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By

| Published July 4th, 2022|  Professionally Reviewed By

Learn / Demystifying Transcranial Magnetic Stimulation (TMS)

Demystifying Transcranial Magnetic Stimulation (TMS)


Traditional therapy and medications aren’t always effective for treating mental health disorders. If this is the case for you, transcranial magnetic stimulation (TMS) could be a viable alternative. This non-invasive treatment works by stimulating different parts of your brain to alleviate symptoms of mental health conditions like depression and PTSD.

Your primary care physician, mental health treatment provider, or rehab treatment team can help you determine if TMS is right for you. Below, we’ll explore more about this therapy:

  • what TMS is
  • conditions TMS can treat
  • what happens in a session
  • possible side effects and other factors to consider

Health Conditions That TMS Can Treat

TMS can be used to treat1 the following:

About 20-30% of patients with MDD continue to experience depressive symptoms2 despite therapy and medication. For those patients, looking for alternatives to traditional treatment approaches is often a logical next step. TMS shows significant potential to improve depressive symptoms among people with treatment-resistant depression and PTSD. It may take several weeks to see results, so it’s imperative for patients to consistently attend the number of sessions prescribed by their doctor.

Repetitive TMS, or rTMS, has also been shown to be successful for anxiety and bipolar disorders,3 although it’s more effective in treating depression than manic episodes. It may also speed up recovery after a stroke, and help alleviate symptoms that arise after the event. In addition, low-frequency rTMS can help control the symptoms of Tourette syndrome and OCD. High-frequency rTMS helps people quit smoking by reducing cravings. rTMS can even reduce cocaine use and cravings4 in people struggling with addiction.

What Exactly Is TMS?

TMS is a non-invasive procedure that stimulates brain tissue3 by producing a high- or low-intensity magnetic field through a copper wire. There are 3 main methods of TMS used today:

  • Single-pulse TMS (spTMS) stimulates the motor cortex while a machine measures and records electrical activity.
  • Paired-pulse TMS (ppTMS) delivers 2 pulses through the same coil, with long or short intervals in between.
  • Repetitive TMS (rTMS) is a popular variation of TMS that applies repeating pulses to a specific area of the brain. This method treats the symptoms that come from mental health disorders. Deep TMS (dTMS)5 is a newer type of rTMS that stimulates deep brain areas because their larger helmet allows for more surface area. All Points North Lodge is one rehab center that offers dTMS treatment.

Typically, spTMS and ppTMS evaluate brain functioning, while rTMS actually creates changes in the brain. If you’re treated for a mental health condition, you’ll most likely undergo rTMS. There are several different coils available for use in TMS treatment. The specialists who deliver your treatment will determine the best one for your needs.

You can either complete TMS sessions at an inpatient rehab center (Inspire Malibu, for example, offers this in partnership with a physician’s office) or at a private clinic as an outpatient. In the latter option, you’d stay at home and commute to your sessions each day.

What Happens During a TMS Session?

Before you undergo any TMS procedures,3 you’ll take a physical and mental health screening to confirm your candidacy. This includes discussion of symptoms, conditions, and any medications you take with your treatment team, who will then guide you through the process.

During your session, you’ll sit in a reclining chair with earplugs (or some sort of hearing protection) with an electromagnetic coil attached to your head. The Dawn Rehab in Thailand even lets you listen to music so you feel as comfortable as possible. During rTMS (the most common type of TMS procedure), the operating physician will turn the coil on and off repeatedly to deliver pulses to your brain. During this process, you’ll feel a tapping sensation, called “mapping.” The professional administering rTMS will slowly increase the dose of magnetic energy to determine the right amount for you.

Most people don’t find TMS painful,6 but some people may feel slight discomfort. The Dawn Rehab describes their TMS sessions as follows:

“A TMS-trained nurse will place an electromagnetic coil against your head which will painlessly deliver brief magnetic pulses – the same as those used in MRI (Magnetic Resonance Imaging) machines – to the region of the brain involved in mood control and depression.”

After your session, you can continue your regular daily routine as usual.

How Long Are TMS Sessions?

Duration can vary person to person, and will also depend on your diagnosis. Standard rTMS treatment for major depressive disorder,7 for example, averages around 20-30 daily sessions for around 4-6 weeks. However, research recommends a minimum of 6 weeks. One study in particular found that 38.4% of MDD patients responded well to just 4 weeks for treatment, but then surveyed patients who didn’t respond well to the initial 4 weeks after an additional 12 weeks of biweekly sessions. 61% of those patients responded well to the longer treatment phase.

Some studies have explored another, faster form of rTMS called “accelerated rTMS” or arTMS. During rTMS, people undergo multiple sessions in one day. Some studies suggest promising outcomes from this procedure, but more research will determine if this is actually a more viable option. Theta burst stimulation (TBS) is another, newer form of rTMS that can produce quicker results.7 Some studies found that, after only 5 days, patients enrolled in TBS arTMS trials reported success rates of 90%.

Some people may continue to attend “maintenance sessions” after their first set of TMS sessions. This involves slowly reducing the number of sessions per week from 3 to 1, which are eventually reduced down to 1 session every 2 weeks. However, some people stop rTMS altogether, and go back to therapy and medications after completing their sessions. Unfortunately, rTMS maintenance isn’t well studied, and needs more research before making any determinations.

Should You Try TMS Therapy? Consider the Cons

While TMS has relatively few drawbacks, they do exist. Side effects are possible, but are usually minimal. And, TMS can be expensive and time-consuming. However, it may still be worth it for you, since lifting your depression to any degree can greatly impact your quality of life. Here are some factors to consider before trying TMS:

Possible Side Effects

Although TMS is non-invasive and seldom produces side effects,3 it can cause seizures in rare cases, and doctors do not recommend it for patients with epilepsy. While the risk of a seizure is small (less than 0.01% if you don’t have epilepsy, and less than 3% if you do), it’s still a possibility. If any of the following apply to you, you may be more likely to experience seizures:

  • pre-existing neurological conditions
  • adolescent
  • changes in medication
  • active substance use

You should talk to your doctor if you have any metal or electronic implants that will be near the TMS coil. This includes cochlear implants. These may cause problems with the therapy, and can be dangerous.

You may feel some slight discomfort in your scalp or neck during the procedure or pain afterwards. You might also become more sensitive to sounds or experience ringing in your ears—which is why treatment providers should always provide ear protection. Some people report feeling fatigued afterwards. However, it’s unlikely that you’ll encounter any of these side effects, and if you do, they will most likely be mild and short-lived.

Cost

rTMS is expensive,7 ranging from $200-300 USD per visit in a private clinic. If you complete the full course recommended by your doctor, you may end up paying $5,000-10,000 USD. Of course, this can differ depending on the duration and number of sessions you attend. Check with rehabs you’re considering to see if TMS is included in the cost of your program, or how much additional costs are.

Could TMS Provide the Relief You’ve Been Looking For?

Being unresponsive to treatment is incredibly frustrating when you’re living with depression or other mental health issues. But the good news is, you still have options. Alternative treatments like TMS just might do the trick for you, and the simple act of being open to trying something new can empower you to move forward in your recovery journey.

To learn more about residential treatment programs that offer this and other alternative therapies, browse our directory of luxury rehabs and connect with centers directly.

  1. Mann, S. K., & Malhi, N. K. (2022). Repetitive transcranial magnetic stimulation. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK568715/ []
  2. Sonmez, A. I., Camsari, D. D., Nandakumar, A. L., Voort, J. L. V., Kung, S., Lewis, C. P., & Croarkin, P. E. (2019). Accelerated tms for depression: A systematic review and meta-analysis. Psychiatry Research273, 770–781. https://doi.org/10.1016/j.psychres.2018.12.041 []
  3. Mann, S. K., & Malhi, N. K. (2022). Repetitive transcranial magnetic stimulation. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK568715/ [] [] [] []
  4. Torres-Castaño, A., Rivero-Santana, A., Perestelo-Pérez, L., Duarte-Díaz, A., Toledo-Chávarri, A., Ramos-García, V., Álvarez-Pérez, Y., Cudeiro-Mazaira, J., Padrón-González, I., & Serrano-Pérez, P. (2021). Transcranial magnetic stimulation for the treatment of cocaine addiction: A systematic review. Journal of Clinical Medicine10(23), 5595. https://doi.org/10.3390/jcm10235595 []
  5. Carmi, L., Tendler, A., Bystritsky, A., Hollander, E., Blumberger, D. M., Daskalakis, J., Ward, H., Lapidus, K., Goodman, W., Casuto, L., Feifel, D., Barnea-Ygael, N., Roth, Y., Zangen, A., & Zohar, J. (2019). Efficacy and safety of deep transcranial magnetic stimulation for obsessive-compulsive disorder: A prospective multicenter randomized double-blind placebo-controlled trial. American Journal of Psychiatry176(11), 931–938. https://doi.org/10.1176/appi.ajp.2019.18101180 []
  6. Croarkin, P. E., Wall, C. A., King, J. D., Andrew Kozel, F., & Daskalakis, Z. J. (2011). Pain during transcranial magnetic stimulation in youth. Innovations in Clinical Neuroscience8(12), 18–23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257981/ []
  7. Miron, J.-P., Jodoin, V. D., Lespérance, P., & Blumberger, D. M. (2021). Repetitive transcranial magnetic stimulation for major depressive disorder: Basic principles and future directions. Therapeutic Advances in Psychopharmacology11, 204512532110426. https://doi.org/10.1177/20451253211042696 [] [] []

Return to Blog Home


By

| Published July 4th, 2022|  Professionally Reviewed By

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Demystifying Transcranial Magnetic Stimulation (TMS)

By

| Published July 4th, 2022
 Professionally Reviewed By


Traditional therapy and medications aren’t always effective for treating mental health disorders. If this is the case for you, transcranial magnetic stimulation (TMS) could be a viable alternative. This non-invasive treatment works by stimulating different parts of your brain to alleviate symptoms of mental health conditions like depression and PTSD.

Your primary care physician, mental health treatment provider, or rehab treatment team can help you determine if TMS is right for you. Below, we’ll explore more about this therapy:

  • what TMS is
  • conditions TMS can treat
  • what happens in a session
  • possible side effects and other factors to consider

Health Conditions That TMS Can Treat

TMS can be used to treat1 the following:

About 20-30% of patients with MDD continue to experience depressive symptoms2 despite therapy and medication. For those patients, looking for alternatives to traditional treatment approaches is often a logical next step. TMS shows significant potential to improve depressive symptoms among people with treatment-resistant depression and PTSD. It may take several weeks to see results, so it’s imperative for patients to consistently attend the number of sessions prescribed by their doctor.

Repetitive TMS, or rTMS, has also been shown to be successful for anxiety and bipolar disorders,3 although it’s more effective in treating depression than manic episodes. It may also speed up recovery after a stroke, and help alleviate symptoms that arise after the event. In addition, low-frequency rTMS can help control the symptoms of Tourette syndrome and OCD. High-frequency rTMS helps people quit smoking by reducing cravings. rTMS can even reduce cocaine use and cravings4 in people struggling with addiction.

What Exactly Is TMS?

TMS is a non-invasive procedure that stimulates brain tissue3 by producing a high- or low-intensity magnetic field through a copper wire. There are 3 main methods of TMS used today:

  • Single-pulse TMS (spTMS) stimulates the motor cortex while a machine measures and records electrical activity.
  • Paired-pulse TMS (ppTMS) delivers 2 pulses through the same coil, with long or short intervals in between.
  • Repetitive TMS (rTMS) is a popular variation of TMS that applies repeating pulses to a specific area of the brain. This method treats the symptoms that come from mental health disorders. Deep TMS (dTMS)5 is a newer type of rTMS that stimulates deep brain areas because their larger helmet allows for more surface area. All Points North Lodge is one rehab center that offers dTMS treatment.

Typically, spTMS and ppTMS evaluate brain functioning, while rTMS actually creates changes in the brain. If you’re treated for a mental health condition, you’ll most likely undergo rTMS. There are several different coils available for use in TMS treatment. The specialists who deliver your treatment will determine the best one for your needs.

You can either complete TMS sessions at an inpatient rehab center (Inspire Malibu, for example, offers this in partnership with a physician’s office) or at a private clinic as an outpatient. In the latter option, you’d stay at home and commute to your sessions each day.

What Happens During a TMS Session?

Before you undergo any TMS procedures,3 you’ll take a physical and mental health screening to confirm your candidacy. This includes discussion of symptoms, conditions, and any medications you take with your treatment team, who will then guide you through the process.

During your session, you’ll sit in a reclining chair with earplugs (or some sort of hearing protection) with an electromagnetic coil attached to your head. The Dawn Rehab in Thailand even lets you listen to music so you feel as comfortable as possible. During rTMS (the most common type of TMS procedure), the operating physician will turn the coil on and off repeatedly to deliver pulses to your brain. During this process, you’ll feel a tapping sensation, called “mapping.” The professional administering rTMS will slowly increase the dose of magnetic energy to determine the right amount for you.

Most people don’t find TMS painful,6 but some people may feel slight discomfort. The Dawn Rehab describes their TMS sessions as follows:

“A TMS-trained nurse will place an electromagnetic coil against your head which will painlessly deliver brief magnetic pulses – the same as those used in MRI (Magnetic Resonance Imaging) machines – to the region of the brain involved in mood control and depression.”

After your session, you can continue your regular daily routine as usual.

How Long Are TMS Sessions?

Duration can vary person to person, and will also depend on your diagnosis. Standard rTMS treatment for major depressive disorder,7 for example, averages around 20-30 daily sessions for around 4-6 weeks. However, research recommends a minimum of 6 weeks. One study in particular found that 38.4% of MDD patients responded well to just 4 weeks for treatment, but then surveyed patients who didn’t respond well to the initial 4 weeks after an additional 12 weeks of biweekly sessions. 61% of those patients responded well to the longer treatment phase.

Some studies have explored another, faster form of rTMS called “accelerated rTMS” or arTMS. During rTMS, people undergo multiple sessions in one day. Some studies suggest promising outcomes from this procedure, but more research will determine if this is actually a more viable option. Theta burst stimulation (TBS) is another, newer form of rTMS that can produce quicker results.7 Some studies found that, after only 5 days, patients enrolled in TBS arTMS trials reported success rates of 90%.

Some people may continue to attend “maintenance sessions” after their first set of TMS sessions. This involves slowly reducing the number of sessions per week from 3 to 1, which are eventually reduced down to 1 session every 2 weeks. However, some people stop rTMS altogether, and go back to therapy and medications after completing their sessions. Unfortunately, rTMS maintenance isn’t well studied, and needs more research before making any determinations.

Should You Try TMS Therapy? Consider the Cons

While TMS has relatively few drawbacks, they do exist. Side effects are possible, but are usually minimal. And, TMS can be expensive and time-consuming. However, it may still be worth it for you, since lifting your depression to any degree can greatly impact your quality of life. Here are some factors to consider before trying TMS:

Possible Side Effects

Although TMS is non-invasive and seldom produces side effects,3 it can cause seizures in rare cases, and doctors do not recommend it for patients with epilepsy. While the risk of a seizure is small (less than 0.01% if you don’t have epilepsy, and less than 3% if you do), it’s still a possibility. If any of the following apply to you, you may be more likely to experience seizures:

  • pre-existing neurological conditions
  • adolescent
  • changes in medication
  • active substance use

You should talk to your doctor if you have any metal or electronic implants that will be near the TMS coil. This includes cochlear implants. These may cause problems with the therapy, and can be dangerous.

You may feel some slight discomfort in your scalp or neck during the procedure or pain afterwards. You might also become more sensitive to sounds or experience ringing in your ears—which is why treatment providers should always provide ear protection. Some people report feeling fatigued afterwards. However, it’s unlikely that you’ll encounter any of these side effects, and if you do, they will most likely be mild and short-lived.

Cost

rTMS is expensive,7 ranging from $200-300 USD per visit in a private clinic. If you complete the full course recommended by your doctor, you may end up paying $5,000-10,000 USD. Of course, this can differ depending on the duration and number of sessions you attend. Check with rehabs you’re considering to see if TMS is included in the cost of your program, or how much additional costs are.

Could TMS Provide the Relief You’ve Been Looking For?

Being unresponsive to treatment is incredibly frustrating when you’re living with depression or other mental health issues. But the good news is, you still have options. Alternative treatments like TMS just might do the trick for you, and the simple act of being open to trying something new can empower you to move forward in your recovery journey.

To learn more about residential treatment programs that offer this and other alternative therapies, browse our directory of luxury rehabs and connect with centers directly.

  1. Mann, S. K., & Malhi, N. K. (2022). Repetitive transcranial magnetic stimulation. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK568715/ []
  2. Sonmez, A. I., Camsari, D. D., Nandakumar, A. L., Voort, J. L. V., Kung, S., Lewis, C. P., & Croarkin, P. E. (2019). Accelerated tms for depression: A systematic review and meta-analysis. Psychiatry Research273, 770–781. https://doi.org/10.1016/j.psychres.2018.12.041 []
  3. Mann, S. K., & Malhi, N. K. (2022). Repetitive transcranial magnetic stimulation. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK568715/ [] [] [] []
  4. Torres-Castaño, A., Rivero-Santana, A., Perestelo-Pérez, L., Duarte-Díaz, A., Toledo-Chávarri, A., Ramos-García, V., Álvarez-Pérez, Y., Cudeiro-Mazaira, J., Padrón-González, I., & Serrano-Pérez, P. (2021). Transcranial magnetic stimulation for the treatment of cocaine addiction: A systematic review. Journal of Clinical Medicine10(23), 5595. https://doi.org/10.3390/jcm10235595 []
  5. Carmi, L., Tendler, A., Bystritsky, A., Hollander, E., Blumberger, D. M., Daskalakis, J., Ward, H., Lapidus, K., Goodman, W., Casuto, L., Feifel, D., Barnea-Ygael, N., Roth, Y., Zangen, A., & Zohar, J. (2019). Efficacy and safety of deep transcranial magnetic stimulation for obsessive-compulsive disorder: A prospective multicenter randomized double-blind placebo-controlled trial. American Journal of Psychiatry176(11), 931–938. https://doi.org/10.1176/appi.ajp.2019.18101180 []
  6. Croarkin, P. E., Wall, C. A., King, J. D., Andrew Kozel, F., & Daskalakis, Z. J. (2011). Pain during transcranial magnetic stimulation in youth. Innovations in Clinical Neuroscience8(12), 18–23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257981/ []
  7. Miron, J.-P., Jodoin, V. D., Lespérance, P., & Blumberger, D. M. (2021). Repetitive transcranial magnetic stimulation for major depressive disorder: Basic principles and future directions. Therapeutic Advances in Psychopharmacology11, 204512532110426. https://doi.org/10.1177/20451253211042696 [] [] []

Return to Blog Home


By

| Published July 4th, 2022
 Professionally Reviewed By

Related Articles

5 Ways to Help Someone Struggling with Depression

Watching someone you love struggle through depression can make you feel helpless: you want to offer support, but feel unsure of how to help. With approximate...

Depression in Men: Recognizing and Treating a Hidden Condition

Depression can be difficult for anyone to discuss, as sufferers have to deal with not only their condition but also the stigma associated with it. This chall...