The Latest in Depression Treatment: TMS for Depression

TMS or transcranial magnetic stimulation treatment is a non-invasive, FDA-approved therapy for depression. Find out what TMS is and how TMS for depression works.

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Article Contents

What Is Depression?

Many people are considering TMS for depression.  Major depressive disorder (MDD) is a mental health diagnosis that requires medical care. With treatment, patients diagnosed with depression can receive significant symptom relief. Screening and early detection are critical components of treatment for MDD. Treatment plans often include medication, psychotherapy, and lifestyle adjustments. In most cases, depressive episodes are not a one-time occurrence. 

People often wonder, what causes depression? Although there is not one single predictor for depression, scientists and behavioral health researchers have studied multiple factors that contribute to the likelihood of an individual developing chronic depression. Substance use, physical illness, brain chemistry, life crises, genetics, and trauma are all possible factors that contribute to clinical depression.1

How Common Is Depression? 

In the United States, about eight percent or nineteen million people have experienced one or more episodes of depression in the past year alone. Treatment is key to overcoming the burden of depression.1

Signs of Depression 

Everyone needs to be familiar with the symptoms and signs of depression. Since early detection is critical, it is helpful to recognize possible depression symptoms for yourself, friends, and loved ones. Common signs of depression include:1

  • Changes in sleep patterns 
  • Decreased or increased appetite 
  • Difficulty concentrating
  • Decreased energy
  • Loss of interest in hobbies or activities 
  • Hopelessness 
  • Bodily aches and pain 
  • Thoughts of self-harm 

Since mental health symptoms can vary from person to person, it is crucial to understand that depressive disorders generally cause changed behaviors for a minimum of two weeks.

How Is It Diagnosed?

To meet clinical criteria for depressive disorder, a patient must have experienced depressive symptoms for more than two weeks. For example, if a patient has struggled with low self-worth, sleep disturbances, and loss of interest for the past three weeks, they may be experiencing symptoms of depressive disorder.    

Types of Depression 

There are quite a few different depression diagnoses that individuals can have. Here are six common types of depression: 2

  • Major Depressive Disorder
  • Persistent Depression Disorder (Dysthymia) 
  • Postpartum Depression
  • Bipolar Depression 
  • Seasonal Affective Disorder (SAD) 
  • Psychotic Depression 

Major depressive episodes are a common theme for patients with a mood disorder such as bipolar.

Treating A Dual Diagnosis of Depression and Addiction

Approximately half of all people with a mental illness also experience substance use. In multiple national surveys, a correlation existed between people diagnosed with substance use disorder and co-occurring mental illnesses, such as depression. Additionally, major depressive disorder is associated with worse treatment outcomes for individuals with one or more substance use disorders (SUD).3

In the past, behavioral health providers would treat whichever disorder appeared earliest as the primary concern. In more recent years, the behavioral health field has recognized that primary versus secondary is immaterial in dual diagnosis treatment. Researchers and clinicians now understand that treatment should address the patient’s symptoms as a whole instead of focusing on one individual diagnosis. For example, many behavioral health providers are now dually licensed to provide co-occurring mental health and substance treatment. Depending on the severity of symptoms, dual diagnosis treatment is available at outpatient and inpatient levels of care.4

CBT 

Researchers, treatment providers, and patients routinely use cognitive-behavioral therapy (CBT) to treat co-occurring depression and addiction. This evidence-based therapeutic approach provides patients with skills to address dysfunctional beliefs and maladaptive thoughts. Studies have shown that CBT is a powerful approach for reducing depressive symptoms and substance use5

EMDR 

Currently, eye movement desensitization and reprocessing (EMDR) is an evidence-based approach used to treat symptoms of post-traumatic stress disorder (PTSD). Studies have begun to evaluate how effective EMDR therapy is for addressing other mental health disorders and substance use diagnoses. Literature reviews suggest that EMDR improves trauma-associated symptoms and addictive behaviors.6

Medications 

A patient-centered treatment plan often includes some form of medication management. Prescribers can treat a patient’s depression using antidepressants, mood stabilizers, and antipsychotics. Additionally, medication-assisted treatment (MAT) is an option for treating substance use disorder. Typical forms of MAT include Suboxone, methadone, and Vivitrol. Generally, prescribers who specialize in mental health or dual diagnosis treatment are well versed in both depression and addiction medications.  

Psychotherapy

As previously mentioned, psychotherapy approaches to treating a dual diagnosis of depression and addiction can include CBT alongside interpersonal therapy and family therapy. 

TMS 

The FDA approved transcranial magnetic stimulation (TMS) to treat major depressive disorder (MDD). TMS stimulates targeted sites in the brain using short magnetic pulses. This treatment modality decreases depressive symptoms for patients that do not respond well to medication management.7

How Can TMS Help In Depression Treatment?

When a patient’s major depressive disorder does not respond to psychotherapy or medication, the individual’s condition can be called treatment-resistant depression or TRD. TMS is an innovative treatment modality that can treat TRD successfully.7

What Is TMS? 

TMS therapy uses magnetic pulses to stimulate nerve cells in targeted sites of the brain. Transcranial magnetic stimulation can address a patient’s diagnosis of major depressive disorder (MDD).8

EEG Evaluation

Electroencephalography, abbreviated to EEG, is a diagnostic test used to detect electrical activity in a patient’s brain. In recent years, scientists have begun pairing TMS treatment with EEG to make exciting discoveries regarding the pathophysiology of the human brain. This paired TMS-EEG approach is a non-invasive, effective way to gather critical information regarding brain activity and pathways.9

Magnetic Pulses

During TMS treatment, a trained provider administers quick electromagnetic pulses through a coil attached to the patient’s forehead. Magnetic pulses pass through the skull and reach specific sites within the patient’s brain. TMS therapy is not painful and compares to tapping or knocking sensations.10

rTMS

rTMS is the abbreviation for repetitive transcranial magnetic stimulation. To clear up any confusion, the terms rTMS and TMS are interchangeable. Essentially, TMS is a shortened term for this type of neurostimulation therapy. rTMS was introduced in 1985 as a therapeutic approach to treating depression, psychosis, anxiety, and other mental health disorders.10 

What To Expect In TMS Therapy

Next, we will dive into the details of TMS therapy, such as the duration, preparation, and administration of TMS treatment.  

How Long Is The Therapy?  

Generally, patients can expect TMS therapy to last for 4-8 weeks. Patients can request an exact timeline from their chosen TMS provider. Each TMS therapy session is approximately twenty to forty minutes.10

How To Prepare for TMS?

To prepare for TMS therapy, patients will need to complete a physical exam and psychiatric evaluation. The purpose of this is to ensure TMS for depression is clinically appropriate for the patient. 

Physical Exam

Before a patient can receive TMS for depression, they must complete a physical health exam. During this physical exam, a medical provider will utilize lab testing, information about pre-existing conditions, and various other measures of health to determine if a patient is eligible for TMS therapy. Patients must be transparent with their physicians about health conditions, substance use, and medications.

Psychiatric Evaluation

During a psychiatric evaluation for TMS participation, a licensed mental health professional will complete an assessment to ensure TMS is clinically appropriate to treat the patient’s depression. The clinician will also screen for patient safety.  

Who Administers TMS?   

Professionally trained and licensed technicians can administer TMS for depression. Throughout the entire therapeutic appointment, the technician answers questions, provides treatment, and monitors the patient.11

Who Cannot Get TMS Therapy?   

TMS for depression is not appropriate if patients are currently reporting concurrent depression and psychosis or bipolar disorder. Additionally, patients evaluated as high risk for suicide may not be suitable for TMS treatment. If a patient has a pacemaker or other metal health device implants, TMS for depression might not be appropriate. The patient’s provider makes this determination during the pre-treatment physical exam.

Benefits of TMS Therapy

Repetitive TMS for depression is an evidence-based therapy that strategically treats major depressive disorder. Unlike other treatment approaches like electroconvulsive therapy (ECT), TMS for depression is non-invasive, highly effective, and results in very few side effects.  

Structural 

Unlike other brain stimulation therapies like ECT, TMS for depression targets only specific sites within the patient’s brain. TMS for depression can provide comparable or greater therapeutic benefits with fewer side effects on a structural level.  

Physiological  

TMS for depression utilizes pulsing magnetic technology to improve a patient’s neurological function and mental health. The physiological effects of TMS can significantly decrease a patient’s mood symptoms.

High-Success Rate 

TMS for depression is an FDA-approved treatment for patients with major depressive disorder that aren’t responding to medications and psychotherapy. Before receiving FDA approval, extensive research and clinical trials studied the efficacy of TMS for depression. TMS for depression is a highly successful treatment approach for patients diagnosed with MDD. 

Non-Invasive 

Generally, people are relieved to learn that TMS for depression is non-invasive. When receiving TMS therapy, individuals do not have to be put under anesthesia. Additionally, patients receive TMS on an outpatient basis, with quick appointments.

No-Side Effects 

TMS for depression is safe, effective, and results in very few side effects. On occasion, patients report mild headaches, tingling sensations in the facial region, and cluster headaches. In sporadic cases, seizure activity is possible. For this reason, people must be transparent with health care providers and TMS technicians about any pre-existing medical conditions.  

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