Transcranial magnetic stimulation (TMS) is a fascinating therapeutic technique that has shown promise in various medical and psychiatric applications. It’s a non-invasive, non-medication, outpatient procedure that uses the power of magnetic fields to stimulate the neural pathways in your brain.
Although antidepressant medications like SSRIs are the most common treatment for mental health conditions like depression, medications don’t work for everybody. Thankfully, there are new alternative treatments such as TMS therapy that are, in many cases, more effective and safer than medication. Through TMS treatment, patients can expect results that they may not have otherwise gained through traditional pharmaceutical treatment.
A History of TMS Therapy
The development and evolution of transcranial magnetic stimulation can be traced back to pioneering research and technological advancements in the field of neuroscience. Although scientists have been investigating the effects of electromagnetic fields on the human body since the 18th century, the concept of using magnetic fields to directly stimulate the brain was first tested in the 1980s. It was the first time a team had conducted non-invasive stimulation of the human motor cortex using a magnetic coil. This groundbreaking work laid the foundation for what would later be known as TMS therapy.
Throughout the 1990s, researchers worked on refining the technology and techniques for delivering magnetic stimulation to the brain. The introduction of repetitive TMS (rTMS), which involved delivering multiple pulses of magnetic stimulation in rapid succession, opened up new possibilities for therapeutic applications. This technique allowed for sustained and more targeted effects on neuronal activity.
In the early 2000s, clinical trials began to explore utilizing TMS therapy in the treatment of various neurological and psychiatric disorders. Major depressive disorder was one of the first conditions investigated, with promising results showing that TMS had significant improvement in depressive symptoms (treatment-resistant depression). Subsequent studies expanded the applications of TMS to include conditions such as obsessive-compulsive disorder and smoking cessation. Today, many more clinical trials are being conducted to test the efficacy of brain stimulation therapies in the treatment of autism, ADHD, post-traumatic stress disorder, schizophrenia, Alzheimer’s, and more.
In 2008, the United States Food and Drug Administration (FDA) granted clearance for the use of TMS therapy in the treatment of major depressive disorder in patients who did not respond to traditional antidepressant medications. This marked a significant milestone, solidifying TMS as a recognized and approved treatment option. In 2009, Dr. Martha Koo was one of the first psychiatrists to acquire a transcranial magnetic stimulation device and incorporate TMS therapy into her treatment plans.
How Does a TMS Device Work?
A transcranial magnetic stimulation device, also known as a TMS chair, is the tool used to deliver the noninvasive brain stimulation via small magnetic pulses. These pulses stimulate nerve cells in the dorsolateral prefrontal cortex and other parts of the brain involved in mood regulation and emotion.
The TMS therapy system is comprised of a few key components, the most important being the magnetic coil, the pulse generator, and the positioning system.
Magnetic Coil
The core element of a TMS device is the electromagnetic coil. It is typically composed of copper wire wrapped to form a figure-eight or circular configuration, depending on the desired stimulation pattern. When electrical currents pass through the coil, they generate a magnetic field. The magnetic coils used in repetitive transcranial magnetic stimulation are similar to those used in magnetic resonance imaging (MRI) machines.
Pulse Generator
The pulse generator, also known as the stimulator, is the electronic component responsible for generating the electrical current that powers the coil. It delivers controlled pulses of electric current to the coil, which, in turn, generates the corresponding magnetic pulses. The pulse generator allows for the adjustment of various parameters such as intensity, frequency, and duration of the magnetic pulses.
Positioning System
To accurately target specific regions of the brain, TMS devices use a positioning system to ensure the treatment coil is delivering magnetic energy to the desired area of the brain. This system allows for precise placement and adjustment of the coil so that TMS technicians can position the prefrontal cortex area of the brain directly beneath the coil. Neuronavigation systems and brain imaging techniques may also be used to aid in accurate coil placement.
How Does TMS Treat Depression Symptoms?
The mechanisms through which TMS exerts its therapeutic effects are still being investigated. We know that magnetic fields can modulate the activity of specific brain regions implicated in mental health conditions like major depression. By stimulating or inhibiting these regions, researchers believe that TMS leverages the brain’s neuroplasticity to restore the balance of neural activity and alleviates symptoms. The rapidly changing magnetic field generated by the TMS coil generates very small electrical currents in the neurons, which can influence the connectivity and plasticity of neural networks. These electrical currents activate cells, promote the growth of new neurons, strengthen existing connections, and enhance communication between different brain areas.
What is TMS Therapy Like?
Before starting TMS treatment, traditionally a patient will undergo both a physical and psychiatric exam. Because of its use as an alternative treatment, it is also a typical pre-requisite that the patient has at least attempted the use of depression medication before being approved for transcranial magnetic stimulation.
Because of its outpatient procedure modality, TMS treatment typically takes place in a regular doctor’s office, not a hospital. For patients who are suffering from depression specifically, there are FDA indications for the number of appointments they will have. Typically, a total of 36 appointments that are daily, five days per week for 4 to 6 weeks is recommended. This is typically followed by six taper sessions that are done at the end. Each session can last between 18 and 24 minutes.
During TMS treatment sessions, the electromagnetic coil will be placed against the patient’s skin, close to the forehead. This coil then sends out magnetic pulses that stimulate nerve cells in the prefrontal cortex. The magnetic pulses are issued for four seconds at a time, then halted for 26 seconds. Patients report that the pulses feel like tapping against the scalp. Though patients may experience minor discomfort or light headaches, there are typically no side effects, and the treatment process is extremely well tolerated.
TMS vs. ECT (Shock Therapy)
TMS therapy is not the same as electroconvulsive therapy, or shock therapy, which works by inducing seizures. Shock therapy is a very invasive procedure, and can be very dangerous and uncomfortable for the patient. While ECT has been proven to be effective for certain psychiatric disorders, it is generally reserved for severe cases.
Is TMS Therapy Right For Me?
TMS therapy has shown promise in treating various neurological and psychiatric conditions, offering a non-invasive and well-tolerated option for those who have not responded to medication alone.
If you are considering TMS therapy, seek guidance from the psychiatrists Neuro Wellness Spa. Neuro Wellness Spa specializes in innovative treatments, and we won’t give up until you find total symptom relief. Take the first step towards exploring TMS therapy as a treatment option for depression, OCD, and more by reaching out to Neuro Wellness Spa to schedule a consultation.