Why does TMS work?
TMS (transcranial magnetic stimulation) has been shown to produce changes in neuronal activity in regions of the brain implicated in mood regulation, such as the prefrontal cortex. As each magnetic pulse passes through the skull and into the brain, this induces brief activity of brain cells underlying the treatment coil.
The frequency of pulse delivery also influences whether brain activity is increased or decreased by a session of TMS. Recent studies also suggest that stimulation over the left and right sides of the brain can have opposite effects on mood regulation.
When is TMS used?
Antidepressant medications and psychotherapy are the first line treatments for major depression. These treatments, however, do not work for all patients. In these instances, TMS might be used as an alternative treatment, or to augment antidepressant medications or psychotherapy. Patients who have failed to achieve an adequate response from antidepressants, or who are unable to tolerate medications, might consider TMS therapy.
What happens during an TMS procedure?
TMS therapy involves a series of treatment sessions. Treatment sessions vary in length depending on the TMS coil used and the number of pulses delivered but typically last around 19 minutes. Patients receive treatment 5 days a week. A typical treatment plan is 4 to 6 weeks. However, this can vary depending on an individual’s response to treatment.
During the first TMS session, several measurements are made to ensure that the TMS coil will be properly positioned over the patient’s head. Once this is done, the TMS coil is suspended over the patient’s scalp. The TMS physician then measures the patient’s motor threshold, by administering several brief pulses. Measuring the motor threshold helps the physician personalize the treatment settings and determine the amount of energy required to stimulate brain cells.
Once the motor threshold is determined, the coil is then brought forward so that it rests above the front region of the patient’s brain. Treatment is then commenced. During the treatment, patients will hear a series of clicking sounds and will feel a tapping sensation under the treatment coil.
Motor threshold is not checked at every treatment but may be reassessed if there is concern it may have changed, for example, because of a change in medication.
Who administers TMS?
TMS is prescribed by your primary care physician or Therapist and administered by our TMS Certified Technicians. The initial motor threshold is always determined by our facility TMS physician who will also perform an in-depth evaluation during on-boarding.
The treatment itself is administered by an experienced TMS technician under the supervision of the TMS physician or by the TMS physician.
How long is an TMS procedure?
TMS therapy involves a series of treatment sessions. Treatment sessions vary in length depending on the TMS coil used and the number of pulses delivered but typically last around 19 minutes. Patients receive TMS 5 days a week. A typical course of TMS is 4 to 6 weeks. However, this can vary depending on an individual’s response to treatment.
Do I need to be hospitalized for a course of TMS?
Unlike ECT, TMS does not require any sedation or general anesthesia, so patients are fully awake and aware during the treatment. There is no “recovery time”, so patients can drive home afterwards and return to their usual activities.
What are the side-effects of TMS?
TMS is well-tolerated and associated with few side-effects the most common side-effect, which is reported in about half of patients treated with TMS, is a mild irritation at the treatment site. These are mild and generally diminish over the course of the treatment
Who cannot get TMS therapy?
Patients with any type of non-removable metal in their heads (with the exception of braces or dental fillings), should not receive TMS. Failure to follow this rule could cause the object to heat up, move, or malfunction, and result in serious injury or death. The following is a list of metal implants that can prevent a patient from receiving TMS:
Aneurysm clips or coils
Stents in the neck or brain
Deep brain stimulators
Electrodes to monitor brain activity
Metallic implants in your ears and eyes
Shrapnel or bullet fragments in or near the head
Facial tattoos with metallic or magnetic-sensitive ink
Other metal devices or object implanted in or near the head
Who will benefit the most?
Existing evidence to date suggests that patients who are less treatment-resistant respond better to TMS than those who are highly treatment-resistant. However, there is much yet to be learned about particular variables that may impact response to TMS. Researchers are presently conducting clinical studies to evaluate who will benefit most from TMS therapy. For example, there is a lot of interest in evaluating whether TMS with antidepressant medications is more effective than TMS alone.