Transcranial Magnetic Stimulation (TMS)

If your drug therapy doesn't work or produces intolerable side effects, TheraMind Centers have the alternative. Transcranial magnetic stimulation (TMS) is a safe and highly effective, FDA-approved, non-drug, non-invasive treatment for people suffering from depression, anxiety, and other mood conditions.

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What is TMS?

TMS therapy uses magnetic pulses of different frequencies and different strengths to stimulate (or inhibit) brain activity in a localized portion of the brain. There are several FDA-approved manufacturers of TMS equipment. While there are differences among them with respect to certain engineering aspects, each is designed to provide a magnetic stimulus to neurons in the brain.

Why TMS?

TMS, transcranial magnetic stimulation, is a safe and effective, non-drug, non-invasive treatment for people suffering from depression, anxiety, and other mood and certain neurological disorders where traditional drug therapy either doesn't work or produces intolerable side effects.

Who is It for?

TMS has been safely and effectively used, among other conditions, to treat:

  • Major Depressive Disorder (MDD)
  • Generalized Anxiety Disorder (GAD)
  • Post-Traumatic Stress Disorder (PTSD)
  • Obsessive-Compulsive Disorder (OCD)
  • Chronic Pain (including Fibromyalgia)
  • Concussion/Traumatic Brain Injury
  • Tinnitus
  • Migraines
  • Aphasia

Results

Drug Response Versus TMS Response

Since 2008, a number of research studies have re-examined the efficacy of various antidepressants using the data provided to the FDA at the time that approval was given to market those drugs. The results can be summarized as follows:

  1. For persons suffering from mild depression, drugs are not superior to a placebo [1,2];
  2. For persons suffering from severe depression, drugs are slightly better than a placebo [1,2].

What makes TMS so attractive as an alternative to antidepressant drug therapy is that it is highly effective, even when multiple courses of previous drug therapy have failed.

TheraMind®Center Response/Remission Rates

TheraMind Center response (> 50% improvement in pre-existing symptoms) and remission (within normal range) rates vary depending upon whether our physicians are provided with advanced brain imaging to inform our TMS targeting. Without such imaging, our response rates are roughly 75%, and remission rates are approximately 50%. With such imaging, response rates near 90+% are achieved, and remission rates are roughly 80%. Researchers at Stanford University recently reported remission rates at 90% using advanced brain imaging coupled with a multi-session daily intermittent theta burst (iTBS) TMS treatment protocol. [3] These results are significantly better than the response and remission rates upon which the FDA relied when originally approving TMS for clinical use [4] and even better than were reported in a 2012 study of outcomes in actual clinical practice. [5]

Our Approach

TMS is a medical procedure requiring a prescription from a licensed physician. TMS is an outpatient procedure that requires no anesthesia or sedation. For patients suffering from depression, our TMS-certified physicians screen for any contrary indications and determine if TMS is an appropriate treatment for each patient. Once the determination has been made that the patient is a good candidate for TMS therapy and a patient-specific treatment protocol has been decided upon, one of our TMS-certified doctors and a TheraMind TMS Technician perform a Motor Threshold determination (MT) on the patient, and the TMS Technician is given a set of treatment parameters by the physician for subsequent TMS sessions for that patient. All TheraMind Centers are equipped to provide repetitive TMS therapy (TMS) as well as intermittent theta burst (iTBS) TMS therapy.

A course of treatment for depression typically consists of thirty-six (36) treatments, usually five treatments a week for six weeks with three weeks of taper following, although the treatment schedule may vary based on patient response and physician prescription. A single-side treatment session normally lasts about 20 minutes for TMS and 5 minutes for iTBS, during which time patients are awake, alert, and comfortable. Our TMS Technicians are present throughout the treatment and interact with the patient while continuously monitoring the treatment to ensure the patient's comfort and the maximum efficacy of the treatment. Weekly reports of patient progress are submitted to all referring physicians and our TMS-certified medical professionals. TMS is generally considered to be free of side effects with the rare exception of headache and localized discomfort of the scalp at the treatment site, which are easily mitigated through reorientation of the magnet and/or reduction in treatment intensity.

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History of TMS

In 1985, English physicist Dr. Anthony T. Barker and two other doctors first demonstrated the use of transcranial magnetic stimulation to cause twitching in the hand of a human being by stimulating the motor cortex of the brain hemisphere opposite that of the hand. This development led to an acceleration of research into and greatly enhanced understanding of how the brain works and the use of TMS to change the brain and treat diseases like depression. TMS therapy was approved by the FDA in October 2008 for the treatment of Major Depressive Disorder (MDD) and, within two years, had become so accepted by the medical community as an effective treatment for depression that the American Psychiatric Association began recommending TMS as a second-line treatment for depression. TMS has since also been approved by the FDA for OCD and Migraines.

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Side Effects

TMS is generally considered to be free of side effects, with the exception of headache and localized discomfort of the scalp at the treatment site, both of which are thankfully rare and fairly easily mitigated.

References

  1. Jay C. Fournier, MA; Robert J. DeRubeis, Ph.D.; Steven D. Hollon, Ph.D.; et al., "Antidepressant Drug Effects and Depression, A Patient-Level Meta-Analysis," JAMA. 2010;303(1):47-53. doi:10.1001/jama.2009.1943
  2. "New Data Show Lack of Efficacy for Antidepressants." MadinAmerica.com, Mad in America, https://www.madinamerica.com/2017/02/new-data-showslack-efficacy-antidepressants/. February 27, 2017.
  3. Cole, E.J., Stimpson, K.H., Bentzley, B.S., Gulser, M., Cherian, K., Tischler, C., Nejad, R., et al. (2020 Apr 7). Stanford Accelerated Intelligent Neuromodulation Therapy for Treatment-Resistant Depression. Am J Psychiatry. appiajp201919070720. doi: 10.1176/appi.ajp.2019.19070720. [Online ahead of print.]
  4. O'Reardon, John P., et al., "Efficacy and Safety of Transcranial Magnetic Stimulation in the Acute Treatment of Major Depression: A Multisite Randomized Controlled Trial," Biol Psychiatry 2007; 62-1208-1216.
  5. Carpenter, Linda L., et al., "Transcranial Magnetic Stimulation (TMS) for Major Depression: A Multisite, Naturalistic, Observational Study of Acute Treatment Outcomes in Clinical Practice," PubMed 2012 July; 29(7): 587-96.

Other Resources

  1. Janicak, Philip G., et al., "Transcranial Magnetic Stimulation in the Treatment of Major Depressive Disorder: A Comprehensive Summary of Safety Experience from Acute Exposure, Extended Exposure, and During Reintroduction Treatment," J Clinical Psychiatry 69:2, February 2008.
  2. Kozel, Andrew F., et al., "Repetitive TMS to augment cognitive processing therapy in combat veterans of recent conflicts with PTSD: A randomized clinical trial Journal of Affective Disorders," March 15, 2018, Vol. 229, 506-514.
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