TMS Therapy
If you have depression, but medication and therapy have not worked, this in-person treatment may be right for you.
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TMS Therapy
If you have depression, but you have not seen adequate results from medication and therapy, this in-person treatment may be right for you. Transcranial Magnetic Stimulation (TMS) therapy primarily targets depression, providing a non-invasive treatment option. Especially recommended for depression resistant to medication, TMS is also used for secondary mental health conditions like anxiety disorders, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and certain types of chronic pain. TMS delivers magnetic pulses to specific brain areas linked with mood regulation, stimulating nerve cells to alleviate symptoms. This therapy presents a safe alternative with minimal side effects, particularly beneficial for individuals unresponsive to traditional treatments.
What is TMS Therapy?
TMS Therapy is an in-office procedure that can relieve symptoms of treatment-resistant depression. This safe, effective treatment uses electromagnetic waves to stimulate specific parts of the brain. It works by delivering magnetic pulses to specific areas of the brain associated with mood regulation. These pulses stimulate nerve cells in the brain, which can help alleviate symptoms of depression in individuals who have not responded well to traditional treatments like medication or therapy.
This type of therapy can seem intimidating to those unfamiliar with it. Some people may confuse it with electroconvulsive therapy (ECT), which can have significant side effects, including memory loss. The two procedures could hardly be more different.
It is essential to understand that it is a non-invasive procedure with few side effects. It is also only used in cases where no other intervention has worked.
TMS therapy is FDA approved for the treatment of Major Depressive Disorder (MDD) in individuals who have not responded adequately to prior antidepressant medications.
Many insurance companies cover TMS therapy for depression because it’s considered medically necessary. However, coverage limits may vary by insurance provider, so you should check with your benefits administrator before scheduling sessions. Most insurances cover TMS after a patient fails to respond to two to four medications.
What Happens in a TMS Session?
During a Transcranial Magnetic Stimulation (TMS) session, the patient typically sits in a comfortable chair or recliner. The TMS technician will then position a special electromagnetic coil against the patient’s scalp, usually near the forehead. This coil emits magnetic pulses that penetrate the scalp and skull to reach specific areas of the brain associated with mood regulation.
Once the coil is properly positioned, the TMS machine delivers a series of repetitive magnetic pulses to the targeted brain regions. These pulses are painless and generally feel like tapping or clicking sensations on the scalp. The intensity and frequency of the pulses are carefully controlled by the technician based on the patient’s individual treatment plan.
Throughout the session, which typically lasts about 16-22 minutes, the patient can relax and engage in quiet activities such as reading, listening to music, or simply resting. After the session is complete, the patient can immediately resume their normal activities without any downtime or recovery period.
TMS does not require anesthesia nor cause pain. Patients can drive themselves to and from a session. While electromagnetic waves may sound intimidating, they are just like the technology used in an MRI.
TMS therapy typically involves multiple sessions over several weeks, with the frequency and duration of treatment determined by the patient’s response and the recommendations of their healthcare provider. Over treatment, many patients experience a gradual improvement in their depressive symptoms, although individual responses may vary.
LifeStance Health is a national leader in mental, behavioral, and emotional wellness with multiple locations in 0 states. Services vary by location.
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What Does TMS Treat?
TMS is an FDA-approved treatment primarily for patients with depression who do not respond to other treatments. Depending on the equipment used, TMS is also FDA-approved to treat anxiety and OCD. TMS has been explored as a potential treatment for OCD, particularly for individuals who have not responded well to traditional therapies like medication or cognitive-behavioral therapy (CBT). Research is underway to see whether TMS can work effectively on other disorders, treating ADHD, schizophrenia, bipolar disorder / depression, PTSD, and substance use disorders such as nicotine addiction and alcohol dependences.
TMS is best suited for people who have tried other interventions for depression without success. This may mean that several different medications did not relieve symptoms or that the medications’ side effects were too much to handle. TMS patients have usually also tried talk therapy.
References
A.K. Memon. Transcranial Magnetic Stimulation in Treatment of Adolescent Attention Defecit/Hyperactivity Disorder: A Narrative Review of Literature. Innovations in Clinical Neuroscience, 2021 Jan-Mar, 18(1-2): 43-46
Dougall N, Maayan N, Soares-Weiser K, McDermott LM, McIntosh A. Transcranial Magnetic Stimulation (TMS) for Schizophrenia. Cochrane Database Syst Rev. 2015 Aug 20;2015(8)
Gold AK, Omelas AC, Cirillo P, Caldieraro MA, Nardi AE, Nierenberg AA, Kinrys G. Clinical Applications of Transcranial Magnetic Stimulation in Bipolar Disorder. Brain Behav. 2019 Oct;9(10)e01419.
Gorelick DA, Zangen A, George MS. Transcranial Magnetic Stimulation in the Treatment of Substance Addiction. Ann N Y Acad Sci. 2014 Oct;1327(1):79-93
Hamlin D, Garman J. A Brief History of Transcranial Magnetic Stimulation. American Journal of Psychiatry Residents. Vol 18.3.
Harris A, Reece J. Transcranial Magnetic Stimulation as a Treatment for Posttraumatic Stress Disorder, A Meta-Analysis. J Affect Disord. 2021 Jun 15;289:55-65.
Rossi S, Hallett M, Rossini PM, Pascual-Leone A; Safety of TMS Consensus Group. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol. 2009 Dec;120(12):2008-2039.
Rush et al, STAR*D Investigators Group. Sequenced treatment alternatives to relieve depression (STAR*D): rationale and design. Control Clin Trials. 2004 Feb;25 (1):119-42
Carpenter, et al. Transcranial magnetic stimulation (TMS) for major depression: a multisite, naturalistic, observational study of acute treatment outcomes in clinical practice. Depress Anxiety. 2012 Jul;29(7):587.
TMS Therapy FAQ
Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation technique used to treat individuals with certain psychiatric conditions. It is FDA-cleared for the treatment of depression. In research settings it is being explored as a treatment for other conditions including generalized anxiety disorder, addiction, and chronic pain.
Some parts of the brain work differently in psychiatric conditions such as depression, and TMS delivers targeted therapy to these brain regions. TMS is a medical device that generates brief magnetic pulses that non-invasively stimulate the underlying brain region. When pulses of TMS are delivered repetitively, this is called repetitive, rTMS.
You get to relax in a comfortable reclining chair. You will feel a tapping sensation on the front part of the left side of your head. Individuals perceive the pulses differently, and the clinician can make adjustments so that the individual is more comfortable.
Yes, the individual needs to come 5 days a week for 6 to 8 weeks and possibly 3 additional weeks to slowly step down the treatment when required by insurance. A typical total of treatments is 36.
A single TMS session will last 20 to 30 minutes, based on various treatment parameters. A course of treatment for depression usually consists of 30 to 36 treatments over 6 weeks, although this can vary depending on an individual’s response. While occasional 1- to 2-day breaks from treatment are understandable, breaks of 10 days or more can decrease treatment response. Individuals can continue with all life activities during treatment, including driving and working.
TMS is generally a well-tolerated procedure with few side effects. The most common side effect is scalp irritation underneath the magnet. Another common side effect is headaches. Minor treatment adjustments can minimize these side effects. TMS is free from side effects caused by many antidepressants such as gastrointestinal upset, sexual dysfunction, weight gain, dry mouth, or sedation. The most serious side effect is seizures, but the risk of seizure is exceedingly low.
TMS is a treatment consideration for anyone whose depression has not responded to medication plus psychotherapy. You cannot have TMS if you have metallic objects or certain medical implants in your head. Dental fillings are okay.
Your provider/technician will work to help you get the best results. Keep taking medications as prescribed. Talk therapy and lifestyle changes also help with getting the best results.
No, the procedures for TMS and ECT are very different. In particular, the way they stimulate brain cells is different. Also, TMS does not require general anesthesia or intentional production of a seizure and is not associated with memory loss. Finally, TMS does not limit an individual’s ability to work, go to school, or drive.
Commercial health insurance generally considers TMS medically necessary for individuals that do not have contraindications to treatment and meet criteria for difficult-to-treat depression. Individuals are provided with an out-of-pocket-cost estimate prior to initiating treatment.
Our TMS machines include both NeuroStar® and Magstim® TMS systems—two of the most trusted and FDA-cleared technologies in the field of transcranial magnetic stimulation. These devices allow us to tailor treatments based on an individual’s need.
Carpenter, et al. Transcranial magnetic stimulation (TMS) for major depression: a multisite, naturalistic, observational study of acute treatment outcomes in clinical practice. Depress Anxiety. 2012 Jul;29(7):587.
