Transcranial Magnetic Stimulation (TMS) uses a magnetic field to stimulate targeted areas of the brain. This is achieved by placing an electromagnetic coil against the scalp, typically near the left front of the head. The stimulation of the brain’s nerve cells promotes increases in cellular activity and neuroplasticity – which is the brain’s ability to make connections and adapt. This elevation in brain activity has proven highly effective, and is thus widely used to treat a number of neurological and cognitive issues.

TMS treatment is very well tolerated and has very few side effects. The procedure is a non-invasive, outpatient treatment and does not require protective covering.

Background

It has been approved by the FDA for treatment of resistant depression since October 2008 (situations where multiple medication and therapeutic failures to effectively manage depressive symptoms) and treatment of OCD since August 2018.

There is evidence that TMS can be effective for conditions other than major depression but for which is not FDA (food and drug administration) approved or covered by insurances. These conditions include bipolar disorder, tinnitus, migraine, and others. 

The interest in magnetic fields started in the mid 1980’s for evidence began showing they possessed potential therapeutic value. The first controlled trials in North America started in 1999 and since then many subsequent trials and clinical experiences have further elucidated the therapeutic value of using Transcranial Magnetic Stimulation as a tool in the treatment of depression. In December 2010 the American Psychiatric Association guidelines in the treatment of depression were modified to include TMS as an appropriate treatment to consider after failing at least one adequate trial of antidepressants, (although some insurance companies require at least 4 failed medication/therapeutic trials).

The FDA recommended treatment for depression is 30-36 sessions (more or less) usually performed 5 days a week for typically 6-8 weeks. We may be able to do a rapid protocol based on need, schedule, etc to bring the time to remission to within a couple weeks.

What to Expect

It feels like someone is lightly tapping on your head with their finger. If the treatment is not considerately delivered it can feel more like a rubberband snapping exposed skin. Rest assured, we deliver treatment in such a way that it is painless while retaining efficacy. The intensity of the tapping depends on the machine level and will always be adjusted to ensure your comfort. 

There are no noticeable changes in thought or emotion during a treatment. You can perform your normal daily activities prior and subsequent to the treatment with no restriction of eating, drinking or driving. If you are on regular medications make sure you keep the same schedule whether they are psychiatric or non-psychiatric medications. If you take medications as needed for anxiety or pain make sure you mention it to the doctor prior to treatment; there are typically no restrictions.

No major changes in awareness, thoughts, or mood occur immediately after treatment. Often, after a treatment (even after the first), people report feeling brighter, more engaged. Others may report difficulty sleeping or improved sleeping.

Because your head muscles have been lightly stimulated, you may experience a very mild and dull, and very treatable headache (usually a tylenol or ibuprofen is enough to subdue the discomfort). This headache is likely only an issue during the first 2-3 treatment sessions, until you adapt.

Benefits can take a while to hold. Results are often felt after treatment is finished. Neurons take a while to fully respond to an intervention. In fact, some people report feeling temporarily worse, before they feel improvement. Some report ongoing benefit starting early and maintaining throughout treatment.

“Things are brighter”, “I feel more present”, “Thinking isn’t as effortful”, and “I can sustain good moods and thinking better” are things we’ve heard.

Do I still need to take medication?

The treatment often augments current medication regimens. It can fully or partially replace some. It can allow some medications to be used in different ways. This issue is a case by case basis and should be discussed with your medication provider.

Where do we go from here?

If you feel you would benefit from TMS please fill out our suitability survey to evaluate if treatment is right for you. From there we can explain the procedure, answer any questions you have, and assess appropriateness.

The TMS treatment at Able Psychiatry has protocol flexibility since it’s being followed by a literature-competent, TMS experienced psychiatrist. It is likely, in the future, there will be more varying protocols for certain disorders. Since we’re a smaller office, we allow for greater transportation and appointment flexibility.