TMS Therapy for Depression
TMS for depression has been used to successfully manage individuals’ depression symptoms. Read on to learn more.
What is Depression?
Studies have shown that some people with major depression don’t respond to treatment via traditional medications and psychotherapy. These people are said to have what is known as treatment-resistant depression, and they make up to 30% of treated patients with major depressive disorder (MDD).1
For a long time, electroconvulsive therapy was the general method for relieving symptoms of MDD. However, due to concerns about its effects on people’s memory and cognition, this treatment method has not been as popular anymore. Instead, a new approach for treating and managing depression has been increasingly employed. This approach is known as transcranial magnetic stimulation (TMS).
How Does Depression Affect You?
Depression is a very common mental health disorder globally. According to a national survey in 2020, about twenty-one million adults in the United States had at least one major depressive episode in the past year, which was mostly prevalent in females and individuals aged 18-25.2
Mood fluctuations and short-lived depressive emotional responses to the various challenges we face daily are normal, but depression, on the other hand, refers to something much more intense. It is defined as a mood disorder characterized by constant feelings of sadness, lack of interest, or anger in a way that affects one’s normal functioning in life.
Types of Depression
There are many different types of depression. These include:3
- Major depressive disorder
- Persistent depressive disorder
- Substance-induced mood disorder (SIMD), which occurs due to substance withdrawal
- Depressive disorder due to another medical condition
- Others, such as minor depression, premenstrual dysphoric disorder, perinatal depression, etc.
Signs of Depression
Below are some common signs that may indicate the presence of depression in an individual:4
- Feelings of persistent sadness, anxiety
- Feelings of hopelessness or pessimism
- Decreased energy or fatigue
- Difficulty concentrating
- Difficulty sleeping and changes in sleep pattern
- Changes in appetite or unplanned weight changes
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in hobbies and activities
- Thoughts of death or suicide, or self-harm, suicide attempts
Treating a Dual Diagnosis of Depression and Addiction
Most cases of dual diagnosis involve substance use disorders and major depression manifesting simultaneously in an individual. Treatment of a dual diagnosis is a delicate process, as both conditions must be thoroughly addressed. Some ways a dual diagnosis of depression and addiction can be treated will be detailed below.
Cognitive behavioral therapy is a form of psychotherapy that focuses on helping affected persons substitute their disturbing emotions and negative coping mechanisms for healthy, desirable new ways of thinking.
Eye movement desensitization and reprocessing (EMDR) therapy is an interactive form of psychotherapy that helps people process trauma that may have led to the development of a dual diagnosis or just a single disorder. During EMDR therapy, patients are able to go through or process their painful memories and unwanted thoughts with professional help.
Medication has always been important in treating and managing mental health conditions, and dual diagnosis is no different in this regard. Recent studies have shown the benefits of some medications, such as quetiapine, in treating patients with dual diagnosis, especially those using cocaine and alcohol. A combination of naltrexone and sertraline has also proven effective in treating a dual diagnosis of depressive disorder and alcohol dependence.5
Psychotherapy, also known as talk therapy, helps patients to cope with their negative emotions in positive and healthier ways. During psychotherapy, mental health professionals create a safe space for people to work through or resolve their emotional and mental issues, thereby improving dual diagnosis symptoms.
Transcranial magnetic stimulation is an innovative method of dealing with treatment-resistant depression. It involves a non-invasive brain stimulation using magnetic impulses and has proven to be very effective in relieving symptoms associated with a dual diagnosis.
How Can TMS Help in Depression Treatment?
Sometimes, people with MDD don’t feel any better after taking medications and going to therapy. People with this kind of depression are classified as being treatment resistant.
With TMS, electromagnetic impulses are used to stimulate the brain’s neurons involved in depression. This, in turn, results in a significant improvement in the states of people dealing with depression. One unique thing about TMS is that it has proven to be highly successful when used to treat people with treatment-resistant depression.
What is TMS?
When there is no noticeable improvement after battling depression with medications or psychotherapy, it may be time to start TMS. For TMS, specific sites in the brain that are involved in depression are targeted using electromagnetic pulses to stimulate the neurons there and provide relief from signs of depression. There are a few practices of TMS to take note of.
Transcranial magnetic stimulation is often used concurrently with electroencephalography (EEG), which records electrical activity in the brain. This combination of TMS and EEG provides a powerful, non-invasive means of peering into the brain to understand its excitability or connectivity while simultaneously learning about and assessing the causes and effects of brain disorders.6
In TMS therapy, the electromagnetic pulses introduced into the brain are used to induce small electric currents which then change the firing patterns of neurons and alter maladjusted brain patterns at specific sites related to depression to improve brain activity.
rTMS (repetitive transcranial magnetic stimulation) is simply another name for TMS. Some people prefer using rTMS because they feel it offers a more accurate representation of what TMS offers. TMS is also called rTMS because it involves administering short magnetic pulses through a coil in a repetitive manner.
What to Expect in TMS Therapy
The first thing to note is that TMS is not a surgical procedure, so you will be fully awake and comfortably seated during any TMS procedure. During your first session, several measurements of your head will be taken, which are necessary as they help your doctor to determine where to place the TMS magnetic coil and ensure it fits properly on your head. You will also be asked to remove anything on you that is magnet-sensitive, such as jewelry or credit cards.7
You should also know that the procedure for TMS treatment is not painful. However, you may experience some tapping or knocking sensation after the magnetic coil is placed on your head and the impulses are released. There may also be loud clicking sounds from the impulses being generated, so it is advisable to protect your ears using metal-free earplugs.
How Long is TMS?
Usually, patients receive TMS five days a week, and these sessions last anywhere from twenty to forty minutes, after which patients can resume their normal daily activities outside the hospital or clinic. The entire rTMS therapy can last for about four to six weeks, depending on the patient’s response to treatment.
How to Prepare For TMS
One major requirement for TMS treatment is that all participants must undergo a physical exam and psychiatric evaluation to ensure TMS for depression is clinically appropriate and safe for them.
- Physical Exam: Patients must complete a physical health examination before receiving TMS for depression. This physical exam will involve lab tests, check-ups, and interviews with the patient for information about any pre-existing health conditions or related life experiences, such as being victims of a shooting, having a history of seizures, etc. You must answer every question your doctor asks as accurately as possible because it’s the information you provide that they will use in developing a treatment plan for you.
- Psychiatric Evaluation: Here, a licensed mental health practitioner will conduct a complete assessment of the patient to ensure TMS is clinically appropriate to treat their depression or other symptoms. This psychiatric exam, just like the physical one, also screens for patient safety.
Who Administers TMS?
Only trained and licensed TMS professionals or technicians are allowed to administer TMS treatment. They are also responsible for answering any related questions and providing patient monitoring during treatment.
Who Cannot Get TMS Therapy?
Although TMS therapy can provide relief from MDD, not everyone with clinical depression can undergo TMS therapy. This is one of the major reasons why physical and psychiatric exams before TMS therapy are crucial. People with any type of non-removable metal in their heads should not receive rTMS. This is because these metals can heat up, move, or malfunction due to the magnetic pulses, thereby resulting in severe brain injury or death.
Implants that Prevent TMS Treatment
Some examples of metal implants that can prevent someone from getting TMS include:8
- Metal implants or plates in the eye, ear, or head
- Tattoos with magnetic-sensitive ink
- Stents in the neck or brain
- Aneurysm clips or coils
- Shrapnel or bullet fragments near the head
Patients with known risk or history of seizures, epilepsy, brain tumors, or severe head trauma should also not undergo TMS therapy. Note that braces and other dental fillings do not prevent people from receiving TMS.
Benefits of TMS Therapy
Listed below are some of the benefits of TMS:9
- TMS targets specific sites on the brain associated with depression leading to fewer side effects compared to ECT, which can affect a person’s memory and cognition.
- Neurostimulation via TMS helps to restore brain function.
- TMS has a high success rate when used to treat MDD, and studies have shown that response rates for TMS for depression are between 30-64%.
- TMS is non-invasive.
- TMS brings no-side effects, although patients may experience slight discomfort in their scalps or short-lived headaches after sessions. Seizures only occur in extremely rare cases.
- It is non-drug, as it does not require the use of medications, though evidence points towards even better treatment outcomes when TMS is combined with medications and psychotherapy.
- TMS is FDA cleared.
- This treatment is covered by most insurance policies.
- With TMS, there is zero recovery time and patients can drive and resume their normal activities outside the hospital immediately after treatment sessions.
TMS at Essence Healthcare