What is Transcranial Magnetic Stimulation and How Can it Help You?
Transcranial magnetic stimulation, or TMS, is a noninvasive procedure used to treat major depression. TMS uses a powerful electromagnet to stimulate neurons in the brain. Since this is done repetitively, the procedure is sometimes called repetitive TMS or rTMS. TMS is not painful and is typically described as a tapping sensation. There is no sedation required and the procedure has minimal side effects.
Who is TMS for?
TMS is primarily a treatment option for people with major depression who have not responded well to other treatments. The first line of treatment for depression is typically psychotherapy, often with the help of medication. Studies show that antidepressant medications improve symptoms in about 40 to 60 percent of people with moderate or severe depression. That means 40 to 60 percent notice little or no improvement and some of the people who do notice improvement may still feel pretty bad. Combining cognitive behavioral therapy, or CBT, the most common form of psychotherapy, and antidepressant medication is only slightly more effective than medication alone. That means for people with moderate to severe major depression, around half are not likely to get adequate relief from standard treatments.
For decades, the last resort for people with treatment-resistant major depression has been electroconvulsive therapy, or ECT. ECT is a procedure in which electric current is passed through the brain while the patient is under anesthesia. ECT has come a long way from early treatments that used excessive voltage and didn’t sedate patients. In its current form, ECT has been shown to improve depressive symptoms in about 80 percent of patients. Despite its effectiveness, ECT does have some drawbacks. There is always some risk of putting a patient under anesthesia and once someone has been put under, it’s usually a day or two before she can get back to normal life. ECT requires a small team of medical professionals to administer, making it more expensive. There are also sometimes side effects including headache, memory loss, confusion, and difficulty learning.
TMS is often a good intermediate option between medication and ECT. TMS doesn’t require anesthesia; patients can come in for a treatment lasting between 20 minutes and an hour, then go about their day. TMS can be administered by one technician and the side effects are minimal. They may include headache, tingling, or dizziness, which are usually temporary. In people with a history of epilepsy or head trauma, it may cause seizures.
How does TMS work?
Since the brain operates through the propagation of electrical signals, brain cells can be stimulated into action using a magnetic field. Brain imaging studies have found that people with major depression have unusual patterns of brain activity. One conspicuous feature of the depressed brain is that the left prefrontal cortex is less active. This area is responsible for, among other things, emotional regulation. In other words, people with major depression may feel depressed because the part of their brain that’s supposed to improve their mood is nearly switched off.
TMS works by using electrical pulses to stimulate activity in the left prefrontal cortex. First, the technician finds the brain’s motor cortex by moving the electromagnet around until it produces movement in the patient’s finger. Then the computer uses this reference point to locate the target area. Rapid electrical pulses are delivered in such a way that causes signals to flow in the underactive neurons. The result, for many patients, is that their emotional regulation starts to come back on line and they feel better.
The brain has a remarkable ability to change and adapt to new stimuli–a feature often called neuroplasticity–but it doesn’t happen all at once. Change only happens through repeated use. There’s a saying, that “neurons that fire together wire together.” In other words, one little zap isn’t going to make your depressive symptoms disappear. A session of TMS stimulates your prefrontal cortex repeatedly for 20 minutes to an hour. This is repeated five days a week for four to six weeks. Patients typically notice an improvement after a few weeks as the target region becomes more active. TMS improves symptoms in about 50 to 60 percent of patients who did not get adequate relief from medication or psychotherapy and about a third of people who receive TMS report complete remission of depressive symptoms. The benefits of TMS last a little over a year on average, at which point the procedure can be repeated. If TMS doesn’t work for you, ECT is still an option.
TMS is still a relatively new treatment. It has been proven safe and effective for treating depression and it is becoming more widely used for that purpose. However, many people believe this technology is still in its infancy. Many factors, including pulse rate, duration, shape of magnetic field, and others have not yet been optimized. There are also newer variations that might stimulate regions deeper in the brain, which might open up new avenues for treating depression and possibly expand the use of TMS to treat other mental health issues. There are already trials using TMS to treat pediatric depression, bipolar disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and smoking. It may also eventually be used to treat chronic pain and assist in physical rehabilitation.
At Patrick Hart Consultants, we provide a number of different services to fit the needs of each individual client. Among these, are helping you choose a treatment provider, helping you develop a treatment plan, helping you establish post-treatment support, and ensuring continuity among the different elements of treatment. Contact us today at 844-262-7970 or Info@PatrickHartConsultants.com or explore our website for more information.