Transcranial Magnetic Stimulation: What Is It?

Transcranial Magnetic Stimulation (TMS) is a non-invasive procedure that utilizes magnetic pulses to stimulate brain nerves. TMS therapy is FDA-approved for use in improving depression symptoms in many patients. It saves them from the common side-effects of antidepressants and does not alter cognitive functions. Patients are often recommended for the procedure when other depression treatments do not yield noteworthy results.

What is transcranial magnetic stimulation?

Transcranial magnetic stimulation is a neuromodulatory procedure that transmits magnetic pulses to the brain areas that are responsible for mood regulation. The magnetic pulses, delivered via a coil, flow seamlessly through the skull to generate an electrical field that produces an electric current in the brain. The generated electric current stimulates brain cells to enhance communication between different brain areas. The delivery of the TMS pulses at specific intervals, which are called repetitive TMS (rTMS).

rTMS is used because it can cause remarkable and lasting changes in brain functions, alleviating depression symptoms and boosting the patient's mental state. TMS therapy's magnetic pulses are like the ones used in MRI machines and are generally deemed safe for use. TMS has lesser side effects than traditional treatments like antidepressants for many patients.

TMS for depression

In the United States, transcranial magnetic stimulation is an approved procedure for treating major depressive disorder. Although depression is generally treatable, TMS is often used when traditional treatment options like medications, self-help techniques, and therapy fail to yield results or when the side effects of medications become too severe to handle.

Many patients who are dealing with treatment-resistant depression can turn to TMS as an option. Like antidepressants try to induce stimulation in the brain with chemicals, TMS uses magnetic fields to achieve the same effects. TMS systems include surface TMS, deep transcranial magnetic stimulation (dTMS), and Rapid TBS (theta burst).

Before treatment

An initial consultation is important for the provider to evaluate whether TMS therapy is the right choice for the patient, and to get to know them, their symptoms, and medical history. A successful TMS therapy begins with accurate mapping of the patient's brain to decide what point on the head to stimulate. The technician will determine the ideal point during the mapping session by sending magnetic pulses and registering the brain's response. The mapping procedure and the first TMS treatment will take around 90 minutes.

During treatment

TMS therapy is performed on an outpatient basis and typically lasts less than an hour. No surgery is involved, so there is no need for anesthesia or sedation, nor bed rest or downtime. Patients will be conscious and alert during the procedure. TMS therapy also does not affect any other part of the body like antidepressants.

For a TMS treatment plan, patients will generally continuously undergo daily sessions (five times every week) for four to six weeks. After completing their first treatment plan, some patients might benefit from occasional maintenance sessions. The average TMS session takes between 20 to 40 minutes, although some newer appliances only need about three minutes per session. After the session, patients can return to their routine and continue their day as usual.

A three-week taper phase follows the six-week course of therapy. Patients will require three TMS sessions in the seventh week, followed by two sessions in the eighth week, and one in the ninth week.

Effectiveness of TMS

Several studies back the effectiveness of TMS for cases of depression. However, the procedure is not a permanent cure for depression and does not mean patients will no longer experience symptoms. The positive results from undergoing TMS are expected to last about a year after the session.

There have been only a few (often mild) documented side effects, although most patients do not cease therapy because of them. Only in the first week of therapy does pain or discomfort typically occur. Each patient's response to TMS will be unique, as will the time it takes to observe its effects. It takes as little as two weeks for some patients to observe a difference in their depressive symptoms, while it may take up to five weeks for others. Patients for whom it takes longer to notice symptom alleviation are nonetheless getting good therapy and may still achieve long-term remission from their depression.

The bottom line

It is crucial to note that chemical disruption in the brain is not the only cause of depression — other factors also contribute. The idea is to use the results of transcranial magnetic stimulation to start psychotherapy or make lifestyle adjustments that can ensure long-term recovery.

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