Deep Transcranial Magnetic Stimulation for Depression and More

What is dTMS Therapy?

Israeli company BrainsWay built upon standard repetitive transcranial magnetic stimulation (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.

Deep TMS treatment received approval for treating depression and obsessive-compulsive disorder (OCD) from the U.S. Food and Drug Administration (FDA) in 2013 and 2018. It’s also CE-marked in Europe for those and other mental health conditions. The therapy meets European Union (EU) safety, health, and environmental protection requirements. 

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Who Benefits From Brains Way Deep TMS?

In the United States, the FDA has granted clearance status for treating MDD and OCD in adults aged 18 or older. To be eligible for deep TMS sessions, people 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.

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

• No prior medical reason that would make them 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 EU, BrainsWay’s Deep TMS device can also treat people with additional medical conditions:

• Alzheimer’s disease
• 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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What to Expect From dTMS Therapy Results

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

After completing a dTMS treatment series, standard care for depression may be necessary for ongoing treatment. This may include medication and psychotherapy.

It’s unknown whether maintenance dTMS 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 dTMS treatment and you experience another episode of symptoms, you can repeat your dTMS therapy. This is known as re-induction.

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How It Works

Deep TMS is a non-invasive approach to brain stimulation that occurs through electromagnetic currents 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 person’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 significantly influences neural activity to improve medical conditions.

Side Effects of dTMS Treatment

Side effects of dTMS treatment sessions vary according to the disease receiving treatment.

When treating MDD, common side effects of dTMS include:

• Site pain
• Site discomfort
• Jaw pain

In the treatment of OCD, side effects may include:

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

Although differences weren’t significant in treatment versus placebo studies, other symptoms that may present as a result of dTMS treatment include:

• Headaches
• Muscle twitching 
• Back pain
• Anxiety
• Insomnia 

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

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DTMS for Substance Addiction

DTMS therapy hasn’t received FDA clearance for treating substance addiction. However, it’s proven promising based on studies conducted outside of the U.S. 

One study exploring dTMS therapy for abstinent people with alcohol use disorder (AUD) reported the treatment may have reduced cravings and relapse rates.²

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 involved 115 people who smoked 20 or more cigarettes per day.⁹  

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 dTMS therapy could be more integral in treating substance addictions, extending to people with a dual diagnosis. A dual diagnosis refers to those suffering from a mental health issue with a substance abuse problem. 

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