Transcranial Magnetic Stimulation (TMS): A Safe Alternative Treatment for Depression

Globally, depression is the leading cause of disability, and in the United States, it impacts the lives of over 17 million people. It is one of the most common mental illnesses and can be significantly debilitating, yet current treatment options for depression are limited in variety, and most lack consistent or predictable results. Two-thirds of individuals with depression do not experience substantial relief from the first antidepressant medication they try, and every subsequent medication is less likely to be effective than the last.

Of course, it is always recommended that any depression treatment be coupled with psychotherapy and social/emotional techniques. However, while these options are ideal, they can take many months or years to make noticeable impacts on mental wellbeing. For many cases of clinical depression, these natural therapies do not provide adequate relief. When it comes to major depression, individuals need treatment options that offer more immediate relief to continue daily functioning.

Beyond antidepressant medication, there are limited treatment options out there. Typically, those who fail to find a satisfactory medication and continue to struggle with depression after years of treatment will turn to electroconvulsive therapy (ECT). ECT is still considered the most effective depression treatment available, providing moderate to long-term relief for over 85% of patients. However, the side effects and risks associated with ECT, such as the use of anesthesia and acute memory loss, make it more of a last-ditch effort and a nonviable option for many.

For people who struggle to find an antidepressant that relieves their symptoms, transcranial magnetic stimulation (TMS) is a safe alternative treatment option. While TMS is still a relatively new treatment, there is now ample scientific evidence that it is effective for treating depression. Various types of TMS are FDA-approved, and the cost can even be covered by health insurance. Due to its efficacy and relative lack of side effects or risks, TMS has attracted much attention in the medical field as a promising treatment for a variety of mental illnesses, such as anxiety, PTSD, and obsessive-compulsive disorder, as well as chronic pain and migraines.

What is TMS?

TMS, or transcranial magnetic stimulation, was first developed in 1985 as a tool in clinical trials for measuring neural excitability and motor conduction times. TMS is a non-invasive process involving transmitting a magnetic pulse, or chain of pulses, onto the scalp to activate neurons in a specified area. Typically, the magnetic transmission will be targeted to a specific area of the brain that is underactive and known to be involved in depression. There are many different types of TMS:

Single-pulse TMS: During sTMS, a single magnetic pulse is transmitted.
Repeated-pulse TMS: During rTMS, multiple magnetic pulses are administered in succession.
Paired-pulse TMS: During ppTMS, two magnetic pulses are administered in succession.
Theta burst stimulation: During TBS or Express TMS, the magnetic pulse is delivered at a specific frequency to mimic brain waves and promote neuroplasticity. It is referred to as Express TMS because the process only takes a few minutes, compared to other TMS methods that can take 30 minutes or more.

A look into the clinical field shows us that TMS is scientifically proven as an effective treatment for depression. Sham-controlled trials show that TMS, on average, lessens the severity of depression significantly compared to a placebo. There have been many scientific studies that show the effectiveness of TMS in relieving depression symptoms. One review of 15 existing clinical studies in 2005 revealed that in almost all of the studies measuring the impact of rTMS on depression symptoms, the treatment shows meaningful results, even within two weeks. Longer-term studies also suggest that treatment periods of at least 4 to 6 weeks are more effective.

Even beyond a controlled, experimental setting, TMS still delivers. In 2012, researchers conducted a naturalistic observational study on TMS treatments administered to patients with Major Depressive Disorder from actual TMS clinics. They discovered that the types and methods of TMS offered by almost all treatment facilities strongly aligned with those known to be effective in scientific studies. Additionally, the observations revealed that efficacy rates in real-world were very similar to controlled trial results. This basically means that, yes, real people with depression experience relief with TMS treatment. Although every individual may experience a different level of relief on a different timescale, TMS was effective for about 60% of patients observed in the study. Additionally, almost 40% of patients reached remission or nearly complete symptom relief.

The length of symptom relief provided can vary by individual, but TMS is an attractive treatment option because it can provide long-term relief, especially with current antidepressant medication. Many patients experience relief for many months or even years before starting another period of treatment.

What is TMS treatment like?

Most TMS clinics specialize in alternative mental health therapies and will craft a personalized treatment plan based on your individual mental health assessment. A typical treatment program involves 30 TMS sessions, with 5 sessions administered each week. So, the full treatment lasts six weeks. Depending on the type of TMS administered, each session can last 20-40 minutes; some of this time is used to calibrate the machine. After the treatment plan is complete, additional sessions can be scheduled as needed, which only occurs occasionally with most patients.

During a TMS treatment session, patients sit comfortably and can pass the time by listening to music, reading, watching TV, etc. Most people report feeling a mild tapping, tingling, or sensitivity on the scalp that often subsides quickly after the session is complete. The most common side effects include lightheadedness or a mild headache that typically resolves after the treatment session or within a week of beginning treatment. Many patients don’t report any side effects at all. The only significant risk for physically healthy patients is a risk of seizure, but this is extremely small (less than .001%) and most often occurs in patients with predispositions or other health problems contributing to the likelihood of a seizure. For this reason, TMS is not recommended for individuals with epilepsy or a history of head injury or neurological issues. Additionally, individuals with metal implants of any kind are not eligible for TMS treatment.

What else can TMS treat?

TMS is currently being studied extensively for a variety of other mental and physical ailments, including OCD, PTSD, smoking cessation, anxiety, and chronic pain such as migraines. So far, the literature is promising, and individuals can receive TMS treatment from a clinic for these ailments.

This new non-invasive treatment could be (or already has been) a groundbreaking development in treating depression and other neurological disorders. It shows exceptional effectiveness compared to other current medication options and poses few side effects and health risks. Now, with FDA approval, TMS treatment can even be covered by insurance. Each insurance company has different requirements, but most offer full coverage if the patient has already tried a specified number of medications in the past. Hopefully, continued scientific research and development will make TMS more accessible to individuals with treatment-resistant depression and other mental illnesses.

If you or someone you know experiences mental health issues, it is important to seek help from a qualified professional. Our Resource Specialist can help you find expert mental health resources to recover in your community. Contact us now for more information on this free service to our users.

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About the Author: Dr. Nima Fahimian, MD, is double board-certified in both Integrative Medicine and Addiction Medicine and is the Medical Director for Bespoke Treatment in Los Angeles, California. Dr. Fahimian is well known for advancing the field of psychiatry with his expertise in psychopharmacology, biofeedback, and Express TMS. He was trained at the UCLA David Geffen School of Medicine, where he was appointed to be the Chief Resident during his psychiatry residency. Dr. Fahimian has held faculty appointments at UC Davis, UC Irvine and is currently an Associate Professor of Clinical Psychiatry at UC Riverside.

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