TMS: Further Investigation
A Further Investigation into TMS
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.
Depression that is left untreated can lead to a range of adverse, negative effects and severely impact a person’s quality of life. Untreated depression increases a person’s risk of turning to drugs or alcohol to cope with their symptoms, and depression always comes with a risk of self-harm and suicide. Treating at-risk, vulnerable patients effectively is imperative to protecting their ability to function and their quality of life. For patients who are unable to find any relief from conventional pharmacological methods, deep brain stimulation techniques, such as transcranial magnetic stimulation (TMS), have been proven effective for alleviating specific clinical subtypes of depression, and several other disorders.
What can TMS treat?
TMS is used to treat major clinical depression that hasn’t responded to medication. It can also be used to alleviate the symptoms of postpartum depression, chronic depression (dysthymia), and obsessive-compulsive disorder (OCD). Currently, researchers are studying the effects of TMS on bipolar depression and schizophrenia, but therapeutic parameters for TMS treatment have not yet been established for these conditions. Also, TMS can be used to treat chronic migraine, and researchers are also looking into using TMS for treating the symptoms of some neurodegenerative disorders like Parkinson’s, Alzheimer’s, and Multiple Sclerosis (M.S.).
When was TMS invented?
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 use of magnets, coils, and electrical fields is critical to TMS technology and how magnetic impulses impact the human brain, alleviating adverse neurological symptoms. TMS was not approved in the U.S. for treating depression until 2008. It wasn’t until 2013 that insurance companies began to offer TMS coverage. Until 2017, TMS was not widely recognized or used for treating stubborn depression symptoms.
How does TMS work?
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.
This magnetic field induces electrical currents across the brain’s neural pathways, which stimulate the creation of neurotransmitters and other mechanisms thought to alleviate adverse symptoms. Patients and doctors both favor TMS to treatment-resistant depression because it is non-invasive and relatively painless. Patients can return to work or school immediately after a session.
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.
Deep transcranial magnetic stimulation (dTMS) is a method that’s newer than rTMS. dTMs is used to stimulate larger, deeper parts of the brain. The coils used in dTMS are designed differently than the coils used to deliver treatment with rTMS methods. The dTMS coils are called H coils, and they can reach about 4 centimeters below the surface of the skull. H coils are divided into different subtypes and are used for alleviating the symptoms of different disorders. For example, H1 coils are specifically designed to treat depression symptoms, but they have not been FDA approved for treating other ailments. In a dTMs session, patients must wear cushioned helmets. These helmets aren’t required for rTMS treatment. The helmet helps produce a short-lived magnetic field. Most dTMS sessions are conducted for 20 minutes, and patients typically undergo treatment for four or six weeks.
At this time, scientists are unsure if rTMS or dTMS are most effective as a single treatment, or if it will be most effective when combined with other treatment methods for a more holistic, integrated approach to mental health disorder treatment. Research into these areas is ongoing.
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.
For example, sTMS is a device that is used for treating chronic migraine. The “s” stands for “single,” and the device emits a single magnetic pulse to reduce migraine pain and migraine frequency. This device wasn’t invented and approved until 2015.
There are numerous studies and clinical trials being conducted in the U.S., Canada, and the E.U. in particular on the science of TMS, and how it can be used to treat many other disorders besides clinical depression. Patients, doctors, and loved ones of those suffering from mental health conditions will find a plethora of scholarly articles, books, podcasts, and television programs about the evolution of TMS.
What are some scholarly articles on TMS effectiveness?
There are dozens of scholarly articles supporting the use of TMS for a range of disorders and ailments. Many universities and medical centers, and government agencies have studied and continued to conduct clinical trials on TMS methods. Many current articles supporting the use of TMS for major depression treatment have come from Cambridge University. And, NCBI has an extensive list of articles outlining several clinical and subclinical trials on TMS.
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.
Dr. Blumberger and his colleagues successfully tested a new form of rTMS, called iTBS, or intermittent theta-burst stimulation. The technique can deliver stimulation to areas of the brain affected by depression in as little as three minutes, and researchers found iTBS to offer symptom relief on par with the standard rTMS treatment. iTBS can deliver pulses that mimic the brain’s natural theta rhythms. Dr. Blumberger works for the Centre for Addiction and Mental Health at the University of Toronto.
Are there any comprehensive books on the use and efficacy of TMS?
Several books have been published on the use and evolution of TMS. One of the most popular and comprehensive books on TMS treatment is Transcranial Magnetic Stimulation: Clinical Applications for Psychiatric Practice. The book has been edited by clinicians directly involved with TMS treatment methods from the beginning of its use in the early 2000s. The book is intended to provide mental health practitioners with everything they may need to know about TMS treatment for mental health disorders.
The book addresses the different factors that impact “treatment-resistance” in depression, including neurobehavioral, biological, and symptomatic factors. The book aims to address the problems clinicians face in identifying patients who are suitable candidates for TMS. The reason why clinicians face these issues is that the treatment modality of TMS is not fully integrated into most psychiatric practices since it is such a new treatment and many insurance companies do not offer coverage for TMS treatment yet. A lot of psychiatrists are also unfamiliar with how TMS works and who can benefit from the treatment. The book gives clinicians a strong, research-backed foundation for using TMS as a safe, effective treatment for stubborn depression and how certain TMS parameters can impact different types of depression disorders, including postpartum depression and dysthymia.
Are there any podcasts for TMS?
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.
Listen to, Susanne Jesse
Also, Susanne Jesse, the CEO, and Founder of a TMS clinical practice in California have been featured on a TMS podcast on Stitcher, where she outlines what TMS is, and how it is used to treat the symptoms of treatment-resistant depression.
Are there any T.V. shows that discuss TMS technology?
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.
Are there any Youtube channels dedicated to TMS?
People who are curious to learn more about how TMS works on a biological level can find a wide range of Youtube videos dedicated to TMS treatment. But, BrainsWay Treatment is one of the few Youtube channels explicitly dedicated to TMS and bringing awareness of the therapy to the public.
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.
TMS is a breakthrough technology that has helped thousands of people around the world achieve remission from painful, distressing mental health symptoms. As more studies and research on TMS continue to evolve, more disorders will become treatable with this technology. While it’s true that TMS is still in its adolescence as a treatment method for mental health disorders, insurance companies are starting to take note of its effectiveness. In the future, more patients will have access to safe, effective TMS treatment for a range of disorders. Concerned loved ones and depression patients can learn more about how TMS can help them through easy-to-access podcasts, books, and Youtube videos.