Transcranial magnetic stimulation therapy (TMS) is a treatment option that many mental health professionals use after counseling and medication have failed to help a patient with depression. TMS is a non-invasive procedure involving electromagnets to stimulate the patient's brain. Anyone contemplating TMS should know that psychiatrists carefully balance the procedure's advantages against any potential risks.
TMS comes in different forms, and the most commonly used ones are repetitive transcranial magnetic stimulation and deep transcranial magnetic stimulation. The two are quite distinct in terms of stimulation depth, coil type, and session time. The following is a brief overview of these two types.
Repetitive TMS is a non-invasive method that includes putting a tiny device directly on the scalp. A coil transmits electricity and produces a magnetic field in this enclosed device.
The device's electrical current activates neurons in the brain, altering their activity levels. Low neuronal activity has been connected to symptoms of mental conditions, such as obsessive-compulsive disorder (OCD). The number of rTMS sessions required is determined by the treatment protocol, which the psychiatrist will review with the patient before beginning.
According to Current Psychiatry Reports, while some studies have shown rTMS to be successful in alleviating OCD symptoms alone or in conjunction with medication, most research results show that rTMS alone is ineffective in treating OCD symptoms. It may indirectly enhance the psychological well-being of persons with OCD by lowering the symptoms of depression that often accompany OCD. According to a consensus suggestion published in the Journal of Clinical Psychiatry in 2019, rTMS may be a safe and effective therapy for patients with medication-resistant depression and considerable anxiety.
Deep transcranial magnetic stimulation, like rTMS, employs a coil placed over the scalp to produce a magnetic field that penetrates the brain. The most significant distinction between the two is that the H-coil used in dTMS enables the pulse to penetrate deeper into the brain.
Deep TMS has proven to be more effective than rTMS in the treatment of mental disorders. Both rTMS and dTMS have been licensed by the Food and Drug Administration (FDA) to treat severe depression. Research on its effectiveness for OCD and other mental diseases, such as bipolar disorder, is now underway.
When OCD is difficult to cure, deep TMS may provide significant results. People with treatment-resistant OCD who get dTMS often exhibit considerable improvement in their symptoms.
The FDA extended the treatment application of TMS to migraine headache symptoms in 2013 and authorized deep transcranial magnetic stimulation for the treatment of OCD in 2018. TMS may also be used to treat conditions like anxiety disorders, Alzheimer's disease, Parkinson's disease, chronic pain, schizophrenia, post-traumatic stress disorder, substance use disorder, and stroke rehabilitation.
The goal of deep transcranial magnetic stimulation is to energize the brain's reward and motivation systems. The subgenual anterior cingulate cortex houses the reward and motivation circuits. This spot is about four millimeters below the surface of the forehead. The intensity of the electromagnetic field must be calibrated before therapy, since the depth varies from patient to patient. Deep TMS has the features to stimulate these brain regions.
Repetitive TMS can reach depths of up to one and a half in the brain. The electromagnetic field concentrates on the dorsolateral prefrontal cortex. Deep TMS focuses on the subgenual cingulate cortex, which is farther away from the scalp.
The dorsolateral prefrontal handles executive and cognitive functions, including abstract thinking, working memory, goal-directed behavior, intent, attention management, and negative affectivity. One reasonable proposition on the probable origins of depression is that it may come from an inability to relinquish unattainable ideas or to break off from a goal-oriented mental process. These challenges relate to negative affectivity. An example would be the more unpleasant and long-lasting form of transient sadness that children feel when they have a request that is denied.
Health care providers should strive to deliver the most effective therapies while minimizing the patient's pain and suffering. Most providers use technology to administer dTMS and provide effective non-medication therapy for severe or treatment-resistant depression.
The effects of TMS may vary depending on the type employed and the condition being treated. For instance, current studies show that although rTMS may be successful in treating depression, it may be less effective in the treatment of OCD.
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