What is DTMS Therapy?

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In 2008, individuals with major depression could begin to undergo a non-invasive treatment called standard rTMS (repetitive transcranial magnetic stimulation). The depression treatment would relay electromagnetic pulses from a handheld device to control brain regions’ neural activity. 

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

  • Focal brain region targeting larger volumes of the brain was not possible at any given moment. 
  • Limited brain stimulation the device could not 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 incorporates magnetic pulses to control the neural activity of brain regions associated with major depressive disorder (MDD). It uses a novel patented H-coil structure (that is, it is unique and cannot be copied) to make the most of electrical stimulation of deep brain structures and decrease the likelihood of targeting errors.

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

Deep TMS treatment has received approval for the treatment of depression and OCD from the Food and Drug Administration (FDA) in 2013 and 2018. It is also CE-marked in Europe for those and other mental health conditions, meaning that this line of therapy meets EU safety, health, and environmental protection requirements. 

Lastly, those who are 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 of 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 that is 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, similar to those in magnetic resonance imaging (MRI) machines, through the skull and into the target brain areas. 

Treatment sessions last approximately 20 minutes; however, the activation of deep brain structures and the use of magnetic fields influence the neural activity to leave significant improvements in medical health conditions. 

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How Are Psychiatrists or Healthcare Providers Involved in Deep TMS?

Referring psychiatrists and other healthcare providers provide open and efficient communication regarding 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, patients typically return to their psychiatrist or 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. However, for individuals to be eligible candidates for deep TMS sessions, they must meet specific criteria per FDA requirements.

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

Approximately 11 million American adults aged 18 or older experienced at least one major depressive episode with severe impairment in 2017. 

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

  • No prior medical reason that would make someone ineligible for TMS therapy, such as psychotic symptoms or suicidal thoughts 
  • Prove 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, though, BrainsWay’s Deep TMS device can also be used to treat individuals 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 cessation

Side Effects of DTMS Treatment

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

In the treatment of major depressive disorder, common side effects include:

  • Site pain
  • Site discomfort
  • Jaw pain

Although differences were not 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 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 with no permanent or significant side effects. 

DTMS for Substance Addiction

Although dTMS therapy has not received clearance status from the FDA for treatment in substance addiction, it has proven otherwise promising based on studies conducted outside of the U.S. 

In one study exploring the use of dTMS therapy in abstinent individuals with alcohol use disorder (alcoholism), authors reported that such treatment may have contributed to a reduction in cravings and relapse rates.

In a separate study by Dinur-Klein et al., investigators assessed the efficacy of dTMS in the prefrontal cortex and the insula (located deep in the cerebral cortex) in 115 individuals who would smoke 20 or more cigarettes per day.  

The findings showed that the study subjects who received high-frequency dTMS and were exposed to smoking cues (or triggers) had a response rate of 81%. Also, in a 6-month follow-up post-treatment, the complete abstinence rate was 33%.

These investigative reports suggest that dTMS therapy could have a more integral role in the treatment of substance addictions. This implication also extends to individuals with a dual diagnosis (that is, suffering from a mental health issue while with a substance abuse problem). 

What Can You Expect From Deep TMS Therapy Results?

If deep TMS therapy works for you, your depression symptoms may reduce or go away 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.

Following completion of 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 is not yet known if maintenance deep TMS therapy sessions will improve your depression. This involves continuing deep TMS treatment when you are symptom-free with the goal that it will prevent the return of symptoms.

If your depression improves with deep TMS treatment, and then later 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 is best to discuss ongoing or maintenance treatment options for your condition with your doctor or healthcare provider.

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Resources +

“BrainsWay Deep TMS - Helping People Quit Smoking.” BrainsWay, 10 June 2020, www.brainsway.com/treatments/smoking-cessation-addictions/.

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, doi:10.1016/j.biopsych.2019.03.272, https://www.biologicalpsychiatryjournal.com/article/S0006-3223(19)30422-6/fulltext

“Major Depression.” National Institute of Mental Health, U.S. Department of Health and Human Services, Feb. 2019, www.nimh.nih.gov/health/statistics/major-depression.shtml.

Mennitto, Donna. Transcranial Magnetic Stimulation (TMS) at The Johns Hopkins Hospital in Baltimore, Maryland, 5 Feb. 2019, www.hopkinsmedicine.org/psychiatry/specialty_areas/brain_stimulation/tms/.

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 (2015): 64-73. doi:10.1002/wps.20199, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4329899/

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 (2016): 107-15. doi:10.1016/j.jpsychires.2015.12.019, https://pubmed.ncbi.nlm.nih.gov/26828370/
FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder, U.S. Food & Drug Administration (FDA), August 2018, fda.gov/news-events/press-announcements/fda-permits-marketing-transcranial-magnetic-stimulation-treatment-obsessive-compulsive-disorder
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