TMS: Further Investigation

Mental health disorders are some of the leading causes of disability worldwide. Depression is one of the most common mental health disorders, and it affects 18% of U.S. adults every year. While there are many different treatment options for depression, first-line, conventional treatments may not work for everyone. In most cases, depressed patients will respond well to a combination of medication and talk therapy. However, a significant minority of depression patients will not see any improvement from taking an antidepressant medication. Unfortunately, patients who don’t respond to their initial antidepressant prescription are less likely to react favorably to subsequent prescription drugs.

In 1985, scientists Andrew Barker and his team invented the first modern TMS device. However, the technology and physics of TMS technology date back several hundred years prior. People first discovered that the human body ran on electrical circuits and impulses in the late 1700s. The modern-day TMS device also has roots that date back to the late 1800s, when scientist Michael Faraday created the first magnetic field when he ran electricity through a coil.

The brain’s complex neurotransmitter systems are responsible for a range of feelings and symptoms. It is believed that when these transmitters are imbalanced, depression symptoms will arise. Pharmacological treatment methods target neurotransmitters and aim to restore the balance necessary to alleviate depression symptoms. But most first-line depression treatments do not offer precise targeting. TMS, however, does.

With TMS, a magnetic coil is placed over certain regions of the brain. The coil delivers magnetic pulses to the regions thought to play a role in the manifestation of adverse symptoms.

rTMS

rTMS, or repetitive transcranial magnetic stimulation, delivers short, electromagnetic pulses to certain areas of the brain for thirty or sixty minutes. These magnetic pulses are about the same strength as the magnetic waves used in an MRI machine.

TMS is a relatively new treatment method that hasn’t been used in the U.S. for very long. Canada was actually the first country to approve TMS treatment, but that was as recent as 2003. The long-term effects of TMS are still not widely known or fully understood since the technique is so new to the field of medicine. Fortunately, short-term side effects for TMS, regardless of the coil type, are short-lived and mild to moderate. Most patients will experience scalp tingling or a headache, but these side effects are known to decrease in frequency and duration with subsequent treatment sessions. What clinicians do know about TMS is that it is not associated with the memory loss commonly seen in other deep brain stimulation techniques like electroconvulsive therapy (ECT).

Because TMS is a new treatment method, research is ongoing in this arena, and new coil types for treating different disorders continue to evolve and meet FDA approval.

As it currently stands, TMS sessions are typically conducted in half-hour to one-hour session, which can be a barrier to treatment for some patients. A recent scholarly article from the Brain and Behavior Research Foundation outlined a recent breakthrough in the evolution of TMS. This study found that it may be possible to shorten TMS sessions to as little as ten or fifteen minutes, according to a team of scientists led by Daniel M. Blumberger, M.D.

Brain Talk

The Brain Science Institute from Johns Hopkins Medicine offers “brain talk” podcasts featuring the latest news in TMS treatment for depression, addiction, and chronic pain. Irving Reti, MBBS hosted the show and is the associate professor for Psychiatry and Behavioral Sciences and the director of the Brain Stimulation Program, and the director of the ECT service at Johns Hopkins Hospital. The Brain Stimulation Program has an active preclinical and clinical research program on brain stimulation techniques, including TMS treatment methods. The NIH funds the Brain Stimulation Program lab.

UCTV, University of California’s private television station, has discussed TMS technology in detail on their channel. The Emmy Award-winning television show, The Doctors, has also featured TMS technology on several episodes and they’ve interviewed patients who have benefitted from the treatment. E.R. physician Dr. Travis Stork, and plastic and reconstructive surgeon Dr. Andrew Ordon host the show.

The company BrainsWay was established in 2003, and it invented a flagship dTMS device for treating major depressive disorder. The treatment is based on patents filed with NIH and BrainsWay holds a license from the NIH for the patent and use of this dTMS technology. BrainsWay’s device has been FDA approved for treating major depressive disorder in adults. The device has been used in private clinics and in numerous clinical trials on dTMS treatment from around the world.