August 2nd, 2023
The lifetime prevalence rate for major depression is around 17.1%.1 This means that 17.1% of the population will experience a major depressive episode at some point in their life. Depression is not an uncommon occurrence, and patients have the right to evidence-based treatment to help with the symptoms they are experiencing. Seeking treatment for depression can be an extremely hard step to make. There are many variables at play, and one may begin to feel they are out of options for treatment.
When it comes to treating depression, there are many different modalities that one can take – psychotherapy (think: talk therapy) and pharmacology (think: SSRIs, SNRIs, etc.), for example. In addition to those first-line agents, noninvasive neuromodulation procedures can be utilized in treatment-resistant depression. These include electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS). Clarity Clinic offers TMS therapy to qualifying patients.
Transcranial magnetic stimulation (TMS) is utilized throughout the world for varying psychiatric disorders and brain-related disorders. TMS is a non-invasive therapy used to improve symptoms of psychiatric disorders, which uses magnetic fields to stimulate nerve cells in the brain. TMS therapy involves using these magnetic fields to induce an electrical current at specific areas within the brain to aid in the treatment of different psychiatric conditions.
There are different types of TMS which differ based on stimulation target, pulse patterns, magnet strength, and pulse frequency.2 Regarding stimulation targets, TMS devices may administer surface cortical stimulation, theta burst stimulation, and deep stimulation.2 Surface cortical stimulation is standard practice, while deep stimulation aims to stimulate nerve cells deeper within the cortex. Theta burst stimulation involves shorter, more frequent bursts of stimulation.2
The US Food and Drug Administration approved TMS for treating treatment-resistant depression in 2008.2 With this FDA approval, TMS therapy is most utilized in patients who have major depressive disorder and have not found successful treatment with pharmacotherapy or psychotherapy. This therapy is typically reserved for patients who have failed at a minimum of one antidepressant medication. While TMS is primarily used in treatment-resistant depression, it has also been used in the following psychiatric disorders:
TMS works to treat different psychiatric diagnoses by modulating activity in cortical regions and the associated neural circuits.2 In layman's terms, TMS uses magnetic fields to pulse electrical currents into certain areas of the brain. This stimulates different neurons in the brain, which has been shown to alleviate depressive symptoms (sleep disturbance, lack of interest, feelings of guilt, lack of energy, lack of concentration, lessened/heightened appetite, increased/decreased psychomotor activity, and suicidal ideation).2 The magnetic fields utilized with TMS therapy are comparable to those used in magnetic resonance imaging (MRI). With an MRI, the magnetic fields cast a wide net as opposed to TMS, which casts a small net. TMS focuses the magnetic fields on one area of the brain. With this in mind, preparing for TMS is quite similar to preparing for an MRI. This will look like removing any metal from one’s body – jewelry, glasses, etc. In addition to this, ear protection is to be worn as the magnets used can cause ear damage without protection.
In practice, when undergoing this therapy, one will wear a device on their head that will pass alternating electrical currents in pulses through a metal coil into specific brain areas. During the procedure, one should feel no discomfort as TMS is a painless procedure. In addition to this, TMS does not require anesthesia, unlike another type of neuromodulation procedure – electroconvulsive therapy. TMS therapy can last anywhere between a couple of minutes to about half an hour, and your provider would be the best resource to find out exactly how long the session will last. TMS is rarely a one-time therapeutic exercise, with most patients having multiple sessions over weeks’ time.2
The success rate of TMS has been supported through many different research studies throughout the years. Multiple reviews based on randomized trials have repeatedly demonstrated that TMS is a safe and effective therapy for patients who are facing treatment-resistant depression.2
A meta-analysis of 11 different trials of TMS vs. placebo (treatment designed to have no therapeutic effect) with patients who displayed symptoms of treatment-resistant depression demonstrated that patients were eight times more likely to have improvement of symptoms with TMS than the placebo treatment.2 This provides ample support for the use of TMS in treatment-resistant depression. Additionally, studies have not only shown the efficacy of TMS, but they have provided support that TMS is well tolerated by patients.
Transcranial Magnetic Stimulation (TMS) is an effective, well-tolerated therapy modality for treatment-resistant depression. Patients who are experiencing depressive symptoms and are not finding full alleviation of these symptoms after trialing psychotherapy and pharmacology are prime candidates for TMS. Clarity Clinic is beyond excited to be able to offer these evidence-based practices in our clinics soon!
References:
Schatzberg AF, DeBattista C. Schatzberg’s Manual of Clinical Psychopharmacology. 9th ed. American Psychiatric Association Publishing; 2019.
Holtzheimer PE. Unipolar depression in adults: Indications, efficacy, and safety of transcranial magnetic stimulation (TMS). In: Roy-Byrne PP, ed. UpToDate.
