Is TMS a Hoax?

Repetitive Transcranial Magnetic Stimulation (rTMS) emerges as a clinically proven method for treating various mental health conditions. FDA-approved and backed by continuous research, rTMS offers practical solutions for those seeking effective interventions beyond conventional treatments. Amidst the proof also exists a plethora of online chatter denouncing TMS therapy as an effective treatment. This is in the form of headlines such as “TMS ruined my life“, negative reviews, and hyper-focusing on negative side effects. This topic has raised a debate: Is TMS a hoax? Through proven clinical trials and ongoing research, the evidence supports that TMS therapy is an effective treatment for a range of mental health conditions, not a hoax.

Overview of Transcranial Magnetic Stimulation

Transcranial Magnetic Stimulation (TMS therapy) is a noninvasive brain stimulation procedure approved by the U.S. Food and Drug Administration (FDA) that uses magnetic fields to stimulate nerve cells in the brain, particularly for the treatment of major depression [13]. Before the development of TMS therapy, electroconvulsive therapy (ECT) was the go-to treatment when traditional therapies failed. ECT is an effective treatment, however, it is more invasive, has more side effects, and requires sedation.

It is considered when standard depression treatments, such as medications and psychotherapy, have proven ineffective in depressed patients. TMS therapy has also received FDA approval for treating obsessive-compulsive disorder (OCD) and migraines and aiding smoking cessation when other treatments have failed. Ongoing research explores additional applications, including epilepsy [13].

Repetitive TMS (rTMS) is a specific form of TMS therapy used to treat depression, OCD, and smoking cessation [13]. In this treatment, repeated magnetic pulses are delivered to the brain region associated with mood control and depression [13]. Deep Transcranial Magnetic Stimulation (deep TMS) is a variation that stimulates broader areas of the brain using a different coil, FDA-approved for OCD and smoking cessation [13].

How rTMS Works:

rTMS, or repetitive transcranial magnetic stimulation, is a type of therapy that uses a wire coil placed near the scalp to produce magnetic pulses that change rapidly  [12]. These pulses create an electric field that triggers depolarization in the underlying brain area  [12].

Depolarization is a change in the electrical charge of a nerve cell or neuron, which is how they communicate with each other [12]. The electrical signals that neurons use involve a shift in the cell’s charge from negative to positive and back again  [12].

The magnetic pulses generated by the coil in rTMS therapy induce an electric field in the targeted brain region, which can cause the nerve cells in that area to undergo depolarization  [12]. This disruption is believed to have a neuromodulatory effect that can influence the activity of the targeted brain region, potentially alleviating symptoms of conditions like depression  [12].

The specific impact of rTMS therapy on the brain’s activity depends on factors like the frequency and strength of the pulses, how long they last, and the part of the brain being targeted. The treatment is tailored to each patient and is determined by their motor threshold [12].

What is rTMS used to treat?

rTMS has been approved by the U.S. Food and Drug Administration (FDA) for the treatment of severe depression or major depressive disorder (MDD) and is effective in treating people with chronic pain [12]. Additionally, it is used to treat the following conditions:

• Treatment-resistant depression
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Generalized anxiety disorder (GAD)
• Smoking Cessation

What are the side effects?

Although rTMS is generally well-tolerated, it may cause some side effects, such as pain at the stimulation site, neck pain, post-treatment headaches, or toothache.

During TMS treatments, muscle twitching and transient changes in auditory threshold (hyperacusis) due to loud clicks produced during TMS pulse may also occur. Seizures are a rare but severe complication, and rTMS is not recommended for individuals with epilepsy.

rTMS is not recommended for people with epilepsy, and people with metallic or electronic implants near the stimulation site should not undergo rTMS [12].

According to the FDA, the most common adverse reaction to the Brainsway device was a headache, reported by 37.5 percent of device recipients and 35.3 percent of those who received the sham treatment [7]. However, no severe adverse reactions related to the Brainsway device were reported, and other adverse reactions were generally mild or moderate, resolving shortly after treatment [7].

Who Shouldn’t Use It?

rTMS is contraindicated for individuals with epilepsy, pre-existing neurological diseases, adolescents, and those changing medication regimes or substance use during rTMS. Patients with metallic/electronic implants in close contact with the TMS coil should also avoid it [12].

Patients must use earplugs during treatment to reduce exposure to loud sounds the device produces [7]. Anyone with a history of seizures should discuss their history with their healthcare provider before using the device  [7].

Why do people think TMS is a hoax?

Some people may think transcranial magnetic stimulation (TMS) is a hoax due to a lack of consensus on its effectiveness and conflicting information in the media. As with anything new, there will always be differing opinions on the effectiveness of something. Brain stimulation therapies are relatively new in health care. Ongoing studies reveal its potential, however, no treatment is perfect.

The media is in the business of reporting. Still, they like to report angles that grab people’s attention, so using trusted sources to read up on medical procedures and treatment options can help weigh all the facts firsthand.

The Food and Drug Association (FDA) initially approved TMS to treat major depressive disorder (MDD) in adults who did not have success with antidepressant medications in 2008 and expanded its use to treat certain migraine headaches in 2013 [7].

In 2017, the FDA expanded its approval to treat other mental health conditions, such as obsessive-compulsive disorder (OCD) in adults, and approved in 2020 as a tool to aid in short-term smoking cessation in adults [7].

Ongoing research/studies

Several studies have demonstrated the effectiveness of rTMS in treating different forms of mental illness. Let’s take a look at the clinical trials and research for each of the conditions below.

Obsessive-Compulsive Disorder (OCD)

Repetitive transcranial magnetic stimulation (rTMS) holds promise as a potential treatment for obsessive-compulsive disorder (OCD). In a study reviewed by the FDA, 38% of patients using the Brainsway device experienced a significant reduction in their OCD severity compared to 11% in the sham device group [7].

The magnetic pulses from the rTMS coil can target specific brain regions affected by OCD. Research suggests that focusing on areas like the dorsomedial prefrontal cortex (dmPFC), pre-supplementary motor area (pre-SMA), and bilateral/right dorsolateral prefrontal cortex (dlPFC) may benefit OCD patients [2].

In another study, using low-frequency rTMS on the frontal part of the brain (DLPFC) and supplementary motor area (SMA), along with high-frequency rTMS on the DLPFC, showed greater efficacy than the simulated treatment  [10]. Notably, low-frequency rTMS on the DLPFC appeared most effective, especially in individuals under 35 [10].

While these findings align with established guidelines and suggest benefits, not all rTMS variations were equally effective. Applying it over the orbitofrontal cortex (OFC) or the anterior cingulate cortex/medial prefrontal cortex (ACC/mPFC) did not show clear advantages over the simulated treatment [10].

Studies targeting brain areas like the bilateral supplementary motor area (SMA) and orbitofrontal cortex (OFC) also show positive effects, indicating a decrease in OCD symptoms, especially in the short term [11]. However, the effectiveness of rTMS for OCD is influenced by study variations, small sample sizes, and differences in stimulation delivery [11]. Drawing broad conclusions is challenging due to limited studies and patient differences [11].

While studies have shown that rTMS holds promise as a potential treatment for OCD, researchers emphasize the need for more research to understand its effectiveness fully.

Post-traumatic stress disorder (PTSD)

Transcranial Magnetic Stimulation (TMS) shows promise in treating and preventing the worsening of post-traumatic stress disorder (PTSD) symptoms [1].

In a study with three chronic PTSD cases, TMS seemed to prevent symptom recurrence despite additional trauma [1]. Veterans undergoing standard TMS treatment reported significant reductions in PTSD symptoms and improvements in mood, anxiety, vigilance, and sleep [1]. TMS targets brain regions like the Dorsolateral Prefrontal Cortex (DLPFC), helping with emotional regulation [1]. While more research is needed, the study suggests TMS may prevent PTSD from worsening, especially in those responding well to treatment [1].

In a separate review by Edinoff et al., various studies on TMS for PTSD treatment were analyzed to assess effectiveness and safety [6]. The findings revealed that applying TMS to the right dorsolateral prefrontal cortex (rDLPFC) at different frequencies significantly reduced core PTSD symptoms.

Ten sessions of 1 Hz TMS to the rDLPFC resulted in statistically and clinically significant improvements, although the effectiveness decreased over a two-month follow-up. High-frequency TMS of the right DLPFC showed long-lasting decreases in PTSD symptoms at the three-month follow-up [6]. This research suggests that TMS could be a potential treatment for PTSD, but more research is needed to determine the optimal parameters and treatment regimens [6].

Treatment-Resistant Depression (TRD)

Treatment-resistant depression (TRD) is a form of major depressive disorder (MDD) where symptoms persist despite trying at least two different antidepressants. rTMS (Repetitive Transcranial Magnetic Stimulation) has proven effective in treating depression that has not responded well to previous treatments.

A study with 291 participants [9] showed improvements during treatment. Those with a shorter depressive episode, higher agitation, and more prior rTMS sessions responded better. Over half the participants showed improvement at some point [9].

Another study found that rTMS were safe and effective in treating MDD, significantly improving symptom clusters up to 6 and 12 weeks of treatment [19]. In a study involving 854 patients, rTMS was more effective than sham rTMS for TRD [17]—patients who had two other treatments before rTMS were more likely to respond, experience reduced depression symptoms, and go into remission. No significant issues with methodology were reported. A meta-analysis revealed that 36% of TRD patients achieved remission with rTMS, compared to 8% in the placebo group [17].

A separate review and meta-analysis of preclinical studies suggested rTMS as a therapeutic option for MDD, with response rates between 30% and 64% [5].

General Anxiety Disorder

rTMS is also being explored as a treatment for Generalized Anxiety Disorder (GAD). GAD affects a significant portion of the population, and standard treatments like medications and therapy may not work for everyone.

In a recent study [14], researchers reviewed six studies involving 152 GAD patients to assess rTMS effectiveness. Results indicated a significant reduction in anxiety levels [14]. Despite variations in study size and design, the overall evidence suggests rTMS as a promising option for managing GAD-related anxiety [14].

Another study [15] conducted a systematic review of Transcranial Magnetic Stimulation (TMS) and its repetitive form (rTMS) across various neurological and psychiatric disorders. Results showed clinically meaningful improvements in anxious and depressive symptoms, with well-tolerated interventions and minimal adverse effects [15]. Targeting the dorsolateral prefrontal cortex (DLPFC) with frequencies ranging from 1 to 20 Hz and sessions lasting 10 to 20, the data supports TMS and rTMS as effective and safe strategies for managing anxiety symptoms [15].

In a study focusing on Generalized Anxiety Disorder (GAD) and Post-traumatic Stress Disorder (PTSD) [4], TMS applied to the right DLPFC at 20 Hz demonstrated significant improvement in GAD symptoms. For PTSD, high-frequency rTMS (10 and 20 Hz) over the right DLPFC showed substantial benefits compared to left DLPFC stimulation. Despite study limitations, the findings encourage further research with larger, well-designed trials to establish TMS efficacy in anxiety-related disorders conclusively [4].

Smoking Cessation

rTMS is emerging as a potential method to aid smoking cessation, with the FDA approving the H4 coil for short-term treatment [8].

In a review of 26 studies, researchers evaluated the effectiveness of rTMS, including the H4 and Figure-8 coils, in reducing smoking cravings. The results indicated that rTMS on the left side significantly reduced cravings, and specific methods on both sides led to a decrease in substance consumption [8]. Notably, the H4 coil shows promise for long-term smoking cessation, reporting a 33% success rate six months post-treatment [8].

In a 2021 study exploring rTMS for smoking cessation [18]. Involving 262 chronic smokers, active rTMS significantly increased the quit rate, reduced cigarette consumption, and gained FDA clearance as an aid for smoking cessation in adults [18]. This emphasizes the significance of rTMS in addiction medicine and its potential for addressing substance use disorders [18].

A study by Chang et al. suggests that ten days of high-frequency rTMS on specific brain regions may effectively help people quit smoking. Ninety percent of participants remained smoke-free for 25 days post-treatment, showing promise. However, the study’s limitations, such as a small sample size and lack of a control group, necessitate further research for confirmation [3].

In a 2022 study investigating the effectiveness of repetitive transcranial magnetic stimulation (rTMS) for smoking cessation [16], researchers focused on adults motivated to quit smoking, exploring variations in rTMS duration (8, 12, or 16 days) and intensity (900 or 1,800 pulses per day) [16].

Results revealed promising outcomes with longer durations and higher intensities, including increased latency to relapse, improved odds of abstinence, and reduced impulsivity measured by delay discounting rates [16]. Notably, the study found that the perceived research burden did not significantly increase, suggesting that participants did not find the intervention excessively demanding [16]. These preliminary findings suggest that rTMS, particularly with extended durations and higher intensities, may offer valuable support for individuals motivated to quit smoking [16].

TMS is an Effective Treatment

Repetitive Transcranial Magnetic Stimulation (rTMS) is a clinically proven method for addressing conditions like depression, OCD, PTSD, and anxiety disorders and aiding smoking cessation. Its effectiveness and FDA approval for specific applications make it a viable treatment option. While generally well-tolerated, ongoing research reinforces its potential, emphasizing the need for continued investigation.

Ready to experience the proven impact of Repetitive Transcranial Magnetic Stimulation (rTMS)? Neuro Wellness Spa, with over 100,000 conducted sessions and a remarkable 74% response rate, invites you to explore effective and practical solutions for mental health. If you or a loved one is struggling with a mental health condition, contact us to learn more about TMS therapy and our in-person or online psychiatrists. Take the next step towards well-being and discover the transformative effects of rTMS at Neuro Wellness Spa.

References

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