Deep transcranial magnetic stimulation may invoke some scary thoughts and images, yet a name is just a name – and despite the words ‘deep transcranial’, dTMS is entirely non-invasive, pain-free, and requires no sedation or medication.
Deep transcranial magnetic stimulation uses a head-worn device with an electromagnetic coil shaped a certain way. This coil sends magnetic pulses – the same used in an MRI machine – past the scalp and skull, and into the brain. Hence ‘transcranial’.
Because dTMS technology uses a different coil than other forms of TMS, this allows the device to reach a few centimeters deeper into the brain than is usual. Hence, ‘deep’.
This difference allows dTMS technology to affect the brain in ways other forms of TMS cannot, often allowing for better or more effective treatment, and potentially allowing for the treatment of conditions other than depression and obsessive-compulsive disorder.
In Europe, dTMS technology and variations of its special coil design have already been approved for the treatment of Alzheimer’s, chronic pain, PTSD, Parkinson’s, and more.
What is Transcranial Magnetic Stimulation?
Transcranial magnetic stimulation uses magnetic pulses to affect how our neurons fire, affecting the ‘action potential’ of a neuron, and causing hyperpolarization or depolarization.
This subtle change has had positive effects on patients with depressive disorders, particularly when aimed at cells in the dorsolateral prefrontal cortex of the brain, as well as portions of the brain linked to the limbic system.
The effects of TMS are subtle at first and require more time to take root. Therefore, TMS treatment requires several dozen sessions in quick succession, often spread out as five weekly sessions over four to six weeks, for a total of 20 to 30 sessions.
Each session takes roughly half an hour or less, during which a patient is asked to sit still while wearing the TMS device.
Some patients report feeling better after just a handful of sessions, while others only begin to feel better once all the sessions have completed, or thereafter.
TMS vs. dTMS
Transcranial magnetic stimulation and deep transcranial magnetic stimulation are set apart by the type of coil used in either treatment.
The H-coil used in dTMS treatment was designed by Brainsway, an Israeli med-tech company developing TMS technology throughout the world.
While regular TMS machines penetrate roughly 2cm under the surface of the skull, deep TMS technology penetrates up to 4cm under the surface of the skull.
This difference might seem superficially small, but it allows the treatment to work much better.
What Does Deep Transcranial Magnetic Stimulation Aim to Treat?
An increased depth allows deep TMS technology to target portions of the brain that are involved in the development of OCD and depression, as well as bipolar disorder, schizophrenia, and a number of other neurological issues.
Portions of the brain currently targeted by TMS technology in the treatment of OCD include the orbitofrontal cortex, pre-supplementary motor area, and the aforementioned dorsolateral prefrontal cortex.
While TMS technology allows doctors to affect the brain in a unique way, there’s more to treating these conditions than applying magnetic waves to the brain. Disorders like depression are incredibly complex in the number of factors that affect and influence them, and treatment has to be equally complex in taking into consideration how all parts of life affect the disorder.
TMS will often be just one part of the equation, even when other treatments fail.
TMS and Other Depression Treatments
Patients need not worry about antidepressants and talk therapy, as neither interfere with TMS treatment for depression.
In clinical studies, TMS technology was tested on both patients with medication, and patients without medication. It does not have a negative effect, nor does it seem to interfere with the treatment.
If you worry about other potentially interfering treatments or medications, speak with your doctor. There are some treatments and circumstances that can affect TMS treatment, particularly any devices or metallic objects in or around a patient’s head and chest.
Pacemakers, pain pumps, and other devices that rely on electrical pulses may be affected by the magnetic waves in a TMS machine, thus ruling out TMS treatment as a possibility in most cases.
It’s also important to remove any jewelry and piercings in and around the head before beginning the treatment, as the magnetic pulses may cause these objects to move or heat up, causing pain or injury.
Dental implants can be safe, although it may depend on the type of implant. Braces, metal fillings, retainers and some palatal expanders may be safe, but it’s important to discuss this with the resident doctor and receive exact specifications from your dentist.
If you are worried about any other forms of treatment or medication while undergoing TMS therapy, simply bring it up with your doctor.
They will be able to help you understand how TMS may or may not affect any given type of treatment.
Is TMS Covered by Insurance?
TMS treatment for major depressive disorder is currently covered by several large insurance companies, albeit with the caveat that it can only be prescribed to patients who have tried antidepressants and talk therapy and have been deemed treatment resistant.
Whether or not your chosen TMS provider is currently working with an insurance company will determine whether their coverage is in-network or out-of-network, which may affect your total out-of-pocket expenses. Be sure to ask your TMS provider for a full list of insurance companies that they currently work with, in order to make the best choice.
Deep transcranial magnetic stimulation is currently only covered by most insurance companies for the treatment of depression, yet this may change to reflect an announcement made by the FDA approving dTMS as a treatment method for treatment resistant obsessive-compulsive disorder.
Although developed in the 1980s and approved over a decade ago, TMS is still undergoing constant growth as it continues to become more widely available.
And due to its new approach to the brain, dTMS will continue to unearth new ways to help patients with various mental health problems and neurological conditions.