The Advantages of TMS vs. Invasive Depression Treatment

Transcranial magnetic stimulation (TMS) has been steadily growing in popularity, ever since becoming a viable and approved option for treatment-resistant depression and OCD according to the FDA. However, there is still a lack of understanding among the general population on how TMS functions, what exactly makes it “non-invasive”, and how it features the benefits of non-pharmacological interventions and other neuromodulation treatments without the inferred risk of more invasive procedures.

While TMS is a comparatively young treatment option for depression, it is exceptionally promising. Research indicates that most of all patients with treatment-resistant depression who opt for TMS treatment end up experiencing at least some lasting relief from depressive symptoms, while about half experience a total remission of depressive symptoms.

Often, TMS is recommend for patients who have tried other forms of depression treatment with little to no success, including different types of medication, as well as therapy. Because TMS is not considered a first-line treatment option for depression, patients must typically first try to manage their symptoms with antidepressant medication until their insurance covers TMS and other alternative treatment options.

Among these alternative treatment options are several different invasive depression treatments, which may require surgery to either inspect and treat a specific portion of the brain or implant a neuromodulation device to manage depressive symptoms. Which is better, and what advantages does TMS have over more invasive depression treatments?


What Is Transcranial Magnetic Stimulation?

Transcranial magnetic stimulation involves the use of a special medical device that sends pulses into the brain through a magnetic coil. This magnetic coil is housed in a special helmet, worn throughout the roughly half-hour process, which is repeated several times a week for about a month for its full effect.

These pulses stimulate a targeted portion of the brain’s prefrontal cortex to elicit a specific reaction within the brain’s center for mood regulation, affecting the way the brain processes certain neurochemicals and otherwise sends its signals throughout the CNS. Research shows that TMS can be used not only to decrease depressive symptoms, but even decrease symptoms of obsessive-compulsive disorder by targeting a specific pathway in the limbic system of the brain.

TMS is often either deep (dTMS) or repetitive (rTMS), with different procedures used for different purposes. Some patients respond better to treatment that targets a person’s neurotransmission (the release and uptake of serotonin, among other neurotransmitters) while others respond better to changes induced in a person’s endocrine function (as TMS can also be used to produce changes in a person’s hypothalamic-pituitary axis). To accurately help a patient, a TMS specialist first utilizes brain imagery technology to correctly map out an area for the device to target, before beginning the first session. After completing all sessions over the course of several weeks, a patient is expected to feel a relief from depressive symptoms.


The Pros and Cons of TMS Treatment

Transcranial magnetic stimulation is fast, non-invasive, and can easily be fit into a busy schedule. However, it is not a magical cure for depression. It is still best paired with regular therapy with a therapist a patient trusts and likes, alongside any needed lifestyle changes. While effective, TMS has both pros and cons.


TMS Pros:

  • TMS treatment is approved for the treatment of major depressive disorder and OCD, and there is a growing body of research supporting the efficacy of TMS treatment as an effective alternative treatment for patients with depression.
  • TMS specifically targets patients who are resistant to first-line depression treatments, giving hundreds of thousands of people a second chance at depression relief.
  • TMS is completely non-invasive, requires no lengthy or risky pre-procedure preparation, no anesthesia, and is well-tolerated (no adverse or lasting side effects).
  • Individual TMS sessions do not take very long, and many clinics and providers help patients establish realistic schedules and take their considerations into mind when designing a treatment plan.


TMS Cons:

  • TMS still experiences limited third-party coverage compared to some other depression treatment options. While getting help for mental health issues is already difficult, finding the financial means to viably seek TMS as a treatment option means many patients may not get the help they need.
  • While individual sessions only take up to an hour at most (and often half that time), the fact that a patient often requires 20-30 sessions over 4-6 weeks means a serious time commitment in terms of travel time, etc.
  • Some patients find TMS treatment uncomfortable, either due to a ticking or tapping sensation, or mild discomfort around the treatment area. This is not common.
  • Some patients also experience headaches during or after treatment sessions. This is also not common.


What Are Invasive Depression Treatments?

Invasive depression treatments are non-pharmacological treatments (i.e. not antidepressants) that involve anesthesia, invasive surgery, or both. Most invasive depression treatments involve the implantation of neuromodulation devices, including trigeminal nerve stimulation devices, deep brain stimulation devices, and other implants that may help stimulate portions of the brain that effectively help patients better deal with depressive symptoms.

However, these devices are quickly falling out of favor when compared to non-invasive alternatives, including cutting edge external devices as well as temporary treatment plans, such as TMS. As medical technology advances, our need to opt for invasive options shrinks.


Why TMS May Be A Better Treatment Option

Invasive depression treatment options that require the implantation of specific medical devices or direct stimulation of nerves or pathways in the brain are safe, effective, and useful. But they also come with a certain amount of risk. Even when all things go according to protocol, there is always a little bit of risk associated with using anesthesia, going under, and then undergoing neurosurgery.

TMS, while less direct, is much safer being a non-invasive option that requires no surgery and no anesthesia. In fact, it doesn’t require any medication whatsoever, as the procedure is nearly completely pain-free save for an occasional headache.

Over time, TMS may grow to become one of the primary ways in which we treat depressive symptoms, especially as coverage and ease-of-access grows significantly, and especially as more data comes in to support the treatment’s efficacy. Until then, it remains an effective alternative for patients with treatment-resistant depression and the right insurance coverage.


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