It is sometimes helpful to recap where we are so we can make the best decisions about how to move forward. It helps to look at the facts and be realistic about where we are, what we know and what more we can learn to gain a fuller understanding of something in its current state and what’s ahead. With this logic in mind, as a practicing psychiatrist, I wanted to expand on what is know about Transcranial Magnetic Stimulation (TMS) Therapy from a clinical perspective.
TMS was cleared by the FDA in 2008 to treat Major Depression that has not responded to one antidepressant treatment. This clearance was expanded to previous antidepressant treatment, no matter the number.
Major Depression is a brain disease. Depression is an emotion just like happiness, but Major Depression is a serious disease that includes symptoms such as depressed mood, disturbance of sleep and appetite, lack of motivation and interest, diminished cognition and suicidal thoughts not explained by physical illness and lasting for at least a couple of weeks. The areas of the brain connected to Major Depression include the prefrontal cortex and the limbic system. Disruption of circuits connecting these areas of the brain can account for the emotional, cognitive and active symptoms of Major Depression.
The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, funded by NIMH looked at over 4,000 patients with Major Depression shows that medication does not help all patients and there is a lessened chance of response as people take more antidepressants due to lack of effect or side effects.
There is a common misconception that TMS Therapy is ECT (Electroconvulsive therapy, or electroshock therapy). TMS is NOT ECT. Perhaps is the 3-letter abbreviation of the treatment, or that both “stimulate” the brain without medication, but let me be clear—TMS involves zero electric “shock” of any sorts. Instead, TMS uses a magnetic pulse to stimulate the brain, much like the magnet used in an MRI machine. TMS is an office-based treatment, and it does not involve sedation or anesthesia and does not have any negative cognitive effects. A patient can drive to the treatment and afterward go to work, school, the gym or where ever they would like. There are no systemic side effects.
The pulsed magnetic field from a TMS magnet causes targeted and direct neuronal depolarization of a specific part of the brain leading to release of neurotransmitters as well as neuronal depolarization in deeper structures affecting mood. There is activation of these brain circuits following TMS.
TMS is effective, and safe in treating Major Depression that has not responded to a previous antidepressant medication. In several randomized, controlled peer-reviewed and published studies, TMS has been shown to be effective with response in over one half and remission in one-third of patients. It has also been shown to be durable and lasting over time.
When someone responds to TMS, if he or she has a return of symptoms, there is a good chance of response to further TMS, usually with fewer treatments.
That is what we know from clinical research. What I know from having been involved with TMS for nine years, having treated more than 400 patients with 15,000+ treatments including the approximately 20% that have returned for retreatment, is that TMS has proven to be a valuable tool in providing optimal, evidenced-based treatment for patients with Major Depression.
It used to be that people were not aware of TMS, but now not a week goes by without someone mentioning TMS and usually knowing someone who had a successful treatment. Knowing what we know, it is understandable that people are becoming more aware of this beneficial treatment option for Major Depression.
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