What is transcranial magnetic stimulation (TMS), and how does it help depression?
TMS is a treatment for depression that works by directly stimulating the brain. TMS activates certain parts of the brain by using electrical energy passed through a coil of wires to create a powerful magnetic field. During a TMS treatment session, energy from this magnetic field is transferred into a patient's brain when the coil device is applied to a person’s head. Magnetic energy passes easily through skin and skull, activating the brain painlessly and without surgery or sedation. TMS is applied to areas of the brain associated with mood regulation. TMS effects chemical activity and function of mood regulation structures in the brain, resulting in symptom improvements in depressed patients.
What does a patient experience during transcranial magnetic stimulation?
During the treatment you are seated and reclined in a comfortable chair. You are fully awake and alert, and you can talk during the treatment. There are no new medications involved in a TMS treatment; most patients continue on the ones they were regularly taking before starting TMS therapy. The TMS doctor or staff rests the magnet coil over the appropriate area of the scalp before starting the session. You will need to remove any metal hair clips, hearing aids, earrings and glasses before the treatment. Usually patients wear earplugs or listen to music during treatment to minimize the clicking sound of the equipment. A typical treatment lasts about 40 minutes, during which time the patient feels a series of taps on their scalp.
How long does it take to get better with TMS?
The most successful TMS treatments for depression occur when patients undergo TMS treatments every weekday for four to six weeks, or a total of 20-30 treatments. Often there is no noticeable mood change during the first few weeks. In the clinical trials, a small percentage of patients required more than 30 treatments to experience relief from depressive symptoms. Others noticed significant benefits from TMS at the end of the second week of TMS treatments. At Butler Hospital, TMS sessions are scheduled in 1 hour blocks.
Will TMS disrupt other areas of brain functioning or change my personality?
One of the benefits of TMS, relative to other depression treatments, is the accuracy it achieves in working on the desired brain region, or “target.” TMS allows clinicians to target very specific parts of the brain, leaving other areas alone. TMS does not lead to memory difficulties or other impairments in thinking. It does not change a person’s personality, though when patients experience relief from symptoms of the depression, their ability to think and function typically improves.
Is TMS the same as ECT?
No, TMS is not the same as electroconvulsive therapy (ECT). ECT, commonly referred to as “shock therapy,” is a treatment for depression that uses electricity to produce seizure-like activity in the brain while a patient is “asleep” under anesthesia. ECT is considered one of the most effective treatments for severe depression, but the side effects can be substantial. TMS is similar to ECT by virtue of its direct brain stimulation method to relieve depression. However, TMS is a treatment performed in the awake/alert patient; no anesthesia or sedation is needed. Magnetic energy, rather than electricity, is applied to the scalp during TMS.
Who will be involved in my treatment?
We have a team of doctors at Butler Hospital trained in the delivery of TMS therapy. A TMS doctor will be involved in all phases of your TMS therapy:
- Meeting with you during a pre-TMS consultation evaluation to determine if you are an appropriate candidate for the treatment.
- Performing a brain mapping procedure and determining your TMS “dose” at the first treatment session.
- Monitoring your daily progress and overseeing the administration of your daily TMS therapy by a trained TMS staff member.
- Meeting with you as needed during the course of therapy to evaluate clinical issues that impact safe and effective delivery of TMS therapy.
TMS clinic staff at Butler participate in screening patients referred for TMS treatments, setting up and delivering daily treatment sessions as ordered by a TMS doctor, communicating with outpatient care providers. Your outpatient psychiatrist or the primary care doctor who may be prescribing medications for your depression will remain involved in your care during TMS and will continue to follow you after you finish TMS. If you are engaged in outpatient psychotherapy, you do not need to stop it during TMS. TMS doctors at Butler Hospital will not typically prescribe medications for you, but they will coordinate care with your outpatient prescribers.
Does TMS hurt?
During the first few treatments, the tapping sensation on your scalp may be uncomfortable. Up to 50 percent of patients who receive TMS will experience some mild to moderate soreness on their head during the first week of treatment. Over-the-counter pain medicines such as aspirin, Tylenol or Motrin can be used, before or after TMS sessions, to manage the discomfort. Over time, the scalp becomes less sensitive to the tapping sensation of the magnetic pulses and the treatment does not produce discomfort.
What are the risks or side effects of TMS?
TMS is relatively free of side effects, compared to other treatments for depression. Studies show that about one in five people will develop a mild to moderate headache or scalp soreness after they receive TMS, especially during the first week. Throughout the NeuroStar TMS Therapy studies, more than 10,000 active TMS treatments were safely performed. Fewer than 5 percent of the patients enrolled in the TMS clinical trials dropped out due to adverse events, reflecting a high degree of tolerability of TMS.
Do I need to stop taking my medications to get TMS therapy?
Not necessarily. This is decided on an individual basis. During your pre-treatment consultation evaluation, the doctor will discuss this with you, provide recommendations about use of medications during TMS therapy at Butler Hospital.
How do I find out if I am a good candidate for TMS at Butler Hospital?
Once you have reviewed the information on this website, you may have a better idea if TMS is a treatment consideration for you. You can begin the screening process by calling (401) 455-6632 and requesting a packet of information be sent to you by mail. After you receive it, you will speak with a TMS Clinic Staff who asks some preliminary questions about you and helps you to gather the information necessary to determine whether you meet criteria for insurance coverage of TMS.
Does Insurance pay for TMS treatment?
The Butler TMS Clinic has been a national leader in advocating for insurance coverage and expanding patient access to TMS therapy. Medicare and most commercial insurances cover TMS therapy for appropriately selected patients. Many patients have co-payments for TMS services, and we will provide information to help you determine what your copays might be.