Depression is notoriously difficult to treat, but advances in neuroscience and electromagnetic technology are enabling new options for some chronic cases. One well-established, if not as well-known, treatment is transcranial magnetic stimulation (TMS).
Don’t be fooled by the sci-fi sounding name: TMS — which uses magnetic fields to stimulate the brain’s natural electrical activity — is approved by the U.S. Food and Drug Administration (FDA), produces minimal side effects, and boasts strong efficacy rates.
“It can be a game-changer for people who suffer from chronic depression,” says interventional psychiatrist Suzanne Jasberg, MD, who began treating patients with TMS more than a decade ago. “I became fascinated with neuromodulation during my medical residency, and I’ve continued to use it ever since simply because it’s so effective.”
TMS has also been FDA-approved for obsessive-compulsive disorder, migraine, and smoking cessation (though insurance does not always cover the cost of treatment for these uses). Trials are underway for a range of other mental illnesses, including bipolar disorder and posttraumatic stress disorder.
How does TMS work?
TMS is performed via an electromagnetic coil that’s placed against the scalp and delivers nerve-stimulating pulses to regions of the brain that tend to be compromised in those with depression.
This is a fundamentally different approach from medication. Antidepressant medications influence the brain’s neurochemistry, affecting the release or reuptake of neurotransmitters like serotonin, norepinephrine, and dopamine. TMS affects the brain’s neurocircuitry, the interconnected neural pathways that enable us to process information, regulate emotions, and make decisions.
TMS works well as a means of enhancing rather than replacing traditional treatments: With healthier neuropathways, the brain can make better use of medication and psychotherapy.
What does TMS feel like?
During TMS sessions, a patient dons hearing protection and settles into a reclining chair beneath or beside a magnetic coil. At an initial session, a TMS technician “maps” a patient’s head to identify the regions of the brain to target. Reflexive twitching in the hands and fingers on the opposite side of the body identifies target brain locations. At subsequent sessions, a technician uses measurements gathered from this mapping process to determine treatment locations.
TMS machines are fairly loud, and patients can hear and feel a tapping sensation against their head, even with ear plugs. The tapping can be uncomfortable or even slightly painful, and patients often experience headaches or dizziness after a session. These side effects are generally mild and pass within a few minutes; it’s safe for a patient to drive and go about their day once a session is complete.
Patients will often bring a friend or family member with them to their first sessions to help them cope with the tapping and make the experience less intimidating.
TMS is not a one-and-done treatment. For several weeks, patients typically undergo sessions every weekday, each lasting between 20 and 50 minutes; many return for follow-up sessions after the initial course of treatment.
Why haven’t I heard more about TMS?
This really comes down to marketing dollars, Jasberg explains. “TMS doesn’t have the marketing budget that pharmaceuticals have.”
TMS also carries some stigma. She finds that people associate TMS with electroconvulsive therapy, a far more intrusive treatment that can lead to memory loss. Or, as she puts it, “they may assume TMS must be woo-woo and experimental.”
“Brain stimulation sounds scary,” she acknowledges. But TMS has been FDA-approved for more than a decade and is backed by a large body of research supporting its efficacy and safety. The side effects tend to be mild, and there’s no memory loss, little risk of seizure, and no need for anesthesia.
Still, the treatment is not for everyone. TMS is not recommended for anyone with a magnetically sensitive implant, such as a pacemaker or cochlear implant. A history of seizures, head trauma, or other neurological conditions may also rule out the treatment.
The history and severity of depressive episodes also determines whether an individual qualifies for TMS. The treatment is approved only for major depressive disorder, and some providers and insurance companies OK it only if the depression is deemed resistant to other treatments — which means an individual has undergone at least two unsuccessful medication trials and received a formal diagnosis of major depressive disorder.
To find a TMS provider near you, work with your insurance company or check out provider directories like Brainsway or the Clinical TMS Society.
How well does TMS work?
Studies have shown that about 60 percent of individuals who undergo TMS for depression experience a significant and sustained decrease in symptoms, and one study found remission rates as high as almost 80 percent. By contrast, the average antidepressant offers relief to only 30 percent of those who take it.
While there are no guarantees, TMS can be life-changing for those who respond well to the treatment. “Many of my patients have been depressed most of their lives,” Jasberg says. “They may have tried 20 or 30 different medications. Understandably, they come in skeptical. But a few weeks pass, and they find themselves doing things they never thought they could do. The world seems brighter. They’re finally able to enjoy life.”
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