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TMS stands for transcranial magnetic stimulation. It is used to treat depression by stimulating the brain using electromagnetic fields, similar to those produced by an MRI machine. TMS is non-invasive, meaning that it does not involve surgery. It does not require any anesthesia or sedation, as the patient remains awake and alert during the treatment. TMS is also non-systemic, meaning that it is not taken by mouth and does not circulate in the blood stream, limiting its side effects.
TMS uses short pulses of magnetic fields to stimulate the area of the brain that is thought to function abnormally in patients with depression. The magnetic field produces an electric current in the brain that stimulates the brain cells (neurons). This results in changes that are found to be beneficial in the treatment of depression.
A typical course of TMS is 5 times per week for 19-minute sessions over 6 weeks with a 3 week taper. Any additional treatments are based on clinical evaluation.
Because TMS is non-systemic and does not circulate throughout the body it does not have the side effects such as weight gain, sexual dysfunction, nausea, dry mouth, and sedation that are common with many antidepressant medications. The most common side effects of TMS reported during clinical trials were mild to moderate headache and scalp discomfort, generally occurring less frequently after the first week of treatment. If these side effects persist, your doctor can temporarily reduce the strength of the magnetic field pulses being administered in order to make treatment more comfortable. Fewer than 5% of patients treated with TMS discontinued treatment due to side effects.
TMS has been shown to be well tolerated and has been demonstrated to be safe in clinical trials with over 10,000 active treatments with no occurrence of seizures. However, there is a small risk of a seizure occurring during treatment. This risk is no greater than what has been observed with oral antidepressant medications.
While TMS has been demonstrated to be effective, not all patients will benefit from it. Patients should be carefully monitored for worsening symptoms, signs or symptoms of suicidal behavior, and/or unusual behavior. Families and caregivers should also be aware of the need to observe patients and notify their doctor if symptoms worsen.
TMS uses the same type and strength of magnetic fields as MRIs which have been used in tens of millions of patients around the world. The magnetic energy used in a full course of TMS is a small fraction of just one brain scan with an MRI.
No, the two procedures are very different. While both are effective in the treatment of depression, there are many differences in side effects and tolerability. During TMS, patients sit in a chair and are awake and alert throughout the entire 19-minute procedure – no sedation is used. Patients can transport themselves to and from treatment. In over 10,000 treatments with TMS in clinical trials, no seizures were observed. TMS was also shown to have no negative effect on memory function in these studies. In contrast, “shock therapy,” or ECT, intentionally causes a seizure, and patients receiving ECT must be sedated with general anesthesia and paralyzed with muscle relaxants. Recovery from an ECT treatment session occurs slowly and patients are usually closely monitored for minutes to a few hours after a treatment. Short-term confusion and memory loss are also common with ECT, and long-term disruptions in memory have been shown to occur.
Yes, in clinical trials, TMS was safely administered with and without antidepressant medications.
Since the FDA clearance of TMS in 2008, insurance coverage for eligible patients has increased significantly. Most major insurance companies have recognized the effectiveness of treating depression with TMS and now cover TMS as part of their plans. These insurance companies include BCBS, United Healthcare/Optum, Humana, Aetna, Memorial Health Partners, and Beacon.
The NeuroStar TMS Therapy System that we use at Statesboro Psychiatric Associates is the first TMS device to be cleared by the FDA for the treatment of major depression. It is also the only TMS system with the durability of its effects established over 12 months. In a clinical trial, 2 out of 3 patients who had either responded to treatment or completely remitted their depression symptoms reported 12 months later that they remained at the level they were at the end of the trial. Additionally, after the trial, only 1 in 3 patients needed to return for maintenance TMS sessions.