TRANSCRANIAL MAGNETIC STIMULATION
TMS is a non-invasive procedure for treatment-resistant depression that delivers magnetic pulses through an electromagnetic coil to the left dorsolateral prefrontal cortex, the region of the brain associated with mood control.
Luigi Galvani and Alessandro Volta first discovered in the late 18th century that nerves carry electrical energy within the nervous system. TMS functions by electrically stimulating dormant brain cells, enabling them to function well again.
TMS was developed in 1985 as the first noninvasive treatment capable of targeting precise regions of the brain without general anesthesia or pain.
Since then, numerous studies have been performed to demonstrate that TMS is safe and effective in the treatment of major depression. TMS was approved by the FDA in 2008 and first covered by insurance in 2013.
Prefrontal Cortex
The prefrontal cortex is located in the anterior part of the frontal lobe. It is highly developed in humans, playing a role in the regulation of complex cognitive, emotional, and behavioral functioning.
The PFC produces the attributes that define human identity: ambition, empathy, foresight, personality, a sense of morality, and a sense of dignity.
When the left prefrontal lobe is damaged, patients may withdraw from the social world and show a marked resistance to do anything at all. They seem to lose all interest in their future and show little to no moral compunctions. IQ, language, and memory remain unaffected, but some of the quintessential human functions like empathy and ambition become inhibited.
The main functions of the prefrontal cortex are:
- Coordinating and adjusting complex behavior
- Controlling impulses
- Displaying appropriate emotional reactions
- Manifesting personality
- Focusing attention
- Considering and prioritizing competing and simultaneous information
- Ignoring external distractions
- Complex planning
- Assessing options and choosing a course of behavior
- Deferring certain immediate gratifications in order to obtain greater long-term benefits
- The left half of pre-frontal cortex is involved in establishing positive feelings
- The right half is involved in establishing negative feelings
Your Brain on Depression
People become depressed for a number of reasons. One of the main causes of depression is deep emotional trauma in childhood or adulthood, including physical and emotional abuse, death of a loved one, loss and betrayal, a chronic medical condition, and sexual abuse. Another major cause is unmet physical and emotional needs. Physical needs are mostly universal – we all have a need for balanced diet and nutrients, sleep and rest, sunshine and water, shelter and warmth. Emotional needs vary per person – some people require more socialization and some more personal space; some people need more safety while some need more adventure.
A number of other factors contribute to the development of depression: such as genetical disposition, biochemical imbalance in the body, electric signal pathologies in the brain, medical conditions, and medications.
When depression develops due to emotional causes, it manifests as impaired expression – a person’s perceived inability or unwillingness to feel and express their emotions. People suppress their thoughts and feelings, creating mental structures to avoid dealing with and processing the root cause of trauma. Eventually, they lose touch with themselves, as their synaptic connections atrophy in the left dorsolateral prefrontal cortex.
Poor diet, genetic conditions, blood sugar imbalances, medical illness, hormone imbalance, lack of exercise, medications, drug and alcohol use, and digestive difficulties are also known to cause or contribute to depression and inhibiting the function of the prefrontal cortex.
In brain-imaging studies using PET scans, depressed people display abnormally low activity in the prefrontal cortex, and the severity of the depression often correlates with the extent of the decline in activity in the prefrontal cortex.
Because the left half of the prefrontal cortex is involved in establishing positive feelings, it is the left prefrontal cortex that shows the greatest signs of weakness in depressed people. In other words, when people are depressed, they find it very hard not only to set goals in order to obtain rewards but also to believe that such goals can be achieved.
How TMS Helps Depression
During TMS, magnetic pulses are delivered precisely to the left dorsolateral prefrontal cortex. The unique nature of magnetic fields allows them to pass through the skull and into the cortex without being distorted in any way, minimizing stimulation of brain tissue not involved in mood.
Once inside the brain, the dynamic nature of the magnetic pulses induces electrical charges and activates brain cells. The magnet is pointed straight at the brain region responsible for cognitive functions, increasing the patient’s ability to process difficult feelings, make decisions, and exercise more control over thoughts and behaviors.
How TMS Treatment Works:
- Patients sit in a comfortable reclining chair in a dedicated room of our spa-like clinics.
- An electromagnetic coil is placed on the left side of the patient’s forehead, allowing magnetic pulses to be safely delivered through the scalp to the brain.
- Each treatment lasts about four minutes.
- Therapy takes place five times a week for six to eight weeks, with 50-60% of patients reporting a complete lift of depressive symptoms by the end of six weeks.
TMS vs ECT – Factual Comparison
Research and Studies:
Hassey G. Transcranial magnetic in the treatment of mood disorders: A review and comparison with electroconvulsive therapy. Can J Psychiatry. 2001;46:720–7. [PubMed]
Schutter DJLG, van Honk J. A framework for targeting alternative brain regions with repetitive transcranial magnetic stimulation in the treatment of depression. J Psychiatry Neurosci. 2005;30(2):91–7.[PMC free article] [PubMed]
Kobayashi M, Pascual-Leone A. Transcranial magnetic stimulation in neurology. Lancet Neurol. 2003;2:145–56. [PubMed]
George MS, Nahas Z, Kozel A, et al. Mechanisms and current state of transcranial magnetic stimulation. CNS Spectr. 2003;8(7):496–514. [PubMed]
Wassermann EM, Lisanby SH. Therapeutic application of repetitive transcranial magnetic stimulation: A review. Clin Neurophysiol. 2001;112(8):1367–77. [PubMed]
Martin JLR, Barbanoj MJ, Schlaepfer TE, et al. Transcranial magnetic stimulation for treating depression. [systematic review] Cochrane Database of Systematic Reviews. 2005;4 [PMC free article][PubMed]
George MS, Wassermann EM, Kimbrell TA, et al. Mood improvement following daily left prefrontal repetitive transcranial magnetic stimulation in patients with depression: A placebo-controlled crossover trial. Am J Psychiatry. 1997;154(12):1752–6. [PubMed]
Klein E, Kreinin I, Chistyakov A, et al. Therapeutic efficacy of right prefrontal slow repetitive transcranial magnetic stimulation in major depression: a double-blind controlled study. Arch Gen Psychiatry. 1999;56(4):315–20. [PubMed]
Berman RM, Narasimhan M, Sanacora G, et al. A randomized clinical trial of repetitive transcranial magnetic stimulation in the treatment of major depression. Biol Psychiatry. 2000;47(4):332–7. [PubMed]
Garcia-Toro M, Mayol A, Arnillas H, et al. Modest adjunctive benefit with transcranial magnetic stimulation in medication-resistant depression. J Affect Disord. 2001;64:271–5. [PubMed]
Garcia-Toro M, Pascual-Leone A, Romera M, et al. Prefrontal repetitive transcranial magnetic stimulation as add on treatment in depression. J Neurol Neurosurg Psychiatry. 2001;71(4):546–8.[PMC free article] [PubMed]
Hoppner J, Schulz M, Irmisch G, et al. Antidepressant efficacy of two different rTMS procedures. High frequency over left versus low frequency over right prefrontal cortex compared with sham stimulation. Eur Arch Psychiatry Clin Neurosci. 2003;253(2):103–9. [PubMed]
FAQs
Some patients experience a sight headache or a tingling sensation on the scalp during TMS. These side effects should dissipate soon after the treatment concludes. No long-term side effects have been documented or observed at this time despite the treatment’s existence for over 10 years.
Most insurance carriers cover TMS for treatment-resistant depression. We submit your information for pre-approval before beginning therapy to ensure you are a candidate.
Therapy takes place five times a week for six to eight weeks.
Each session should last between 4-6 minutes.
No, TMS does not inhibit your focus & concentration.
The initial results vary, however, many patients report improvement in functioning and depression scores within 2-3 weeks of the initial treatments. Some patients notice benefits and improvements in as little as one week of treatments.
There are no particular medication contraindications; however, use of benzodiazepines at higher doses or changes to medications that can reduce or increase the seizure threshold during the active treatment may lead to reduced effectiveness and/or increased side effects. Because of this it is very important to tell your physician / TMS treatment team of any changes to your medications.
Yes, psychosis does not eliminate you from receiving TMS. However, as antipsychotic medications can affect the seizure threshold your medications should be maintained at the same level for the duration of the treatment.
We do not recommend TMS if you:
- Are pregnant or nursing
- Have metal or implanted devices above your heart, such as cochlear implants, stents, stimulators, aneurysm clips or coils, pacemakers, bullet fragments, medication pumps, etc.
- Have a history of seizures
- Have brain damage from injury, stroke, or tumor
We are here to help you
Reach out to us by calling 866-951-HEAL, stopping by a clinic close to you, or filling out the form. One of our intake coordinators will be in contact with you within 24 to 48 hours.