TMS (or Transcranial Magnetic Stimulation) is a painless and effective treatment for depression and has been used to treat thousands of patients worldwide for over thirty years. It has also been used to treat conditions such as obsessive compulsive disorder (OCD), addiction, chronic pain and post-traumatic stress disorder (PTSD).

TMS is a procedure that uses highly concentrated electromagnetic pulses to specific regions of the brain that regulate mood. In more technical terms, during an rTMS session an electrical current passes through a small coil placed close to the scalp. This current induces a magnetic field. The magnetic field can travel through the skull and pass into the brain.

The first appointment is called the TMS “induction” which includes brain mapping, motor threshold determination, and initial treatment session. At this appointment the treating psychiatrist will begin by mapping out a region on your scalp which correlates to the dorsolateral prefrontal cortex (DLPFC). We will then test the minimum energy needed to stimulate your brain, also known as your resting motor threshold. This determines the dose of magnetic stimulation that you will need during the course of your treatment series. Motor threshold determination is performed by stimulating the left scalp over an area of the brain (pre-motor cortex) that controls your right hand. Stimulation with the TMS magnetic wand in this location will cause your hand to have a single muscle jerk or twitch. Once we have completed brain mapping and motor threshold determination, we will proceed with the initial treatment.

Sessions are held usually 3-5 times per week and antidepressant effects may be noticed within the first 10 – 20 sessions. Up to 20 – 35 sessions are usually needed to consolidate the antidepressant effects. A full course of treatment can be completed within 1 -2 months. This makes TMS a fast-working treatment program for patients looking for an alternative for medications. 

The severity of depression is assessed in various ways. The most common is to examine the depressive symptoms experienced by a patient at the time of their evaluation. This is done with objective ratings (including DASS, GAD7, and MADRS) as well as reviewing all medications and psychotherapy that the patient may have undergone in their current depressive episode and in their lifetime to assess how resistant they are to conventional therapy. Although the severity of symptoms in the current depressive episode does not predict worse outcomes, it is generally believed higher treatment resistance and more failed conventional treatments in the current depressive episode may negatively influence the benefits received from TMS. That is, TMS is less likely to work in people who have been ill for many, many years, or who have tried and failed almost all other options. With that said, each person is different and even if you feel you have exhausted all options, you may actually be only ‘treatment resistant’ compared to the patients who have participated in prior TMS research studies. Talk to our doctors about your specific likelihood of responding and your risk of any potential side effects.

Our TMS Team will work with you and your referring providers to choose the next best treatment for you. The clinic may also provide you with some leads on ongoing treatment that may also be helpful.

Unfortunately, yes. TMS is not a guaranteed cure, and it does not get rid of symptoms in everyone. All available treatments in psychiatry work for some, but not all, patients. TMS is not an exception. Studies have shown that psychotic depressed patients, patients who have failed a course of ECT, and patients with severe comorbid mental disorders like schizophrenia, post-traumatic stress disorder or panic disorder generally do not benefit from the traditional depression TMS protocol. Each case needs to be assessed individually.

TMS may not work for everyone. There is a risk that clinical symptoms of depression would worsen if they are not adequately treated. In some patients, particularly those with underlying bipolar disorder or severe anxiety, TMS can be overly stimulating to the brain and induce worsening anxiety, panic, or insomnia.  The clinicians here in Mind Oasis Clinic will be assessing your progress each treatment day and obtaining mood rating scores once weekly to closely monitor for these symptoms.

Our clinicians will carefully review your treatment regimen and work with you to help optimize your treatment and reduce any risks associated with psychiatric medications. In general, you can continue to take your regular medications during your TMS series. However, some medications may need to be stopped or reduced prior to initiating TMS to avoid the risk of seizure.

TMS is a durable treatment for depression with sustained response over long term after a successful induction course of treatment. All known antidepressant treatments require a maintenance regimen to sustain initial responses. TMS also follows this general rule. The research on TMS as a maintenance therapy is very limited. After your initial TMS series, you may be advised to monitor symptoms closely with your primary psychiatrist and therapist to evaluate for any worsening mood. If you and your providers determine that maintenance TMS is warranted, we will work with you on creating a maintenance schedule that meets your needs.