlled by physiological signals. This includes pacemakers, implantable cardioverter defibrillators (ICDs), and vagus nerve stimulators (VNS) You are at high risk such as those with epilepsy, a history of head injury, or other serious neurologic issues.
Is TMS better than antidepressants? ›
Antidepressants are not as accurate at treating depression as TMS Therapy. For this reason, antidepressants cause more side effects.
Is TMS worth the cost? ›
But despite this cost, research has shown that TMS is a cost-effective treatment compared to SSRIs. Many experts believe that TMS should be closer to a first-line treatment for depression and other diagnoses because it's shown to be so effective.
Does TMS help permanently? ›
While there is no permanent cure for depression and anxiety, TMS therapy heals your brain by encouraging neuroplasticity: your brain's capability to adapt and reorganize itself.
What is the most serious side effect of TMS? ›
Addressing More Serious TMS Side Effects
Please note that the risk of TMS-caused seizures is 0.1%, hearing issues are caused by the loud clicking noise during treatment but can be avoided with earplugs, and mania is a side effect that mainly impacts individuals with bipolar disorder.
The bottom line is that transcranial magnetic stimulation won't change your personality, but it may help with symptoms that led to behavioral changes that appeared to impact your personality in the first place. You may notice things like: Feeling happier and wanting to do more activities with loved ones.
What is the success rate of TMS? ›
Approximately 50% of patients go into full remission, meaning they become completely asymptomatic after one treatment routine.
Is anger a side effect of TMS? ›
Experiencing an increase in feelings of aggression or irritability during TMS treatment may be a positive indicator of effective treatment. It may also be a useful predictor of reaching eventual remission. In past research, the stimulation of the DLPFC has been shown to impact anger and aggression.
Can TMS worsen anxiety? ›
There is no evidence suggesting TMS can worsen anxiety, but people may experience the following side effects: headache. neck pain. scalp pain.
Is TMS therapy snake oil? ›
When asked why some psychiatrists still believe it's "snake oil", Professor Loo's response is decisive. "There is top quality, gold standard evidence of which I chaired in 2013, that TMS is effective in treating depression. The trials we are doing now is to improve the current treatment.
Is TMS therapy ethical? ›
The TMS committee of experts on safety, ethical considerations and application already con- ceives this concept as a possible “brain-doping” that carries with it a social and ethical prob- lem.
Does TMS disrupt mental functions? ›
Finally, TMS delivered as repetitive trains of stimulation (rTMS) may activate, inhibit, or otherwise interfere with the activity of neuronal cortical networks, depending on stimulus frequency and intensity, and brain-induced electric field configuration.
What is the dip in TMS therapy? ›
Similar to antidepressants, TMS therapy may have a temporary setback in progress, known as a "TMS dip." It's common to initially feel better, so a dip can be puzzling. The dip happens because TMS rewires the brain, targeting the prefrontal cortex and disrupting its usual function.
Can TMS cause memory issues? ›
Does TMS Therapy cause memory loss? No, TMS Therapy system was systematically evaluated for its effects on memory. Clinical trials demonstrated that TMS Therapy does not result in any negative effects on memory or concentration.
