TMS for Depression: Treating Depressive Disorders With Transcranial Magnetic Stimulation

Transcranial magnetic stimulation (TMS) has been around since the 1980s and was originally used as a technique to map the brain and determine which parts of the brain are responsible for particular functions. With further research, it was discovered that TMS could not only map areas of the brain, but alter its activity. This was proven to be particularly effective for those struggling with depression, and in 2008, the FDA approved TMS as a treatment option for this disorder.

Since then, TMS therapy for depression has helped many achieve enhanced mood and emotional resilience. However, for those unfamiliar with this procedure, TMS can raise questions and be an intimidating process to start. But by learning how TMS works and understanding the promising results that indicate its efficacy in managing symptoms of depression, you can start your new chapter of mental health care with confidence.  

What Is TMS Therapy?

TMS therapy is a non-invasive medical procedure that uses magnetic fields to stimulate specific areas of the brain. This FDA-approved depression treatment involves a series of outpatient sessions where an electromagnetic coil is placed against the scalp to deliver precisely targeted pulses. TMS therapy represents an alternative treatment for depression and various other neurological and psychiatric conditions when conventional approaches haven’t provided adequate relief.

Related: How Long Does TMS Last?

What Is Depression? Understanding the Spectrum of Depression

Depression is defined as a mood disorder that’s characterized by symptoms of persistent sadness, loneliness, or loss of interest in activities that once brought joy. Symptoms of depression are long-lasting, interfere with daily functioning, and exist on a spectrum of mild to severe. Depression symptoms affect brain activity in key brain regions, particularly the dorsolateral prefrontal cortex, which is where TMS therapy targets its magnetic pulses to reactivate underperforming neural networks.

Common types of depression

There are various types of depression that TMS therapy can help treat, including:

• Major depressive disorder (MDD): This is the most common type of depression, characterized by physical symptoms of appetite and sleep pattern fluctuations, fatigue, and difficulty concentrating. MDD was the original condition that TMS was FDA-approved for.
• Persistent depressive disorder (high functioning depression or dysthymia): Dysthymia comes with similar symptoms to those of major depression, though less severe and experienced for a longer period of time. You must exhibit two or more symptoms outlined in the DSM-5-TR to meet the clinical threshold of dysthymia.
• Seasonal affective disorder (SAD): A form of depression that’s experienced seasonally and for at least two consecutive years.
• Bipolar depression: This is characterized by depression symptoms that emerge during mood swings experienced by those with bipolar disorder.

Understanding the specific type of depression you have helps medical professionals determine which precise areas of the brain to target during TMS treatment for optimal outcomes.

What is treatment-resistant depression?

A mental health professional will diagnose you with treatment-resistant depression (TRD) when at least two first-line interventions, such as psychiatric medication and therapy, provide little to no relief. TMS offers promising results to help treat those with TRD, as it improves depressive symptoms through an entirely different mechanism than medication. However, this does not undermine the importance of integrating multiple care approaches along with TMS therapy for treating TRD.

Related: Depression in the Elderly

How TMS Therapy Can Treat Depression

To recap, TMS therapy is a non-invasive, medication-free, safe, and effective procedure that uses gentle magnetic pulses and brain stimulation to “wake up” certain areas of the brain responsible for mood control. In other words, it stimulates nerve cells that are understood to be underactive in those struggling with depression to strengthen activity. TMS comes with minimal side effects and provides hope to those who have found inadequate relief from first-line interventions, such as therapy and antidepressants.

What is TMS for depression like?

During TMS treatment sessions, you’ll relax in a private room and recline in a chair. A TMS technician will start by positioning a cap over your head, which will deliver gentle magnetic pulses. This process can be noisy, but each session will only last about 20 minutes, during which you can read, listen to music, watch TV, or even meditate. 

Since TMS does not require sedation or medication unlike electroconvulsive therapy (ECT), which is another form of deep brain stimulation therapy. Therefore, patients are safe to drive themselves to and from treatments and return to their daily routines immediately after treatment. Additionally, most insurance companies fully cover TMS for TRD.

Can TMS make depression worse? Understanding the TMS dip

While research shows that TMS can have profound long-lasting benefits on mental well-being — especially when compared to the benefits of talk therapy or medication used independently — approximately 20% of patients experience a “TMS dip” ¹. A TMS dip is a temporary worsening of symptoms typically occurring around the second or third week of treatment as the brain adjusts to changes. 

This may cause hesitancy in those considering TMS therapy, but this dip is typically followed by overall symptom improvement. It’s important to consult a TMS provider to assess risk factors, suitability, and understand the pros and cons of TMS therapy.

Related: Why Mental Health Treatment Matters More Than Ever

How Effective Is TMS Therapy for Depression?

Multiple studies have been conducted since the mid-2000s establishing TMS therapy as an effective treatment option for depression. In one early study, a series of double-blinded, randomized, placebo-controlled trials established the efficacy of TMS for depression and led to its FDA approval. The first of these studies — the Neuronetics Clinical Trial in 2007 — found that patients randomly assigned to a TMS treatment group demonstrated a clinically meaningful improvement when compared to subjects in the placebo group ².

An even larger study published by the National Institute of Mental Health (NIMH) found that those who completed a TMS therapy treatment course were four times more likely to see symptom remissions than those in the placebo-control group ². Study after study has highlighted the profound impact that TMS therapy can have on treating depression, especially when participants undergo repetitive transcranial magnetic stimulation (rTMS) maintenance sessions.

At Neuro Wellness Spa, we are proud to have administered over 153,000 TMS sessions and counting, with 73% of patients responding positively. 

Efficacy of TMS therapy for TRD

As research grows, so too does our understanding of how TMS can effectively provide relief for TRD. A long-term study of unmedicated patients with TRD found that a significant percentage maintained benefits from TMS treatment, especially when they undergo TMS maintenance sessions ³. However, it’s important to note that TMS should not be viewed as a replacement for antidepressants — many clinicians find that medication and TMS therapy used in tandem may offer enhanced benefits for patients with TRD.

Related: TMS Ruined My Life (And Other Scary Headlines)

Comparing TMS Therapy to Traditional Depression Treatments

Since the early 1950’s, depression has typically been treated with a combination of counseling and prescription drugs. In the past decade, the prevalence of depression and other forms of mental illness has increased drastically, and with it, the options for depression treatments have expanded as well ⁴. TMS is among the newest approaches and is drug-free, twice as effective as traditional treatments, and can be used alone or in conjunction with medications and talk therapy. Understanding the benefits and limitations of each treatment, and how they compare to TMS therapy, can help you start treatment with the care that gives you the best chance at success.

TMS therapy and antidepressants 

Research suggests that as many as one in 10 Americans take some form of antidepressant. This trend is not without controversy though, as several recent studies have questioned the efficacy and long-term feasibility of medications for depression ⁵. Antidepressants come with potential side effects that can either persist until you cease taking them or subside after a few weeks. Additionally, research shows that approximately 50% of people who took antidepressants noticed symptom improvement after six to eight weeks, compared to 30% who took a placebo — suggesting a 20 percentage point treatment effect ⁶.

In comparison, research indicates that those who have struggled to find success with medications report a 50% to 60% clinically meaningful response after completing TMS ⁷. While TMS comes with minimal and manageable side effects, it does require regular outpatient visits unlike medication. However, it’s important to note that medications and TMS therapy can be complementary rather than competitive treatments, and you may benefit from an integrated approach using both options.

TMS therapy and psychotherapy for depression

Psychotherapy or talk therapy is a valuable approach for treating depression, offering a confidential and judgment-free space to discuss feelings and emotions, learn coping skills, and reframe negative thought patterns. While depression therapy has minimal side effects, some patients may temporarily feel overwhelmed or experience a brief worsening of symptoms. Its effectiveness depends on several factors, including therapist compatibility, the type of therapy utilized, and your commitment to implementing learned techniques in daily life.

Even if you haven’t found success with talk therapy alone, it serves as an important supplement to TMS therapy by providing a structured way to monitor treatment progress and symptom improvement. Additionally, research shows that when patients with TRD use psychotherapy as an adjunct treatment to TMS, 66% report a positive response and 56% achieve remission, demonstrating the enhanced effectiveness of this integrated approach ⁸. Make sure to talk to your psychiatrist about prescribing antidepressants to know if its right for you.

Integrating TMS therapy into comprehensive depression treatment plans

Addressing depression treatment from multiple angles can give you the best chance at success. In addition to TMS, antidepressants, talk therapy, and holistic approaches like proper diet and exercise can support mood as well. Think of depression treatment as a team effort — individual players may be effective on their own, but when strategizing toward a common goal, they can be greater than the sum of their parts.

Related: A Mother’s Story About TMS Therapy for Teen Depression

Is TMS Therapy for Depression Right for Me?

For years, the initial response to treat depressive disorders have been medication management and talk therapy. These conventional treatment methods may work for some, however, they don’t work for everyone. If you’re taking medications and have experienced inadequate results or adverse side effects, TMS may be an ideal treatment option. TMS targets depression at the source, as opposed to medications that can affect the whole body. 

TMS therapy could be your next step if:

• You’re experiencing symptoms of depression, comorbid anxiety and depression, obsessive-compulsive disorder (OCD), migraines, or are trying to quit smoking. These are all FDA-approved conditions to be treated with TMS.
• You’ve tried traditional antidepressants and they’re not working, or you’ve experienced unwanted side effects.
• You’ve felt consumed by your symptoms or feel disconnected from “who you are.”
• Your symptoms are interfering with your daily life or affecting your relationships with friends and family.

Beyond depression: TMS therapy for other mood disorders

TMS therapy can be an off-label treatment for a multitude of other mental health conditions, in addition to the conditions its FDA-approved for. Other conditions that TMS may help you find relief from include:

• Anxiety disorders.
• Post-traumatic stress disorder (PTSD).
• Bipolar disorder.
• Addiction treatment beyond smoking cessation. 
• Memory loss.
• Attention-deficit/hyperactivity disorder (ADHD).
• Parkinson’s disease.
• Chronic pain conditions.

While TMS is considered an off-label treatment for these conditions, more research is being done that may lead to the FDA’s approval for additional applications. Navigating a depression diagnosis can be draining and overwhelming, but when you understand all your options, you can reignite hope. Don’t hesitate — begin your TMS journey so you can find the relief you deserve. 

How Neuro Wellness Spa Can Treat Depression With TMS

If you or a loved one is struggling with depression, reach out to Neuro Wellness Spa today. Our care team consisting of therapists, psychiatrists, nurse practitioners, and other healthcare professionals will collaborate to help you achieve your mental health goals and find the best depression treatment for you. After an initial assessment, a mental health professional may decide you can benefit from psychiatric medication management, talk therapy, TMS therapy, or a combination of the three. 

Schedule a consultation today to learn more about all of our treatment options for depression. We welcome the opportunity to support your mental health journey and help you find relief from depression.

References

1. Daskalakis, Z.J., Christensen, B.K., Fitzgerald, P.B., Chen, R. (2002). Transcranial magnetic stimulation: a new investigational and treatment tool in psychiatry. Journal of Neuropsychiatry and Clinical Neurosciences, 14(4), 406-415.

2. George, M. S., Taylor, J. J., & Short, E. B. (2012). The expanding evidence base for rTMS treatment of depression. Current Opinion in Psychiatry, 26(1), 13–18. https://doi.org/10.1097/yco.0b013e32835ab46d

3. Mantovani, A., Pavlicova, M., Avery, D., Nahas, Z., McDonald, W. M., Wajdik, C. D., Holtzheimer, P. E., George, M. S., Sackeim, H. A., & Lisanby, S. H. (2012). LONG-TERM EFFICACY OF REPEATED DAILY PREFRONTAL TRANSCRANIAL MAGNETIC STIMULATION (TMS) IN TREATMNT-RESISTANT DEPRESSION. Depression and Anxiety, 29(10), 883–890. https://pmc.ncbi.nlm.nih.gov/articles/PMC4413472/

4. Major Depression. (n.d.). National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/statistics/major-depression

5. Petersen, A. (2019). New concerns emerge about Long-Term antidepressant use [Journal-article]. https://adaa.org/sites/default/files/New%20Concerns%20Emerge%20About%20Long-Term%20Antidepressant%20Use.pdf

6. Institute for Quality and Efficiency in Health Care (IQWiG). (2024, April 15). Depression: Learn More – How effective are antidepressants? InformedHealth.org – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK361016/

7. Stern, A. P., MD. (2020, October 27). Transcranial magnetic stimulation (TMS): Hope for stubborn depression. Harvard Health. https://www.health.harvard.edu/blog/transcranial-magnetic-stimulation-for-depression-2018022313335

8. Somani, A., & Kar, S. K. (2019). Efficacy of repetitive transcranial magnetic stimulation in treatment-resistant depression: the evidence thus far. General Psychiatry, 32(4), e100074. https://doi.org/10.1136/gpsych-2019-100074