Transcranial magnetic stimulation

Depressive disorders are a debilitating disease that probably affects over 300 million people around the world. Researchers estimate that by 2020 Depression will be the second leading cause of disability in the world.

Every year, more than 30,000 people commit suicide in the United States alone, 60% of whom are depressed. Too often a slow approach is used to solve the problem, and the patients themselves end up with suboptimal treatments that do not bring results.

It is well known that antidepressants do not work at all. In fact, a study published in the journal American Medical Association revealed that 4.5 million people in the United States suffering from depression do not respond fully to prescription antidepressants.

The good news is that there are proven non-pharmacological treatments, such as transcranial magnetic stimulation (TMS), which can be part of the discussion from the very beginning. Since 2010, the American Psychiatric Association has recommended the use of transcranial magnetic stimulation (or TMS) as a second-line treatment in adult patients with depression who have not used the initial antidepressant treatment.

Although this is a newer treatment for depression (the first NeuroStar machine was approved by the FDA in 2008), TMS is a proven option with impressive performance indicators and test results.

How does TMS work?

In contrast to electroconvulsive therapy, which applies electricity directly to the brain to create convulsions, TMS is an infectious, non-invasive treatment that uses magnetic impulses to stimulate areas of the brain that are inactive in depression, such as the prefrontal cortex. Patients do not sleep during treatment and can return to their daily activities, including driving right after the session.

During the first treatment session, the doctors identify the patient’s motor threshold, which is the intensity of the magnetic field, which will be administered during the entire treatment. The strength of the field is tailored to the individual needs of each patient to ensure the correct therapeutic dose.

Individual TMS sessions do not last this long. The device can provide the right dose in just 19 minutes. The therapy is usually applied five days a week for four to six weeks. At the end of treatment, a period of cone may occur, in which the number of treatments is gradually reduced.

Who is TMS for?

TMS is indicated for the treatment of adult patients with major depression who have not responded to at least one antidepressant. However, TMS may not be suitable for everyone. Patients are encouraged to talk to their doctor about treatment. TMS should not be used in patients who have indelible conductive metal or implants in or near the head or in patients with active or inactive implants, such as deep brain stimulators, cochlear implants, or vagal stimulators.

For those who do not respond to medication or who do not tolerate the negative side effects of drugs and want to explore other therapies, TMS can be a viable option. The most common side effect associated with TMS is mild or moderate pain or discomfort at or near the treatment site, which is a temporary side effect that usually occurs only in the first week of treatment.

Is TMS effective?

Many studies confirm the effectiveness of TMS in depression. A randomized controlled study of 199 patients showed that TMS increased the chances of remission four-fold after six weeks compared to the sham procedure. An open-label study found that 58% of patients responded remarkably to treatment, and 37% achieved complete remission of depressive symptoms.

The patient’s response to treatment varies, and some of them give positive results in the first few weeks. The effectiveness of TMS mirror tests results from clinical trials. On average, these patients have not seen success with more than nine antidepressants, and the average length of their current depressive episode is three to five years.