Transcranial magnetic stimulation or TMS is a non-invasive, diagnostic and therapeutic technique that uses small magnetic fields to stimulate or inhibit brain regions by electromagnetic induction via a generator coil placed over the patient’s head. Our clinic is set to treat conditions such as depression and obsessive-compulsive disorder (OCD) in both adolescents(age15+) and adults.
Your doctor will discuss with you the best way to administer TMS. Each session is scheduled out in 45 min blocks although the actual duration of treatment is shorter and will vary depending on the protocol used.
Every patient is different. Most large TMS research studies provided 36 treatment sessions, five days a week for 7-8 wks. There is no demonstrated toxicity from treatment beyond this amount of sessions and, in some situations, it may be reasonable to continue treatments beyond this number. Some patients may require a schedule of maintenance treatments following the completion of the first course of 36.
Both TMS and ECT are forms of neuromodulation used to treat depression. Electro-convulsive therapy (ECT) involves passing an electric current through the brain. This causes a generalized (grand mal) seizure requiring a general anesthetic. While having ECT, patients may require inpatient care or require someone to drive them to and from ECT treatments. ECT can cause short term memory loss for the period before and after each treatment session.
TMS uses an electromagnetic coil to create an alternating magnetic field over the scalp and this magnetic field induces small currents in the brain.
TMS is an outpatient procedure that does not require an anesthetic and patients can resume their normal life activity after the session.
Both TMS and ECT can lead to a rapid improvement in symptoms. Up to 70% of depressed patients who fail to respond to antidepressants respond to ECT and about 60% of patients who fail to respond to antidepressants respond to TMS. Your doctor will advise you about which is the best treatment for you.
Antidepressants work by modifying the actions of neurotransmitters (brain chemicals) or neurotransmitter receptors across the brain globally TMS induces small electrical currents to a focalized location in the brain improving the connections between brain cells and increase the growth of brain cells.
Treatment with antidepressants involves taking medications which are absorbed through the mouth, stomach and small intestine with possible side effects throughout the body. They can cause adverse effects such as gastrointestinal side effects weight gain and can have an effect on sexual function (reduced sex drive and delayed ejaculation). Patients can also be allergic to antidepressants or other chemicals contained in the medication.
TMS does not involve the ingestion of chemicals, therefore, there are no systemic adverse effects. There is no impact on the digestive system, on sexual function, and there are no allergic responses
Antidepressants can take between three to six weeks to work, while TMS has a faster onset of action. Studies show that in patients who have not responded to two or three antidepressants the response rate of the next antidepressant is 10-15%. If such patients are given TMS, the response rate is about 60%.
TMS does not involve the ingestion of chemicals, therefore, there are no systemic adverse effects. There is no impact on the digestive system, on sexual function, cognition and there are no allergic responses. The only side effect with TMS that is greater than 5% is transient site pain, headache which abates typically within the first week as patients desensitize to the treatment.
Antidepressants modify brain chemicals and receptors via an effect on protein synthesis, they can take between three to six weeks to work, while TMS has a faster onset of action. Studies show that in patients who have not responded to two or three antidepressants the response rate the next antidepressant is 10-15%. If such patients are given TMS, the response rate is about 60%.
The most common side effects of TMS are discomfort at the site of treatment during the treatment sessions and a mild headache for a few hours following the sessions. Occasionally patients experience discomfort in the eye, teeth or jaw and typically alleviated with over the counter analgesics.
The only side effect with TMS is the low potential for a transient site pain, headache which abates typically within the first week as patients desensitize to the treatment.
Some patients may experience increased anxiety and sleep difficulties. All of these usually decrease following the first week of treatment.
TMS is a loud treatment, wearing appropriate ear plugs during sessions protects hearing. There is a very small risk that some patients will develop seizures during treatment sessions. The probability of a patient without a history of epilepsy developing seizures is 1 per 60,000 treatment sessions. This is less than the risk of seizures developing in patients who take antidepressants.
TMS is a well-tolerated treatment, the vast majority of patients can have TMS. People with non-removable, ferromagnetic objects less than 30 cm from the treatment coil may not be suitable for TMS. Consult with your TMS prescriber if you have any of the following:
TMS can still be given to people with certain types of stents and implants. Dental work including fillings/implants and piercings are not a contraindication for TMS.
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