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Updated on February 1, 2022

Deep Transcranial Magnetic Stimulation Therapy

What is DTMS Therapy?

In 2008, people with major depression could undergo a non-invasive treatment called standard rTMS. This is short for repetitive transcranial magnetic stimulation.

The depression treatment relays electromagnetic pulses from a handheld device to control brain regions’ neural activity. 

However, despite its safety and efficacy in treating depression symptoms, the device’s figure-8 shape had two main drawbacks:

  • Focal brain region — targeting larger volumes of the brain wasn't possible
  • Limited brain stimulation — the machine couldn't reach extensive neuronal pathways and deeper brain regions

In response, Israeli company BrainsWay built upon the standard rTMS to present Deep Transcranial Magnetic Stimulation (DTMS) therapy.

Like standard rTMS, dTMS therapy uses magnetic pulses to control the neural activity of brain regions linked with major depressive disorder (MDD).

It uses a patented H-coil structure that's unique and can't be copied for electrical stimulation of deep brain structures. The treatment also decreases the likelihood of targeting errors.

Unlike standard rTMS, it also treats other mental illnesses such as obsessive-compulsive disorder (OCD). 

Deep TMS treatment received approval for treating depression and OCD from the FDA in 2013 and 2018. It's also CE-marked in Europe for those and other mental health conditions. This means that the therapy meets EU safety, health, and environmental protection requirements. 

Eligible candidates for deep TMS therapy can receive daily sessions without the need for anesthesia or recovery. 

How It Works

Deep TMS is a non-invasive approach to brain stimulation that occurs through electromagnetic currents being sent through a helmet containing a patented H-coil.

The H-coil has three significant advantages when compared to the figure-8 coil of standard rTMS:

  • A flexible base suitable for the patient’s head shape
  • Stimulation of a larger volume of gray matter in the prefrontal cortex (PFC)
  • Higher likelihood of stimulating target brain areas consistently

The coil relays short magnetic pulses through the skull and targets brain areas. These pulses are similar to those in MRI machines.

Treatment sessions last approximately 20 minutes. The activation of deep brain structures and magnetic fields influences neural activity to improve medical conditions significantly.

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Side Effects of DTMS Treatment

Side effects of DTMS treatment sessions vary according to the disease being treated.

In treating major depressive disorder, common side effects include:

  • Site pain
  • Site discomfort
  • Jaw pain

Although differences weren't significant in treatment vs. placebo studies, other symptoms that may present as a result of DTMS treatment include:

  • Headaches
  • Muscle twitching 
  • Pain in the back 
  • Anxiety
  • Insomnia 

In the treatment of an obsessive-compulsive disorder, side effects may include:

  • Headaches
  • Anxiety
  • Jaw pain
  • Common cold
  • Gastrointestinal symptoms 
  • Diarrhea
  • Neck pain
  • Fatigue

Overall, deep TMS therapy is a safe and effective treatment. There are no permanent or significant side effects. 

What Can You Expect From Deep TMS Therapy Results?

If deep TMS therapy works for you, depression symptoms may reduce or disappear entirely. However, symptom relief may take a few weeks of treatment.

After completing a deep TMS treatment series, standard care for depression may be suggested for ongoing treatment. This standard care treatment may include medication and psychotherapy.

It's not yet known if maintenance deep TMS therapy sessions will improve depression. This would involve continuing deep TMS treatment when you're symptom-free to prevent the return of symptoms.

If your depression improves with deep TMS treatment, and then you experience another episode of symptoms, your deep TMS therapy can be repeated. This is known as re-induction.

Some insurance companies cover re-induction. If deep TMS therapy improves your depression symptoms, it's best to discuss ongoing or maintenance treatment options with your doctor or healthcare provider.

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How Are Psychiatrists or Healthcare Providers Involved in Deep TMS?

Healthcare providers provide open and efficient patient progress during deep TMS therapy.

Patients maintain relationships with their current psychiatrist or healthcare provider. A deep TMS coordinator ensures that all critical information regarding patient treatment is sent directly to the referring psychiatrist or healthcare provider.

Once deep TMS treatment is complete, people typically return to their healthcare provider for follow-up care.

Who Benefits From BrainsWay Deep TMS?

In the United States, the FDA has granted clearance status for the treatment of MDD and OCD in adults aged 18 or older. For people to be eligible for deep TMS sessions, they must meet specific FDA criteria.

For example, in the case of MDD, people must demonstrate a lack of significant improvements from an antidepressant medication in a current episode.

Approximately 19.4 million American adults experienced at least one major depressive episode with severe impairment in 2019.8 

Insurance providers in the United States may request that people meet additional criteria, such as:

  • No prior medical reason that would make someone ineligible for TMS therapy. For example, psychotic symptoms or suicidal thoughts 
  • Proof that evidence-based psychotherapy was ineffective on multiple occasions 
  • Must have Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis of F33.2 (Recurrent Depressive Disorder, Current Episode Severe Without Psychotic Symptoms) or F32.2 (Severe Depressive Episode Without Psychotic Symptoms)

In the European Union, BrainsWay’s Deep TMS device can also be used to treat people with additional medical conditions:

  • Alzheimer’s Disease (AD)
  • Autism
  • Bipolar Disorder
  • Chronic Pain
  • Multiple Sclerosis (MS) 
  • Parkinson’s Disease
  • Post-stroke rehabilitation
  • Post-traumatic Stress Disorder (PTSD)
  • Schizophrenia 
  • Substance addictions, mainly smoking

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DTMS for Substance Addiction

DTMS therapy hasn't received clearance from the FDA for treatment in substance addiction. But it's proven to be promising based on studies conducted outside of the U.S. 

In one study exploring dTMS therapy for abstinent people with AUD, it was reported that the treatment may have contributed to a reduction in cravings and relapse rates.

In a separate study by Dinur-Klein et al., researchers assessed the efficacy of dTMS in the prefrontal cortex and the insula, located deep in the cerebral cortex. The study was made on 115 people who would smoke 20 or more cigarettes per day.  

Those who received high-frequency dTMS and were exposed to smoking cues had a response rate of 81 percent. Also, in a 6-month follow-up post-treatment, the complete abstinence rate was 33 percent.9

This suggests that dTMS therapy could have a more integral role in treating substance addictions. This also extends to people with a dual diagnosis. A dual diganosis refers to those suffering from a mental health issue with a substance abuse problem. 

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Resources

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  1. “BrainsWay Deep TMS - Helping People Quit Smoking.” BrainsWay, 10 June 2020
  2. Harel, Maayan, et al. “O7. Deep Transcranial Magnetic Stimulation Over the Medial Prefrontal and Anterior Cingulate Cortices Alters Brain Connectivity and Reduces Relapse to Alcohol Use.” Biological Psychiatry, vol. 85, no. 10, 2019
  3. “Major Depression.” National Institute of Mental Health, U.S. Department of Health and Human Services, Feb. 2019
  4. Mennitto, Donna. Transcranial Magnetic Stimulation (TMS) at The Johns Hopkins Hospital in Baltimore, Maryland, 5 Feb. 2019
  5. Levkovitz, Yechiel et al. “Efficacy and safety of deep transcranial magnetic stimulation for major depression: a prospective multicenter randomized controlled trial.” World psychiatry : official journal of the World Psychiatric Association (WPA) vol. 14,1 : 64-73
  6. Kedzior, Karina Karolina et al. “Cognitive functioning and deep transcranial magnetic stimulation (DTMS) in major psychiatric disorders: A systematic review.” Journal of psychiatric research vol. 75 : 107-15
  7. FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder, U.S. Food & Drug Administration (FDA), August 2018
  8. Major Depression, National Institute of Mental Health (NIH), October 2021
  9. Dinur-Klein, Limor et al. “Smoking cessation induced by deep repetitive transcranial magnetic stimulation of the prefrontal and insular cortices: a prospective, randomized controlled trial.” Biological psychiatry vol. 76,9 : 742-9

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