- Transcranial Magnetic Stimulation (TMS) is a treatment for depression using magnets to change brain activity.
- TMS has been FDA-approved for depression, migraines with aura, OCD, and smoking cessation.
- There are several TMS protocols being utilized and researched for different conditions.
“It will feel like a woodpecker knocking against a helmet,” the psychiatrist said as we discussed my beginning Transcranial Magnetic Stimulation (TMS) treatments. Even if he had said, “It will feel like being bitten by 50 woodpeckers at once,” I would have consented to the treatment. This particular depressive episode had drawn the color from my life, and everything I threw at it seemed to have little or no effect.
I appeared at the center five days a week for several weeks. They placed a helmet on my head as I looked up at a corner of the room. I didn’t feel any different. I wondered about what this was doing to my brain and feared it was doing nothing.
In the past, biological depression treatments typically had one of two effects on me: no effect or a sort of numbing. Like an emotional anesthetic. I would feel less of everything, a welcome relief, but I missed experiencing the full range of life. I hoped that something more helpful might exist for me in addition to medication.
After a few weeks of treatment, I found myself curious again. I wanted to fly a kite in the park, so I did. It’s amazing when you’re depressed how much harder things are than when you’re not. Watching the kite fly, I saw it swerve and dip. It took a dive and then resurfaced. It reminded me of my own spirits. I didn’t feel muted.
When I’ve shared my experience with TMS, both with friends and fellow practitioners, I have gotten a variety of responses. Some questioned if it was like crystal work, and many were surprised to learn that mine was covered by insurance. Few really understood how it works. I’d like to share a few facts about TMS.
1. Transcranial Magnetic Stimulation Is a Well-Studied Treatment.
I first learned about TMS on a radio commercial following something about a miracle weight loss wrap. I was immediately skeptical. After a Google Scholar search and a conversation with a psychiatrist, I learned TMS is actually a well-studied treatment that utilizes strong magnetic pulses to alter brain activity, thereby improving symptoms of depression and other illnesses (George, 2019). It can be hard to imagine that something we’ve all held in our hands, magnets, could treat anything, yet we appreciate the images brought by MRI technology each day.
2. TMS Has FDA Approval.
TMS is currently an FDA-approved intervention for major depression, migraines with aura, obsessive-compulsive disorder, smoking cessation, and anxiety in people with depression (Cohen et al., 2022). In addition, other indications are being explored, including schizophrenia, Alzheimer’s disease, bipolar disorder, and others (George, 2019). While research using TMS dates back to the late ’80s, there is still much to be explored regarding its potential.
3. TMS Does Not Work for Everyone.
The exact response rate for TMS is somewhat unknown. A piece of this is because most research has focused on treatment-resistant depression, usually defined as someone who has not been helped by four or more medications, as opposed to individuals experiencing a non-treatment refractory variety, making it plausible that response rates could be underestimated. One study of people with treatment-resistant depression using rTMS found a 46 percent response rate (Liu et al., 2014), which is quite high compared to the 16.8 percent response rate found for individuals receiving a fourth trial of antidepressants (Voineskos et al., 2020).
4. TMS Is Not Just One Thing.
Just as there are multiple types of medication, there are several TMS protocols. This includes variations in the placement of the coils, length or number of sessions, and depth of stimulation. Some of this variation is based on the targeted condition; however, for some conditions, like depression, there are multiple protocols for the same entity.
4. TMS Is Not Just for Rich People.
When I first heard about TMS, I thought it would be prohibitively expensive, but TMS is often covered by health insurance. I’m very lucky with my insurance, which I receive through the healthcare exchange, in that my treatments are covered.
5. TMS Is Intense.
TMS usually begins with daily treatments with a total of 36 treatments. It goes without saying that this is a decent commitment. This structure turned out to be beneficial for me; however, it does require an adjustment to normal routines.
We are close to the horizon with Transcranial Magnetic Stimulation. Time will tell what all applications and indications will come of it. I am thankful to have met the magnetic “woodpecker” some years ago. I am thankful for the technological innovations that could assist in mental health treatment.
Cohen, S. L., Bikson, M., Badran, B. W., & George, M. S. (2022). A visual and narrative timeline of US FDA milestones for Transcranial Magnetic Stimulation (TMS) devices. Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation, 15(1), 73-75.
George, M. S. (2019). Whither TMS: a one-trick pony or the beginning of a neuroscientific revolution?. American Journal of Psychiatry, 176(11), 904-910.
Liu, B., Zhang, Y., Zhang, L., & Li, L. (2014). Repetitive transcranial magnetic stimulation as an augmentative strategy for treatment-resistant depression, a meta-analysis of randomized, double-blind and sham-controlled study. BMC psychiatry, 14(1), 1-9.
Mantovani, A., Pavlicova, M., Avery, D., Nahas, Z., McDonald, W. M., Wajdik, C. D.& Lisanby, S. H. (2012). Long‐term efficacy of repeated daily prefrontal transcranial magnetic stimulation (tms) in treatmnt‐resistant depression. Depression and anxiety, 29(10), 883-890.
Voineskos, D., Daskalakis, Z. J., & Blumberger, D. M. (2020). Management of treatment-resistant depression: challenges and strategies. Neuropsychiatric disease and treatment, 221-234.