Transcranial magnetic stimulation (TMS) is an outpatient procedure used in patients with hard-to-treat depression.
In this procedure, the patient is completely awake and seated in a chair. The magnetic arm of the machine is placed near the front, left side of the head. The machine sends magnetic pulses into the brain through this arm and causes it to create brief electrical currents. This therapy creates changes in the way the brain cells (neurons) interact in specific parts, or circuits, of the brain that controls mood.
The Center for Interventional Psychiatry began offering TMS therapy in July 2015.
When do you use TMS?
TMS is approved by the U.S. Food and Drug Administration (FDA) for treatment-resistant depression in patients who fail to improve after treatment with two antidepressants.
In some patients, antidepressants fail because they do not relieve the symptoms of depression. Other patients may not be able to tolerate the side effects of antidepressants. Some are not able to take them because of other medications or conditions.
How is TMS performed?
TMS is performed in an outpatient setting. The patient sits still in a comfortable chair while the procedure is performed. During the first visit (called the mapping session) a machine is adjusted to fit the particular needs of the patient. The exact dose of magnetic pulse and location of placement of magnet is determined. These settings are then used throughout the course of treatment by the TMS clinician.
Typically, the treatment is performed five days a week for four to six weeks. Patients are tapered off TMS once they complete a course of treatment.
Some patients may not see improvement for several weeks, while others will see a positive change in their symptoms more quickly.
How do I prepare for TMS?
All patients are evaluated by our clinical staff and a doctor to make sure they are a good candidate for TMS. Some people cannot have TMS because it uses powerful magnets. Your doctor will need to know if you have any metal objects in your body, such as the following:
- Aneurysm clips or coils in your head, neck, or upper body
- Arterial stents in your upper body
- A cardiac pacemaker
- Tattoos with metallic or magnetic sensitive ink
If your doctor decides that TMS is a good treatment option for you, you do not need to do anything to prepare.
What are some of the side effects of TMS?
TMS is a safe procedure with minimal side effects. The most common side effect is headache, and this can be treated with over-the-counter medication. Some patients may experience a slight burning sensation in the scalp under the magnet during the procedure. A few patients may have facial twitches during their TMS session, but the machine can be moved slightly to relieve these twitches.
What if TMS doesn’t help me? Do I have any options?
TMS is one of several options available to you, if you have hard-to-treat depression. This therapy works very well for some patients, but the overall success rate is about 40 to 50%. Patients who are helped by TMS can expect to have a remission of their depression symptoms for up to one year. If you have failed two different treatments of antidepressants and psychotherapy, you may be eligible to have electroconvulsive therapy (ECT). ECT is effective for treatment-resistant depression, and is also a safe, nonsurgical option that works very quickly to relieve symptoms. You may also benefit from esketamine internasal therapy (EsKIT) for hard-to-treat depression.
Contact the Center for Interventional Psychiatry at UPMC Western Psychiatric Hospital
For more information or to schedule an appointment with the Center for Interventional Psychiatry, please call 412-246-5063.