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Updated on September 27, 2022

Transcranial Magnetic Stimulation Therapy

What is TMS Therapy?

Transcranial magnetic stimulation (TMS) is a non-invasive, FDA-approved outpatient procedure that uses magnetic resonance to target specific parts of the brain.

Magnetic field pulses and electrical currents stimulate nerve cells in the prefrontal cortex, which has proven to effectively treat conditions such as drug addiction and depression. 

TMS therapy is not an instantaneous treatment. It causes gradual changes in the brain over time and must be given on an on-going basis. It is usually applied for thirty minutes at a time, five days a week, for six to eight weeks. Due to the need for this prolonged exposure, this therapy is sometimes referred to as repetitive transcranial magnetic stimulation, or rTMS.

Repetitive TMS is typically used when other treatments have not been effective for patients.

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What Happens During a TMS Procedure?

Since TMS uses magnetic pulses, patients must remove any magnetic-sensitive items before treatment. This includes jewelry and credit cards.

Patients should also wear earplugs during the procedure for hearing protection because TMS creates a loud clicking noise with each pulse, similar to an MRI machine.

TMS patients sit during each session. During the first procedure, several measurements are made to ensure that the TMS coil is properly positioned over the patient’s head. Then, the TMS coil is suspended over the patient’s scalp.

The TMS physician then measures the patient’s motor threshold by processing several quick pulses. The motor threshold is the minimum level of power required to make the patient’s thumb twitch and differs from person to person.

Measuring the motor threshold helps the physician customize the treatment settings and understand the level of energy required to stimulate brain cells. Once the motor threshold is understood, the coil is brought forward, so it rests above the front area of the patient’s brain.

During TMS, patients hear a series of clicking noises and experience a tapping sensation under the treatment coil.

The motor threshold is not assessed at every treatment. However, it will be reassessed if it shifts due to a change in medication.

Who Administers TMS?

A TMS physician always administers TMS. The initial motor threshold is also always determined by a TMS physician.

The treatment itself is performed by an experienced TMS technician supervised by a TMS physician. The TMS technicians, clinicians, or physicians will always be there to check the patient during treatment.

The patient can halt treatment at any time by requesting it from the staff members present.

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TMS Therapy Side Effects

There are very few side effects of TMS therapy, and very few patients discontinue treatment because of them.

The most common side effects that do occur are typically mild and include:

  • Headache
  • Twitching of the face
  • Scalp discomfort 
  • Short-term hearing impairment
  • Risk of seizures (though these are exceedingly rare)

What Does TMS Therapy Treat?

TMS therapy is mainly used to treat major depressive disorders and other mental illnesses, but it is also used to treat other conditions, including:

  • Anxiety
  • Drug addiction
  • Alcoholism
  • Post-traumatic stress disorder (PTSD)
  • Schizophrenia
  • Parkinson’s disease
  • Alzheimer’s disease
  • Chronic pain
  • Stroke rehabilitation
  • Bipolar disorder
  • Memory loss

TMS Therapy for Alcoholism or Drug Addiction

TMS therapy is a generally safe and effective treatment for alcoholism (alcohol use disorder) and drug addiction (substance use disorder).

The magnetic pulses have been shown to calm the areas of the brain that cause cravings. By targeting these areas, patients can break free from addiction without using pharmaceutical pills, which can have more adverse side effects than TMS therapy. 

TMS Therapy for Anxiety

TMS therapy has shown promising results when treating anxiety.

It is especially useful when other types of treatments, such as pharmaceuticals, have failed. TMS therapy does not completely suppress anxiety, but it reduces symptoms and can lead to significant improvements for patients. 

TMS Therapy for Depression

Treatment of depression is the most common use of TMS therapy.

It is particularly helpful for treatment-resistant depression that is not responding to antidepressant medications. TMS therapy usually takes a few weeks before patients feel any noticeable improvements. Depression symptoms gradually begin to fade with consistent treatment.  

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How Long Is a TMS Procedure?

TMS therapy consists of a series of treatment sessions. Sessions vary in length according to the TMS coil used and the number of pulses delivered. However, a session usually lasts around 30 to 40 minutes.

Patients receive TMS five days a week, and a typical course is around four to six weeks. However, this can vary depending on a patient’s response to treatment.

Who is a Good Candidate for TMS?

If you have depression, your healthcare provider or doctor will likely recommend antidepressants and psychotherapy before TMS.

However, you may be a suitable candidate for TMS if you:

  • Have used one or more antidepressants without effective results
  • Have experienced adverse side effects when using antidepressants
  • Are a child or teenager

If you are young, TMS may be a good choice. Younger people are more prone to developing negative side effects from antidepressants.

TMS is considered safe, but it is not suitable for everyone.

You should avoid TMS if you have metal in your head, including:

  • Deep brain stimulators
  • Electrodes
  • Neck or brain stents
  • Aneurysm clips or coils
  • Shrapnel or bullet pieces
  • Facial tattoos with metallic ink
  • Metal plates
  • Cochlear implants
  • Permanent piercings

The magnetic fields in TMS can make these components heat up or move. This can lead to severe injuries. However, it is acceptable to receive treatment if you have braces or dental fillings.

You may also need to avoid TMS if you:

  • Have a history of epilepsy or seizures
  • Are taking stimulants
  • Have a medical condition that heightens the risk of seizures

TMS Therapy Pros and Cons

Pros of TMS Therapy

The benefits of TMS therapy include:

  • Well-tolerated treatment
  • Non-invasive
  • No possibility of addiction
  • Less severe side effects than other treatments
  • High efficacy

Cons of TMS Therapy

The downsides of TMS therapy include:

  • Still a relatively new treatment option
  • Requires a substantial time commitment
  • No data on long-term effects

TMS Therapy Success Rate

TMS has mainly been studied as a therapy for depression. The success rates of TMS treatment for depression are impressive. Response rates for depression are between 30 and 64 percent.7

However, more research is necessary to understand the success rates for other conditions.

TMS Therapy Cost

TMS therapy’s average cost is between $400 and $500 per session, with a total cost of around $15,000 for a full course of treatment. 

This is considerably less than the most comparable treatment, electroconvulsive therapy (ECT), which costs about $2,500 per treatment session and requires a full ten sessions. You would also have to factor in the cost of a weeklong hospital stay for ECT treatment, which is not needed with TMS therapy. 

What is the success rate of TMS therapy?

Most TMS therapies have a success rate of 70 to 80 percent.

What are the benefits of TMS?

Generally, TMS therapy is a safe and effective treatment for alcoholism (alcohol use disorder) and drug addiction (substance use disorder).

This therapy is also well-tolerated, non-invasive, non-addictive, and produces less severe side effects than other treatments.

How long do the effects of TMS treatment last?

Each individual's level of depression is unique, so it is difficult to determine how long TMS treatment will last.

Some patients have mild to moderate depression, while others struggle with severe depression. However, most patients who let the treatment run its full course see improvements in their symptoms for six months to a year+.

Can TMS make you worse?

There is no evidence that suggests TMS treatment can make anxiety or depression symptoms worse.

Do you have to miss work for TMS therapy?

During TMS, you are expected to receive treatment five days a week for multiple weeks. This means you may have to miss a few hours of work daily. This depends on your work schedule, the location of the clinic, and the hours of your appointments.

As sessions can take anywhere between 30 to 40 minutes, you may be able to receive treatment before or after work.

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Resources

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  1. NIMH. “Brain Stimulation Therapies.” National Institute of Mental Health https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies
  2. Janicak, Philip G, and Mehmet E Dokucu. “Transcranial magnetic stimulation for the treatment of major depression.” Neuropsychiatric disease and treatment vol. 11 1549-60. 26 Jun. 2015, doi:10.2147/NDT.S67477, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4492646/
  3. Chail, Amit et al. “Transcranial magnetic stimulation: A review of its evolution and current applications.” Industrial psychiatry journal vol. 27,2 : 172-180. doi:10.4103/ipj.ipj_88_18, https://pubmed.ncbi.nlm.nih.gov/31359968/
  4. NIAAA. “Rehabilitating the Addicted Brain With Transcranial Magnetic Stimulation.” National Institute on Alcohol Abuse and Alcoholism https://niaaa.scienceblog.com/67/rehabilitating-the-addicted-brain-with-transcranial-magnetic-stimulation/
  5. Chou, Ying-Hui et al. “A systematic review and meta-analysis of rTMS effects on cognitive enhancement in mild cognitive impairment and Alzheimer's disease.” Neurobiology of aging vol. 86 , https://pubmed.ncbi.nlm.nih.gov/31783330/
  6. Gold, Alexandra K et al. “Clinical applications of transcranial magnetic stimulation in bipolar disorder.” Brain and behavior vol. 9,10 , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790310/
  7. De Risio, L., Borgi, M., Pettorruso, M. et al. Recovering from depression with repetitive transcranial magnetic stimulation (rTMS): a systematic review and meta-analysis of preclinical studies. Transl Psychiatry 10, 393 , https://www.nature.com/articles/s41398-020-01055-2

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