TMS therapy (transcranial magnetic stimulation) is a nonsurgical electromagnetic therapy that involves using electromagnetic fields to deliver continuous magnetic pulses to stimulate and excite neuronal cells in the brain.1
Transcranial magnetic stimulation is a form of brain stimulation therapy that has been mainly employed for depression. However, it has also been widely employed in treating and managing other neurological or mental health disorders such as obsessive-compulsive disorder (OCD), multiple sclerosis, and post-traumatic stress disorder (PTSD) due to prior successes recorded when it has been employed.
TMS is also referred to as rTMS (repetitive transcranial magnetic stimulation). This additional name is because the TMS treatment involves continuous (repetitive) delivery of magnetic pulses to stimulate neural cells in the brain.1
rTMS offers an advantage over other similar techniques. The pulses rarely penetrate more than two inches into the brain, allowing for greater precision and minimizing harmful effects caused by pulses reaching undesirable locations.
The increasing popularity of transcranial magnetic stimulation as an alternative to medications and therapy is more than justified since very impressive statistics back up its efficacy. Studies have shown that TMS has successfully affected remission in patients suffering from major depressive disorder (MDD), where drugs and therapy have had little to no effect.2
Transcranial magnetic stimulation is an alternate therapy usually utilized to treat patients with neurological or mental disorders who have shown little or no response to other conventional treatment methods (such as those involving medications and psychotherapy) to relieve their symptoms.
A qualified doctor (also known as a TMS physician) handles the TMS therapy procedure. The patient is not anesthetized since surgery is not required. Because TMS can be performed as an outpatient operation, it could be performed in a medical clinic. If it’s done in a hospital, patients will not have to remain overnight in the hospital. However, the patient will be awake for the length of the procedure and may experience scalp discomfort during the procedure.
The TMS device, which has an electromagnetic coil, is either implanted near the patient’s left prefrontal cortex or in the front side of the scalp, both of which are locations that have been identified to play a significant role in the occurrence of symptoms of neurological and mental disorders.3
For example, in one session of TMS, The TMS device is held in place for around forty minutes to allow the area of the brain implicated in the neurological or mental disorder to receive a constant stream of electric current. These impulses created and delivered to the brain trigger chemical processes that help to improve the patient’s condition over time.
A single course of rTMS treatment is usually made up of thirty sessions, broken down into five sessions per week for four to six weeks. Doctors recommend and encourage that when treatment begins, patients undergoing the rTMS treatment should endeavor to complete the treatment course to obtain the best possible results rTMS has to offer. Although most patients only require one course of treatment to experience relief from their symptoms, there are occasions where the treatment does not work. In these cases, the second course of rTMS can be given.
Although TMS treatment is usually quite successful, it is crucial to remember that relapses can occur like most other therapies for mood disorders. Therefore, TMS maintenance therapy sessions may be required to retain symptom relief from disease symptoms. Most TMS patients report feeling better for months after treatment (with the average response length being just over a year).
TMS is most commonly used to treat major depressive disorder (MDD). It Is usually suggested for people who have not gotten any relief from medicine or psychotherapy. TMS has, however, also been employed in the treatment and management of several other neurological and mental disorders.
Major depressive disorder (MDD) is a mental condition characterized by protracted periods of depression, a loss of energy and interest in life, as well as discomfort that has no obvious explanation.4 Major depressive disord r affects around 15 million people in the United States. While some people are depressed practically all of the time, others have episodes of depression that come and go, sometimes lasting years.5
The conventional treatment for MDD is antidepressant medications. While such medication has been effective in some cases, there is the worrying fact that treatment-resistant depression occurs in more than 40% of MDD patients. Depression that is resistant to such treatment is referred to as treatment-resistant depression. This fact means that antidepressants fail to alleviate symptoms associated with depressive states in these cases.
Magnetic therapy for depression, or transcranial magnetic stimulation, has been approved by the FDA (US Food and Drug Administration) for over a decade.5
TMS therapy is rapidly gaining acceptance in medical circles as a safe and effective treatment for MDD. Magnetic therapy for depression effectively manages depression, including treatment-resistant depression cases. For patients with unipolar major depression who have failed at least one antidepressant prescription, TMS is also an exceptional option.
Just as TMS is effective in treating psychiatric problems such as depression and OCD, it can also be utilized in the management of anxiety, because these illnesses frequently generate anxiety symptoms. TMS therapy for anxiety may effectively treat generalized anxiety disorder (GAD).6
According to a 2019 study, Increased nerve cell activity in the prefrontal cortex is common with anxiety. TMS therapy for anxiety may be utilized to lower activity in this location.6 TMS effectively treats individuals diagnosed with “anxious depression” or depression with concomitant anxiety.
OCD, or obsessive-compulsive disorder, is an anxiety-based mental health problem that affects millions worldwide. OCD is a mental health condition characterized by a pattern of anxious thoughts and activities. OCD causes a person’s well-being to be disrupted by serving as an excessive defense mechanism. By focusing one’s attention on stress-inducing triggers, the illness aggravates more common fears and concerns.
Transcranial magnetic stimulation (TMS) has shown potential as an adjunct in treating obsessive-compulsive disorder (OCD) symptoms.7 TMS has been found to safely and successfully relieve the symptoms of obsessive-compulsive disorder (OCD), especially in individuals who have not responded to typical OCD treatment choices.
People with OCD generally have increased activity between the prefrontal cortex and the striatum. Severe OCD symptoms are linked to this hyperconnectivity. TMS can reduce OCD symptoms by suppressing activity in this area of the brain.
TMS therapy is an excellent PTSD treatment. According to research, TMS therapy for PTSD appears to be a promising alternative to conventional therapies that have failed. TMS therapy may not eliminate your PTSD symptoms, but it can assist in lessening them and making them more manageable.8
TMS targets the prefrontal cortex, responsible for processing fear and worry. A trial conducted in 2018 on the efficacy of TMS for PTSD proved that TMS in combination with cognitive processing therapy is beneficial for the management of PTSD symptoms. This combination’s therapeutic impact lasted for six months.
Multiple Sclerosis is a debilitating autoimmune central nervous system (CNS) disease that involves the brain and the spinal cord. With multiple sclerosis, the protective sheath (myelin) that surrounds nerve fibers is attacked by the immune system in MS, causing communication issues between the brain and the rest of the body.
As a result, the condition might eventually cause permanent nerve injury or degeneration. The amount of nerve damage and which nerves are damaged determine the clinical manifestations of MS. Severe MS could cause loss of ability to walk independently or at all.9
In treating and managing multiple sclerosis with transcranial magnetic stimulation, spasticity was reduced when TMS treatment was employed in combination with physical therapy.
Chronic pain is a disabling condition in which a person experiences pain for an extended period.10 In general, chronic pain is defined as persistent discomfort that lasts longer than three months. Chronic pain can often appear with no obvious cause.
For example, chronic pain can sometimes develop from an acute injury that destroys the nerves in the area, resulting in pain that lasts far longer than the normal healing time. However, it is impossible to pinpoint the source of the discomfort in other cases.10
Transcranial magnetic stimulation is sometimes utilized to treat and manage chronic pain, especially when other treatment options have failed. Research has shown that TMS is an effective treatment for people suffering from chronic pain. However, it is important to note that despite very promising results obtained from the research, TMS for chronic pain is considered an off-label treatment as the FDA has not approved it as a treatment option for chronic pain.10
Autism, often known as autism spectrum disorder (ASD), is a complex illness characterized by communication and behavioral issues.11 ASD can manifest itself in a wide range of symptoms and abilities.
TMS is beneficial in reducing the symptoms of autism in ways that other therapies have failed to achieve.11 TMS is, however, not yet available as a popular treatment option for ASD because several types of research still need to be conducted to evaluate the true potential of TMS in the treatment and management of ASD.
A stroke happens when the blood flow to the brain is interrupted or reduced due to a blockage or leak of blood vessels.12
According to studies, TMS could help people recover their motor skills after a stroke. The concept is that magnetic pulses generated during TMS treatment can modify the functioning of the motor cortex, which is the part of the brain responsible for regulating muscle function.
Schizophrenia is a severe psychological disorder in which patients have aberrant perceptions of reality. Schizophrenia can include hallucinations, delusions, and profoundly abnormal thought and behavior, making it difficult to function daily.13
Most people with schizophrenia usually experience symptoms not alleviated by antipsychotic medications. TMS has been offered a novel therapeutic option for schizophrenia, particularly those who suffer from chronic auditory hallucinations.14
The temporoparietal cortex, which serves as a cortical hub for various types of spatial perception, is useful as a target in the treatment of schizophrenia symptoms.
Parkinson’s disease is a mobility disease occurring due to damage to the nerve system. Symptoms appear gradually and may begin with a barely detectable tremor in only one hand.15 Tremors are common. However, they are often accompanied by stiffness and reduced mobility.
Low-frequency repeated TMS over the supplementary motor area (SMA) has been shown to improve motor symptoms in Parkinson’s disease efficiently. It has also been observed that the connections between areas of the brain implicated in gait freezing become normalized after TMS treatment.
Alzheimer’s disease is a neurologic ailment that gradually erodes memory and reasoning skills and the ability to carry out even the most basic duties.16
According to more recent studies, TMS is expected to aid the management of Alzheimer’s disease by modifying the brain connections involved in memory and learning. However, additional research is needed to fully comprehend how TMS can help people with Alzheimer’s disease.
Transcranial magnetic stimulation (TMS) has primarily been researched as a depression treatment. TMS therapy for depression appears to have a high success rate, with between 30% and 64% of people who are depressed responding positively.
Extensive studies have also highlighted TMS as potentially beneficial in treating and managing other diseases such as OCD, anxiety, and PTSD. However, more research is needed before TMS can be fully employed as a treatment option in other disease conditions.
Other benefits of TMS include that, since the procedure is non-invasive and requires no surgery, there is no need for anesthesia. It is highly tolerated amongst individuals who receive it with little to no side effects. Moreover, TMS can also be provided as an outpatient service, so the patient’s everyday activities are not disrupted.
Although TMS is generally considered a safe and well-tolerated procedure, the treatment is also accompanied by some side effects. TMS therapy side effects are divided into:
The most common TMS therapy side effects experienced by patients undergoing these procedures are headaches and scalp discomfort. The scalp discomfort is often associated with implantation of the TMS device and to the level of stimulation of the TMS device. However, both effects can be easily alleviated upon complaint to a TMS physician. In addition, common pain medications have also been effective in managing headaches.
Other common side effects associated with TMS include lightheadedness, tingling or spasms, and twitching of one’s facial muscles.
As earlier stated, TMS is generally considered to be a safe procedure associated with minor side effects. However, the treatment potentiates severe adverse effects in some cases. These uncommon effects include seizures or mania. Moreover, hearing loss can occur as a result of poor ear protection during therapy.
While TMS is generally safe, there are some contraindications. TMS should be avoided if you have metallic implants like electrodes, deep brain stimulators, shrapnel, permanent piercings, and so on. The magnetic fields produced during TMS can cause these implants to heat up or shift, resulting in significant damage. You can still have the TMS treatment if you have braces or tooth fillings.
This type of treatment should also be avoided if you have or have had epilepsy or seizures in the past, if you are currently taking stimulants, or if you have a medical condition that makes the occurrence of seizures more likely. You should also avoid this type of treatment if you have previous head trauma or experienced an opening of the skull.17
TMS therapy cost varies depending on your insurance plan, the disease being treated, and the number of sessions required.18 A single course of TMS can cost anything from $6,000 to $12,000. Most insurance providers cover TMS, but coverage may depend on your medical history.
You may have to miss a few hours of work each day because you’ll be getting treatment five days a week for several weeks. This factor is determined by your schedule, the clinic’s location, and the times of your visits.
Because a treatment session can last anywhere from thirty to sixty minutes, you may be able to do it before or after work. In addition, TMS is offered as an outpatient service, disruptions to your normal routine could be kept at a minimum.
For most patients, the TMS procedure is pain-free, although, in some instances, some patients may experience jaw clenching, painful scalp sensations, and facial twitching.19
If you have not experienced relief from depression symptoms or other diseases earlier mentioned after treatment with medication and psychotherapy, your doctor could prescribe TMS to you.
The majority of TMS patients use medications both before and after TMS therapy. However, there is evidence that using TMS as an adjunct therapy with medications can improve responding to TMS and maintaining TMS effects after treatment is completed. So, it is recommended that patients continue taking their medications to avoid a relapse.