Everything You Should Know About TMS Therapy for Depression

September 5th, 2023

Since being approved as a therapeutic modality of treatment-resistant depression by the US Food and Drug Administration in 20081, TMS therapy has become an increasingly utilized evidence-based treatment for those facing treatment-resistant depression and other psychiatric disorders. Clarity Clinic is thrilled to offer patients transcranial magnetic stimulation (TMS) treatment in the fall of 2023. In this article, TMS, specifically for major depression will be explored.

What is Major Depression Disorder?

Major Depression Disorder (MDD), or unipolar depression, is a mood disorder that causes persistent feelings of sadness, hopelessness, and loss of interest. MDD presents, as stated by the DSM-5, as experiencing five or more of the following symptoms over a minimum of 2 weeks, with at least one of the symptoms being depressed mood and/or loss of interest/pleasure2:

Depressed mood most of the day, nearly every day.

Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.

Significant weight loss when not dieting, weight gain, or an increase/decrease in appetite nearly every day.

Insomnia or hyposomnia nearly every day.

Psychomotor agitation or slowing down of thought and reduction of physical movement, which is observable by others.

Fatigue or loss of energy nearly every day.

Feelings of worthlessness or excessive or inappropriate guilt nearly every day.

Diminished ability to think or concentrate, or indecisiveness, nearly every day.

Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

The World Health Organization (WHO) estimated that MDD was the 11th most common cause of disability and mortality worldwide among 291 diseases and causes of injuries.3 First-line treatment for MDD consists of Serotonin Selective Reuptake Inhibitors (SSRIs) such as escitalopram, sertraline, and fluoxetine. While patients may see a response to these medications (≥50% improvement), they may not meet the qualifications of remission – or resolution of symptomology.3 Finding oneself in a position of not finding relief of symptoms of depression with medication can be an isolating feeling. At Clarity Clinic, we are thrilled to be able to offer Transcranial Magnetic Stimulation (TMS) to qualifying patients.

What is Transcranial Magnetic Stimulation (TMS)?

Transcranial magnetic stimulation (TMS) is a non-invasive therapy that uses magnetic fields to induce an electrical current at specific areas within the brain. This therapy is used throughout the world for a plethora of different psychiatric disorders and brain-related disorders. TMS has been used in therapy for major depressive disorders, obsessive-compulsive disorder, generalized anxiety disorder, bipolar disorder, post-traumatic stress disorder, schizophrenia, and tinnitus.1

A common analogy for TMS is going to the gym for your brain. When you go to the gym and work out similar muscles, you start to be able to lift more and use the muscles differently. As you continue TMS therapy for depression, you are training your brain and strengthening neuropathways that influence thoughts, emotions, and behaviors and, in effect, alleviate symptomology of depression (fatigue, sadness, hopelessness, etc.)1

Transcranial Magnetic Stimulation (TMS) for Depression

Treatment-resistant depression is typically defined as major depression, which does not find remission after 2+ antidepression medication trials and adequate psychotherapy (talk therapy, CBT, etc.). TMS is an evidence-based treatment for treatment-resistant depression. Multiple meta-analyses of randomized trials looking at treatment of treatment-resistant depression with TMS vs. placebo have demonstrated that TMS is a superior option.1 A meta-analysis done by Brunoni et. al. demonstrated patients were three times more likely than placebo to find a response to TMS therapy (odds ratio 3.3, 95% CI 2.3-4.6).1

Patients who have trialed multiple pharmacological and psychotherapeutic treatment options for major depression and are not seeing full remission of their depressive symptoms are prime candidates for TMS. TMS therapy for major depression treatment involves the placement of a device on the patient’s head that will transmit the electrical currents in pulses through a metal coil into specific areas of the brain. TMS treatment involves daily treatments for 6-9 weeks. TMS's most common side effects are mild and transient – headaches and scalp irritation.1

Summary

Transcranial magnetic stimulation (TMS) has been shown to be an effective and well-tolerated therapy for treatment-resistant depression. Candidates for TMS are patients who are experiencing depressive symptoms and are not finding full alleviation of their symptoms after trials of psychotherapy and pharmacology. Clarity Clinic is thrilled to be able to offer this evidence-based practice at our Loop and Arlington Height locations!

Written by: Summer Slininger, PA-C

Clarity Clinic

At Clarity Clinic, we have highly trained staff who specialize in therapy and psychiatry services. To learn more about how we can support your mental health, call Clarity Clinic at (312) 815-9660 or schedule an appointment today.

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References:

Holtzheimer PE. Unipolar depression in adults: Indications, efficacy, and safety of transcranial magnetic stimulation (TMS). In: Roy-Byrne PP, ed. UpToDate.

Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed., American Psychiatric Association, 2013.

Lyness, J. Unipolar depression in adults: Assessment and diagnosis. UpToDate.