Transcranial Magnetic Stimulation (TMS)

Transcranial magnetic stimulation (TMS) is an outpatient procedure used in patients with hard to treat depression.

This procedure is performed while 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 transcranial magnetic stimulation therapy in July 2016.

When do you use TMS?

TMS is approved by the US Food and Drug Administration (FDA) for treatment-resistant depression after failure to improve with exposure to two antidepressant medication.

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, or may not be able to take them because of other medication 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 ping session) the machine is adjusted to fit the particular patient's needs, and the exact dose of magentic pulse and location of placement of magnet is identified. These settings are then used throughout the course of the treatment by the TMS clinician.

Typically the treatment is performed 5 days a week for 4 to 6 weeks. We do taper the patient off of TMS once they complete a course of treatment.

Some patients may not see an improvement for several weeks, while others will see an improvement in their symptoms more quickly.

How do I prepare for TMS?

Each patient will be evaluated by our clinical staff and a physician 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 percent. 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 the gold-standard in treatment-resistant depression, and is also a safe, non-surgical option, which works very quickly to relieve symptoms.