Transcranial Magnetic Stimulation is definitely a mouthful! The word "transcranial" essentially means "on the skull." At its most fundamental, TMS is a form of magnetic stimulation therapy that targets the brain.
Despite the scary sounding formality of the name, this type of therapy is actually totally non-invasive, well researched, and quite safe. As an option for treating clinically-resistant depression (depression symptoms that have not responded favorably to other forms of therapy), Transcranial Magnetic Stimulation is a welcome and exciting addition to the psychiatric field.
Sometimes TMS is also called rTMS, or repetitive Transcranial Magnetic Stimulation, since each treatment session includes many magnetic pulses. This treatment is typically prescribed after more standardized treatments such as medications, or other forms of psycho-therapy, have not delivered desirable results. The focus to date has been on patients whose symptoms remain unalleviated by these common treatment approaches.
In this article, learn more about TMS, an innovative, effective and painless form of depression treatment.
The Origin of TMS
The therapy we know of today as transcranial magnetic pulse therapy was first developed in 1985. However, the building blocks of research and testing began far earlier in the late 18th century.
The most important thing for patients and loved ones to know, is that this therapy is now approved both by Health Canada and by the U.S. Food and Drug Administration (FDA) for use in treating depression.
In 2010, the National Institutes of Health (NIH) conducted a rigorous clinical trial to test this therapy for use in treating depression, and it found the treatment to be quite effective.
In 2015, the NIH conducted a thorough review of clinical trials and research to date on the use of this therapy to treat resistant depression and found substantial evidence of its usefulness.
What Is a Treatment Session Like?
You will be asked to remove anything magnetic you may be wearing or carrying, from jewelry to smart phones, because the treatment itself uses magnetic pulses and you don't want anything magnetic to interfere with its effectiveness.
Next, it is necessary to precisely measure the scalp to determine optimal placement of the treatment device. This measurement only needs to be done once - it won't be necessary on follow-up appointments.
Before your treatment begins, you will be asked to take a seat in a comfortable reclining chair and wear earplugs. The use of earplugs is recommended because the device emits clicking sounds, which some patients may find jarring or loud.
The next step is to do a test run of the device to be sure you are receiving the right strength of magnetic pulses for the most effective results this is called the "motor threshold".
We measure motor threshold by adjusting the pulses until your thumb twitches. The motor threshold can be different for every person and finding the optimal motor threshold is important to customize the procedure to suit your needs.
The treatment phase begins with the strategic placement of an electro-magnetic coil on your scalp. This coil is completely non-invasive, it lightly contacts the surface of your scalp only.
You will be asked to remain still and quiet during the 30 to 40 minute treatment period. You may also feel a sensation some people describe as "tapping" (and which is called "mapping") near the area where the electromagnetic device is touching your scalp.
Treatment is generally prescribed for four to six weeks, five times per week. Because the treatment requires no down time and has no adverse side effects, patients can return to their regularly scheduled activities immediately after each treatment session.
How Does It Work?
So let's take a look now at how this type of magnetic stimulation therapy works.
The placement of the electromagnetic device on your scalp is a critical component for treatment effectiveness. The magnetic pulses can improve mood and ease depressive symptoms by stimulating neural activity in specific areas of the brain which are known to impact and regulate mood.
The motor threshold of the magnetic pulses and the frequency of the repetitive pulses also play a part in treatment results. Specially accommodating these features for each patient is a key to personal treatment success.
While researchers have yet to understand all aspects of brain function, it is known that the left hemisphere and the right hemisphere of the brain impact mood differently. This offers lots of options to maximize effectiveness of rTMS treatment.
What About Side Effects?
Unlike traditional treatments and many anti-depression medications, transcranial magnetic therapy has very few, if any, side effects. Temporary patient-reported side effects can include minor scalp discomfort, post-treatment headaches, light-headedness or tingling near the treatment site(s).
However, rTMS is not the right treatment for all patients, specifically those with a history of bi-polar disorder or seizures. As well, because it uses magnetic pulses, it is not always recommended for pregnant patients or patients with pacemakers or other implanted metallic devices.
Is It Safe?
Transcranial magnetic therapy is considered safe for most individuals. The best way to know if you are a good candidate is to consult with your doctor.
Patients who have a history of seizures, heart disease, high blood pressure, severe headaches, aneurysms, bipolar disorder, brain damage or metallic/magnetic implants should talk with their doctor.
Why Not Just Use ECT?
ECT, short for Electro-Convulsive Therapy, is the traditional treatment approach for addressing major depression and psychotic depression that has been unresponsive to medications and/or psycho-therapy.
ECT can result in certain known side effects which include short-term cognitive lapses, memory loss, mental confusion, blood pressure elevation, nausea and others.
ECT, unlike rTMS, also requires extensive testing and blood work prior to treatment and requires a general anesthetic be administered during treatment.
Many patients are understandably reluctant to undergo ECT solely based off the side effects, additionally the high cost can prove to be another huge obstacle. While ECT is still prescribed to treat non-responsive major depression, many patients appreciate having TMS as another option. It is more generally favorable because it is non-invasive, with few side effects, and for many people it is just as, if not more effective than traditional ECT.
Does It Require Drugs to Work?
Transcranial magnetic therapy does not require the use of any medication to be effective (unlike ECT, for example, which requires general anesthesia via IV during each treatment).
Is It Covered by Insurance?
There is no standard in the insurance industry governing rTMS treatment. Some insurers cover the treatment while others do not. The best approach is to contact your insurer to find out.
Since more and more insurers are choosing to cover this non-invasive, clinically-proven, lower-cost alternative to ECT, if your insurer does not yet cover the treatment it may be worth it to file an appeal.
If you think TMS therapy is right for you, Contact TMS Health and Wellness located in Costa Mesa today to schedule a consultation.