Transcranial magnetic stimulation (TMS) involves the use of magnetic waves, employing them in the treatment of various mental health conditions, including migraines, Tourette’s, OCD, and major depressive disorder.
However, TMS therapy is an alternative treatment rather than a first line treatment for these conditions, owing to the comparative lack of data regarding TMSs full potential and optimal protocols, as well as the general lack of availability currently still felt throughout the country.
While TMS is growing rapidly, with clinics and hospitals offering the treatment in an ever-expanding list of cities across the United States, it will be some time before TMS becomes a more common and affordable treatment. But for many who seek an alternative to other first line treatments and need something to effectively combat a condition that is not respond to other therapeutic methods, TMS offers a potential at a much better quality of life.
Even in cases where the condition has become quite severe, research shows that cases of treatment-resistant depression and OCD can experience not only a reduction in symptoms, but a full remission of symptoms in some cases, sometimes for upwards of a year after treatment has ended. To understand its benefits, it’s important to understand how TMS therapy works and how it developed.
TMS is a Concrete Alternative
First approved for the treatment of depression in 2008, TMS has since become known as a very promising and effective tool in the treatment of various different conditions. Currently, insurance companies generally work with TMS providers to offer TMS therapy as an alternative treatment for depression after a doctor has confirmed that other attempts at treatment through more conventional means have failed. This includes the use of at least one form of psychotherapy/talk therapy, and at least 3 or more different types of antidepressants, often trying different brands before moving onto a different type.
Treatment for depression is not very clear cut, with some patients responding much better to certain techniques than others. That is why it’s important for psychiatrists to command an ever-expanding toolkit of effective therapeutic strategies, so as to ensure that they have the right answer for every case. Everything from increased sunlight and better eating habits to a medication schedule and daily meditation can massively impact a person’s depressive disorder, depending on their diagnosis and the nature of their condition.
Finally, once a psychiatrist is sure that other treatments are ineffective, TMS becomes a viable (and often effective) option. But it isn’t a panacea, or an instant win. TMS can help reduce symptoms in most people (over 50 percent) and may even put depressive symptoms in complete remission for some time (in over a third of patients), but there are also cases where even TMS doesn’t work. Other therapies and forms of neuromodulation might, however, so it remains true that the most important element in treating depression and other mental health conditions is hope.
How TMS for Depression Works
The brain is a complex organ, roughly divided into different regions responsible for different functions. While a popular myth asserts that we only use ‘ten percent’ of our brain, the truth is far more complex – although incomplete, early neurologists already understood the brain’s plasticity and capability for reassigning functions to cope with physical trauma. These findings were misconstrued into the notion that many parts of our brain are unused, yet modern neuroscience is more complete. We use the entirety of our brain over a given day, yet each region is largely attributed to a specific set of functions.
When targeting the brain to treat depression, TMS machines are aimed at the dorsolateral prefrontal cortex (DLPFC), a portion of the prefrontal cortex dedicated to inhibition, planning, organization, cognitive flexibility, and more. The DLPFC is connected to the thalamus and the hippocampus, and through the use of a TMS machine, magnetic waves are sent through the scalp and skull into the portions of the brain that connect the amygdala, hippocampus, and thalamus through connections in the DLPFC. By affecting the limbic system, TMS aims to disrupt brain signals flowing between these regions in the brain that are understood to regulate thought, mood, stimuli, and more. The effect is a clinically relevant decrease of depressive systems in more than half of all cases, a total remission in a third of those cases, and minor positive changes in many others.
While the idea that the brain can be changed through electromagnetic energy is nothing new, older forms of neuromodulation have had their fair share of side effects. From ECT to invasive procedures like deep brain stimulation and vagus nerve stimulation, neuromodulation has been previously successful in the treatment of depression, yet at the cost of potentially inducing seizures, causing disturbances in memory, and more. TMS completely bypasses all of these symptoms by requiring no general anesthesia or medication, utilizing only mild magnetic waves to affect specific portions of the brain related to depression and other conditions.
What to Consider Before TMS?
Because TMS relies on magnetic waves, there are certain restrictions and precautions to consider. Be sure to speak with a TMS physician and your doctor regarding TMS, as certain medical devices, dental implants, and other procedures may preclude TMS due to potential interference between the devices and the machine, or the risk of applying magnetic energy to a metallic object in a patient’s body. Devices in question include cochlear implants, pacemakers, auto-defibrillators, pain pumps, insulin pumps, aneurysm clips, any metal in the eye socket or cranial cavity, and more.
Piercings and jewelry must be removed before treatment. Any unremovable piercings also precludes TMS until the piercing is temporarily removed. Dental fillings and braces are typically okay, but it’s important to check with your TMS physician and dentist to determine the type of dental material used. Some are paramagnetic, and thus are not strongly attracted to the magnet. Others are strongly attracted or repelled by the magnet, and other concerns include thermal heating, or the dislodging of a crown/denture/wire.
Non-Invasive, Non-Drug, Non-Mainstream
The main benefits of TMS are that it is effective, non-invasive, safe, and requires no medication. This also drastically cuts down on potential side effects, largely reducing the side effects of TMS to infrequent headaches and scalp discomfort. However, TMS technology is not as widely available as other forms of depression treatment, and most must rely on their insurance provider’s policies on TMS to seek it out as an option.
If available, TMS is an effective way to combat treatment-resistant depression, when medication and talk therapy fail. And because it is a developing technology, new treatment protocols are being researched, potentially reducing costs and treatment time.