What is Deep TMS?

In modern day psychiatry, there is a treatment method for depression and obsessive-compulsive disorder that relies on magnets. One might say it’s a brave new world, yet transcranial magnetic stimulation (TMS) machines are based on research and experimentation decades old.

Yet instead of using electricity, TMS machines use magnetic waves to subtly affect certain brain signals, targeting areas of the brain that tie into our mood and behavior, particularly in cases of depression.

While TMS was first approved for the treatment of depression in 2008, research surrounding TMS and depression is much older, and today’s treatments involve a different form of TMS that reaches deeper into the brain and further targets areas that are more likely to produce a positive result in patients.

This technology is deep transcranial magnetic stimulation, setting itself apart from other forms of TMS by reaching deeper into the brain to affect the portions of our brain involved in rewarding behavior and changing moods.

The technology surrounding TMS is evolving fast, allowing for shorter treatment times and less inherent risk. Yet the risk surrounding TMS is already astoundingly low, producing no lasting side effects while requiring no medication or anesthesia.

However, it’s not a perfect treatment. We are going to go over how dTMS targets depression in the brain, how treatment occurs, and who is most likely to benefit from it.


How Deep Transcranial Magnetic Stimulation Works

Transcranial magnetic stimulation utilizes a machine that generates magnetic pulses through a coil built into specialized headgear. During the procedure, a patient lies motionless while wearing the headgear, with the coil positioned directly above a targeted area.

An attending technician and specialist use imaging technology to pinpoint the area where treatment will take effect, before starting the procedure.

From there, magnetic waves are sent through the helmet, past the scalp and skull, into the brain. The waves only penetrate so far into the brain, however, usually stopping short of anywhere from 0.6 inches to 1.6 inches depending on the type of machine used.

Deep transcranial magnetic stimulation sets itself apart due to this difference in distance, allowing for greater efficacy.

Treatments last roughly half an hour, during which time a patient may watch TV, read, listen to music, or speak with the attending specialist.

For the treatment to take full effect, a patient must undergo TMS therapy five times a week, for four to six weeks (a total of 20 to 30 treatments).

Some patients report improvements in mood after just a handful of visits, while others report incremental improvements, often only after the first few weeks. The reason for the many treatments is simple: to leave a lasting impact on the brain, consistent repetition is necessary.


The Brain and Depression

When treating depression, the coil is situated above the left side of the patient’s scalp, targeting an area within the dorsolateral prefrontal cortex. This portion of the brain is partially responsible for memory, emotion regulation, and behavior.

Once in the brain, the magnetic waves subtly affect brain signals being swapped between neurons in the limbic system – a pathway of neurons that connects between several regions of the brain which are partially responsible for motivation, emotion, and memory.

Much of the neuroscience on depression is still a mystery. However, we know that targeting the right neurons and stimulating them through magnetic waves ensures that certain portions of the brain are properly communicating, when they might not be.

Some cases of depression can be partially explained through the miscommunication between different portions of the brain, leading to irregularities in the neurology or endocrinology of a patient. Targeting the right cells through dTMS technology elicits a positive response in patients with depressive symptoms, reducing symptoms in over half of the cases in the long-term.


dTMS Side Effects

While the idea of passing magnetic waves through the brain might sound terrifying, these waves are entirely harmless and are about as powerful as the magnetic waves utilized in imaging technology, such as MRI machines.

This means the procedure leaves no lasting side effects, and the only complaints issued after the use of TMS technology were complaints related to the physical sensation of the magnetic waves (akin to a light tapping), scalp discomfort due to the headgear, and mild headaches. Most patients reported that their discomfort waned with subsequent treatments.

Movement disturbances, memory issues, and other such side effects sometimes attributed to other forms of neurostimulation have not been found to occur after TMS treatment.

Cases of convulsions experienced after TMS exist, although the circumstances of these cases helps explain their occurrence: six cases occurred during TMS safety research involving parameters that no longer correspond to current standards, and one involved a patient who did not consult her doctor regarding the use of several conflicting medications.


How dTMS is Paid For

Most major insurance companies cover deep transcranial magnetic stimulation, and several TMS clinics throughout the country work with companies to provide coverage to their clients.

However, TMS is only covered by insurance when meeting the right standards. In most cases, insurance companies will require that a patient first undergoes first line treatment for depression.

This is because TMS treatment has proven most effective in cases of treatment-resistant depression, where antidepressants and psychotherapy do not elicit a positive response or cause extreme side effects.

Qualifying criteria for TMS coverage include:

• Failure to respond to antidepressants.
• Failure to respond to ‘additional augmentation’ (non-SSRI antidepressants and other atypical treatment).
• Failure to respond to at least one type of psychotherapy/talk therapy.

For more information, check with your local TMS providers and current healthcare provider to determine whether TMS is an option for you.


dTMS As Part of a Larger Treatment

Deep transcranial magnetic stimulation is particularly effective in cases where other treatments do not work, but like any treatment, it does not boast a 100 percent success rate. Depression is a tricky disorder to treat, and there are many factors that contribute to its spread and growth.

While not perfect, the ideal treatment would include a multipronged approach, tackling not only the brain, but a patient’s physical and emotional wellbeing, through stress reduction techniques, a healthier home and work environment, physical improvements through personalized dietary changes and exercise, and support from a loving family.

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