Most people with anxiety and depression feel better with prescribed treatment, but unfortunately, about 30% still can’t seem to shake off the mood swings, sadness and hopelessness. This is especially true if you respond poorly — or don’t respond at all — to antidepressants.
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For those with treatment-resistant depression, a noninvasive treatment called transcranial magnetic stimulation (TMS), offers hope.
“This option can bring relief when other treatments for depression fail,” says psychiatrist Murat Altinay, MD.
How TMS works
FDA-approved since 2008, TMS uses a magnetic field — similar to that used in magnetic resonance imaging (MRI) — to stimulate your brain’s dorsolateral prefrontal cortex, which plays a key role in mood.
“Increasing the activity of neurons in this area lessens depression,” Dr. Altinay explains. Having your brain stimulated by a magnetic field may sound a bit scary, but
the experience isn’t painful or harmful.
“The typical TMS session lasts about 30 to 40 minutes,” he says. “During the session, patients are fully awake and sitting in a comfortable chair.”
Here’s what goes down during a TMS session:
- The doctor places the TMS coil on the top left side of your head.
- The coil delivers stimulation for about 4 seconds, stops for about 15 seconds, then starts again.
- This cycle repeats about 75 times per session.
- During stimulation, you hear a tapping sound and feel a tapping on your scalp. “Those who are a little more sensitive may experience some scalp discomfort,” Dr. Altinay says.
Throughout treatment, you are fully aware of what’s going on. You can speak, read or even nap. “After treatment, you can resume your daily activities immediately without restrictions”, he adds.
One drawback of TMS is that it’s time-consuming, at least in the beginning. During the first phase, you’ll likely receive treatment every weekday for six weeks (about 30 times).
During the second (maintenance) phase, the doctor tailors the frequency to meet your needs. You may get treatments every other week, monthly or every two months. The frequency gradually decreases over time.
TMS is proven to be effective and safe
Research shows that regular maintenance with TMS helps prevent recurrence and reduces the symptoms of depression rears its ugly head in the future.
TMS has relatively few side effects. “The most frequent side effect is headache, but not everybody experiences that,” says Dr. Altinay. If you do get headaches, taking Advil® or Tylenol® before treatments can help.
If you have a seizure disorder, discuss options with your doctor before undergoing TMS. “Having a seizure disorder would prevent a patient from being the best candidate for TMS, but some literature suggests that if a seizure disorder is well-controlled with anti-epileptic drugs, TMS might still be an option,” adds Dr. Altinay.
Who can benefit from TMS
TMS is available to adults 18 and older and “TMS mainly targets those who don’t respond adequately to at least one round of antidepressants or who are completely medication-resistant,” says Dr. Altinay. TMS also can be offered if antidepressants cause severe reactions or side effects, or worsen other health issues. However, TMS is not recommended for anyone with a:
- Poorly controlled seizure disorder.
- Metallic implant close to the head.
- Brain tumor or brain disease.
- Substance abuse disorder.
How TMS differs from ECT
You may have heard of another treatment for medication-resistant depression called ‘electroconvulsive therapy (ECT)’, inaccurately referred to as ‘shock therapy.’
While TMS and ECT share similarities, TMS offers several advantages:
- Both techniques rely on stimulation, but ECT uses electrical energy to stimulate the entire brain. “You can’t control which area you stimulate with ECT,” says Dr. Altinay. The global brain stimulation, coupled with the need for anesthesia, often causes short-term memory loss.
- TMS uses a magnetic field instead of electrical energy and stimulates only the part of the brain involved in depression. This results in fewer side effects. “In fact, TMS has actually been shown to enhance memory,” he adds.
Only a limited number of healthcare providers offer TMS as a depression treatment option, so it may take some research to find a solution near you. “It’s also important to note that not all health insurance companies will pay for TMS,” Dr. Altinay says.
However, this option does offer hope for those who’ve struggled to find relief from depression through traditional avenues.