Veterans Affairs Canada
Funding may be available for eligible veterans and RCMP members, subject to authorization.
Transcranial magnetic stimulation
TMS treatment
A non-invasive approach to treatment when conventional care has not provided enough relief.
What is TMS?
Transcranial magnetic stimulation uses focused magnetic pulses to stimulate specific brain networks involved in mood and other psychiatric symptoms. Treatment is non-invasive, does not require anesthesia and is generally well tolerated.
Why consider TMS?
Another option when medication hasn’t helped
TMS can improve certain mental conditions when conventional medications have not provided enough relief.
Non-invasive, targeted treatment
Magnetic pulses stimulate brain areas involved in mood regulation, cognition, and behaviors.
Well tolerated
Common side effects, such as scalp discomfort or headache, are usually temporary.
Get back to your day
Most patients can return to their usual activities after each session.
Read more about the technology
Transcranial magnetic stimulation (TMS) is a non-invasive brain modulation technology. It does not require anesthesia and is generally 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-chemical release.
What happens during treatment?
When you arrive
When you arrive, our technician will check in with you to see if you have any special concerns. Stimulation intensity is established through motor-threshold assessment, and the treatment position is determined through brain mapping.
What it feels and sounds like
The coil produces a repetitive clicking sound during stimulation. Hearing protection is provided during treatment.
Session length and course
Each session may last up to 30 minutes. NeuroLinks offers theta-burst stimulation, which can reduce the stimulation portion of selected TMS sessions to as little as three minutes. The complete appointment may take longer. Treatment is typically given five days a week over 4 to 6 weeks. An accelerated course given over 5 days is available on request.
Comfort and progress
A NeuroLinks psychiatrist oversees treatment planning, clinical progress, tolerability and safety throughout the course.
How TMS works
The clinical effectiveness of TMS is established for selected conditions, although its underlying mechanisms remain an active area of research. Proposed mechanisms include targeted stimulation, changes in connected brain networks and neuroplastic effects.
01
Targeted stimulation
Magnetic pulses induce small electrical currents in a selected area of the brain.
02
Network modulation
Repeated stimulation may influence connected brain networks involved in mood regulation.
03
Neuroplastic changes
Treatment may support changes in neural activity, connectivity and neuroplasticity over time.
Read more about proposed mechanisms
- Nervous-system growth. One proposed effect is stimulation of nervous-system growth, most notably in the hippocampus, a structure involved in mood and memory that can be affected in many mental disorders. A published study in patients with depression reported an increase in hippocampal size after TMS.
- Functional connectivity. TMS may change neural-network connectivity, including remote brain regions involved in mood regulation.
- Neurochemical effects. TMS may stimulate the release of brain chemicals. One example is brain-derived neurotrophic factor (BDNF), which is involved in nerve growth, neuronal survival and neural connections. Like conventional antidepressants, TMS has also been reported to stimulate serotonin and dopamine release.
Conditions considered for TMS
The evidence, regulatory status and suitability of TMS differ by condition. A diagnosis listed here does not mean that TMS will automatically be recommended.
Commonly considered
- Major depressive disorder
- Treatment-resistant depression
- Obsessive-compulsive disorder
Considered individually
- Post-traumatic stress disorder
- Bipolar depression
- Anxiety disorders
- Selected pain conditions, including migraine and fibromyalgia
Who may be eligible?
We assess your suitability for TMS by reviewing your symptoms, treatment history and relevant medical factors.
Treatment funding and coverage
Coverage is not automatic. Authorization depends on the program, the clinical indication and individual eligibility.
WorkSafeBC and other programs
Coverage may be available in selected cases and depends on program approval.
Extended health benefits
Patients should contact their insurer to determine whether their plan provides reimbursement for any part of treatment.
Is TMS appropriate for you?
Suitability depends on your diagnosis, previous treatments, medical history and individual goals. A psychiatric assessment is required before treatment is recommended.
Frequently asked questions
Answers to common questions about TMS, including suitability, side effects and how it compares with other treatments.
How likely will depression improve with TMS?
Depression without treatment resistance
In non treatment resistant depression, most patients show significant improvement and two thirds of them can see absence of depressive symptoms.
Treatment-resistant depression
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 TMS 30%, without TMS 6%.
Are there any side effects from TMS?
Most side effects are mild and self-limiting.
Common effects
The most common one would be headache and discomfort at the site of stimulation.
Rare risks
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.
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.
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.
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.
Therefore, when you have significant symptoms even with medications, you should consider TMS. 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.
Metal implants that can prevent TMS include:
- 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 health conditions, they work differently. In contrast to ECT, TMS is non-invasive and it does not need anesthesia.
| Feature | TMS | ECT |
|---|---|---|
| Anesthesia | non-invasive; does not need anesthesia | needs anesthesia |
| Recovery after treatment | can return to work straight after | requires recovery time (could be up to a few hours) |
| Memory effects | neutral/procognitive effect on memory | mild short-term memory loss and confusion |
| Seizure involvement | rarely induces seizure (<1/10000) | requires a seizure every time |
| Typical treatment course | 30 sessions | 6-12 sessions (3-6 weeks) |
| Coverage | not covered by MSP (enquire private insurance) | covered by MSP |
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.
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?
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)
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 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.
Published research
The remission rate was near 80% for patients with depression in a controlled study conducted by Stanford University.