TMS Treatment: Illuminating the Journey Through Mental Darkness

About TMS Transcranial Magnatic Stimulation

What is TMS?

Transcranial magnetic stimulation (TMS) is a non-invasive brain modulation technology. It does not require anesthesia and it is generally exceptionally well tolerated, in contrast to the side effects of medications and electroconvulsive therapy (ECT). The TMS machine produces an alternating magnetic field which induces electric currents at a specific area of the brain. The strength of the magnetic field generated is similar to that of a magnetic resonance imaging (MRI) device. It stimulates a discrete part of the brain, resulting in multiple changes in the nervous system, including promoting neural growth, modulating neural networks, and stimulating brain chemicals release. TMS has been proven safe and effective.

Stimulates nervous system growth

Releases brain chemicals

Changes neural network

How does TMS improve mental disorders?

Despite the efficacy of TMS having been well established, the underlying mechanism is still a hot topic of research and there have been several proposed mechanisms:

  • TMS stimulates the growth of the nervous system – most notably the hippocampus, a brain structure which is crucial for mood and memory, and which is dysfunctional in many mental disorders. A study in patients with depression demonstrated that the size of the hippocampus increased after TMS. 
  • TMS changes the neural network (functional connectivity), particularly affecting remote brain regions which are responsible for mood regulation.
  • TMS stimulates the release of numerous brain chemicals. The most remarkable example is brain-derived neurotrophic factor (BDNF), which is a chemical crucial for nerve growth. It enhances neuronal survival and improves neural connections. Like conventional antidepressants, TMS also stimulates the release of serotonin and dopamine.
human brain 2021 08 26 15 33 00 utc 1
  • TMS stimulates the growth of the nervous system – most notably the hippocampus, a brain structure which is crucial for mood and memory, and which is dysfunctional in many mental disorders. A study in patients with depression demonstrated that the size of the hippocampus increased after TMS. 
neurons electrical pulses 2021 08 26 18 26 30 utc 1
  • TMS changes the neural network (functional connectivity), particularly affecting remote brain regions which are responsible for mood regulation.
3d illustration model of serotonin molecule horm 2021 08 31 13 46 21 utc 
  • TMS stimulates the release of numerous brain chemicals. The most remarkable example is brain-derived neurotrophic factor (BDNF), which is a chemical crucial for nerve growth. It enhances neuronal survival and improves neural connections. Like conventional antidepressants, TMS also stimulates the release of serotonin and dopamine.

Conditions We Treat

depression

Major Depressive Disorder

ocd

Obsessive Compulsive Disorder

Other Conditions

While TMS is not FDA approved for some diagnoses, we understand that patients may have tried all other treatments with little success. We may accept patients with the following conditions if the benefits appear to outweigh the potential side effects.

 

Click on the diagnoses for more information about the evidence of TMS in those conditions.

Frequently Asked Questions

I have been taking medications. Why do I need TMS?

Most patients are only  treated with medications. However, up to 30% of patients with depression are medication resistant (i.e. do not adequately respond to at least 2 antidepressants). This is even worse in obsessive-compulsive disorder, for which up to 60% are treatment resistant. Therefore, when you have significant symptoms even with medications, you should consider TMS.

We often see residual symptoms in depression and obsessive-compulsive disorder, which can result in poor mental wellbeing; impaired social functioning, both occupational and interpersonal; and poor physical health.

TMS is a neuromodulation therapy, which has different mechanisms from medications. TMS is effective in reducing symptoms in treatment-resistant depression and obsessive-compulsive disorder.

Who cannot receive TMS?
Most patients can receive TMS, but there are some contraindications. Since TMS involves magnetic induction, any patients with non-removable metal in their head (except  braces or dental fillings) should not receive TMS. The following is a list of metal implants that can prevent a patient from receiving TMS:
  • Brain stent
  • Aneurysm clip/coils
  • Deep brain stimulator
  • Metallic implants in your ears and eyes
  • Facial tattoos with metallic or magnetic-sensitive ink
  • Other metal devices or objects implanted in or near the head
There are also some relative contraindications, mostly related to an increased risk of seizure. For example, a recent (<30 days) hemorrhagic stroke or head injury. Please discuss with our psychiatrist to evaluate the benefits and risks before the TMS treatment.
What is the difference between TMS and electroconvulsive therapy (ECT)?
While both are effective for the treatment of several mental illness, they work differently. In contrast to ECT, TMS is non-invasive and it does not need anesthesia. Other differences are shown in the table below.
TMS versus ECT
TMSECT
Recovery timeCan return to work straight after TMSRequires recovery time (could be up to a few hours)
Effect on memoryNeutral/Procognitive effectMild short-term memory loss Confusion
Induction of seizureRarely occurs (<1/10000)Requires a seizure every time
Sessions requiredUsually 20-30 sessions (4-6 weeks)6-12 sessions (3-6 weeks)
Insurance coverageNot covered by MSP. Please enquire your private insurance provider for coverageCovered by MSP
Are there any side effects from TMS?

Most side effects are mild and self-limiting. The most common one would be headache and discomfort at the site of stimulation. Rarely, there is a <0.1% risk that seizure could occur. Notably, this is NOT higher than the lifetime prevalence of seizure in the general population.

I am pregnant. Can I receive TMS?

TMS is considered safe for mothers and the fetus. Treatment of depression during the pregnancy and post-partum period is important. With significant depressive symptoms in the mother, babies have more difficulties developing a secure attachment. They can be withdrawn or passive, and develop skills later than their peers. In toddlers, they tend to be less independent, have more trouble accepting discipline and be more aggressive. School-age children might not do as well in school and have an increased likelihood of anxiety, depression and other mental illness.

A recently published long-term study demonstrated the safety of TMS in both children and mothers. After the mothers had received TMS, they and their children were followed for more than 20 years. None of the mothers or children experienced any detrimental effects from TMS.

What factors affect the treatment outcome?

We hope that all our patients can improve with TMS, but there are numerous factors affecting the chance of recovery.

Positive predictors of TMS outcome include:

  • Shorter duration of depression
  • Recurrent depressive episode
  • Taking a concomitant antidepressant
  • Being less treatment resistant
  • Presence of sleep disturbance 

Negative outcome predictors include:

  • Older age
  • Short duration of TMS therapy (<15 sessions)
  • Psychotic depression
  • History of poor response to electroconvulsive therapy (ECT)

Read More:  Predictors of Response to Repetitive Transcranial Magnetic Stimulation in Depression: A Review of Recent Updates

How likely will depression improve with TMS?
In non treatment resistant depression, most patients show significant improvement and two thirds of them can see absence of depressive symptoms. In treatment-resistant depression, about one in three patients show significant improvement. Compared to patients without TMS, TMS is more than 5 times as likely to achieve a clearance of depressive symptoms:
Remission rate of treatment-resistant depression
With TMSWithout TMS
30%6%
How good is the treatment effect in obsessive-compulsive disorder (OCD)?

The data with TMS has been encouraging. About 40-60% of patients with OCD are resistant to at least one medication.

With TMS, near half of patients with treatment resistant OCD can improve their symptoms significantly. TMS also improves depressive symptoms in addition to the obsessive-compulsive symptoms.

Is the effect of TMS durable?

Yes, the effect of TMS is durable. After the successful initial treatment, half of patients see sustained responses up to 1 year. Receiving a maintenance course of TMS can sustain the therapeutic effect of TMS. We also recommend patients to continue their oral antidepressants to maximize the durability of the treatment effect of TMS.

Read more about the study

Is a shorter but more intensive course of TMS available?

Yes. The treatment course of TMS can be given several times a day over 5 days. The remission rate was near 80% for patients with depression in a controlled study conducted by Stanford University.