What is Transcranial Magnetic Stimulation, and How Can TMS Therapy in NYC Help Patients with Depression?

Transcranial magnetic stimulation (TMS) is a noninvasive technology used to treat mental health and mood disorders. It’s best known for its ability to relieve depressive symptoms in patients diagnosed with treatment-resistant depression. (1,2) TMS works by using gentle magnetic pulses to activate certain regions of the brain associated with mood. Throughout a course of TMS therapy, patients receive 1 treatment a day for approximately 20 minutes, 5 days a week, for four to six weeks. Patients then go through a taper period for the next three to five weeks. The total time for a course of TMS treatment is approximately nine weeks. 

TMS received approval from the FDA to treat treatment-resistant depression in 2008. (3) It offers a safe and effective alternative treatment for depression for patients who do not respond to antidepressant medications and/or psychotherapy.  

The Mechanisms Behind TMS

In patients with depression, neurotransmitters can become dysfunctional or depleted. When this occurs, communication between neurons and therefore neural networks that connect different regions of the brain is affected. TMS differs from other depression treatments because it is a noninvasive, nonsystemic method. 

How Does TMS Work?

Neurons are electrochemical cells, which means they can be stimulated either electrically or chemically. Traditionally, antidepressant medications have been used to chemically stimulate neurons. However, we now know that antidepressants do not provide symptom relief for all patients diagnosed with depression. (4)

Transcranial magnetic stimulation is a noninvasive, nonsystemic therapy that stimulates neurons electrically. During a TMS session, a magnetic coil is placed over a specific location of the patient’s scalp. This coil emits magnetic pulses that then prompt an electrical response in the brain. By placing the coil over a predetermined location of the scalp, TMS activates the neurons in areas of the brain associated with depression. When these neurons are stimulated, they begin to release more neurotransmitters, resulting in increased communication among neuronal pathways and the stimulation of other regions of the brain involved in mood regulation.

The theory behind TMS is founded on two basic principles of physics: Ampere’s law and Faraday’s principle of magnetic induction. (5) 

What’s Happening in the Brain After a TMS Session?

A study published in Proceedings of the National Academy of Science (PNAS) has revealed new evidence that points to the effects of TMS on neural connections and therefore neural networks after a TMS session. Results from this study show that TMS places neurons into a state of reorganization, allowing them to form new neural pathways. 

For this study, investigators administered TMS to cats. Before administering TMS, researchers used voltage-sensitive dye (VSD) imaging to create cortical orientation maps of the visual cortex of the brain. These orientation maps were also created after TMS sessions to observe any changes in neural activity.  

At first, cats were exposed to the same visual stimulus both before and after TMS. Researchers observed that after TMS neurons did not respond in a predetermined pattern, but in a less defined way than before TMS was administered. Investigators then started to show the cats one type of visual stimulus before TMS treatment, and a different visual stimulus after TMS treatment. Researchers observed that, after TMS, when cats were exposed to visual stimulus different from what they were shown before TMS, new neural pathways were formed. Moreover, neurons showed a preference to the patterns created after TMS, even hours following treatment. 

The results observed in this study suggest that TMS makes neurons vulnerable to reorganization, meaning that individuals can reshape neural networks and therefore form new behavioral and mood patterns. This evidence is very important to the future of understanding the exact mechanism of how TMS helps relieve symptoms of mental health and behavioral disorders. (6)

TMS Provides Long-Term Results After Just One Course of Treatment

A great advantage to TMS therapy is that it has been proven to provide long-term results with just one course of treatment. One study showed that as many as 62.5 percent of patients who respond to treatment or who achieve remission with TMS continues to show improvement of depressive symptoms one year after treatment. (7)

One course of TMS treatment consists of 9 weeks of sessions, with each session lasting only 19 minutes. The patient has 5 sessions per week for the first few weeks of treatment, and then gradually tapers off to fewer treatments per week until the 9 weeks are completed. Most patients have no trouble fitting TMS appointments into their daily lives.

TMS in New York City is Covered by Insurance

Additionally, TMS is covered by insurance. As a practitioner of transcranial magnetic stimulation in New York City, many of the insurance providers I’m in-network with offer coverage for TMS, and I have had no problems arranging single-case agreements with plans I’m out-of-network with.

TMS May Help Patients Diagnosed With Other Mental Health Disorders

TMS is currently approved by the FDA to treat treatment-resistant depression and OCD. (8) But many clinics are already using TMS off-label to treat other mental health and behavioral disorders, including:  

Post-traumatic stress disorder (PTSD) 

TMS has been shown to improve PTSD symptoms in veterans and individuals diagnosed with PTSD and traumatic brain injury (TBI). (9) Currently, the Providence VA Medical Center in Rhode Island administers TMS to veterans diagnosed with PTSD, with support from the US Department of Veterans Affairs Center for Compassionate Care Innovation (CCI) for the use of TMS for the treatment of PTSD. (10)

Anxiety

Similar to depression, individuals diagnosed with general anxiety disorder have been shown to have an abnormality in the regulation of activity in certain regions of the brain, more specifically the anterior cingulate and dorsal medial prefrontal cortex. Since TMS can regulate neural activity in individuals with depression, scientists believe that TMS might also be an effective treatment for anxiety. (11) 

Cognitive function

TMS has been shown to enhance long-term memory in adults suffering from age-related cognitive decline by improving hippocampal-cortical network function. This small sample study shows promise in future research regarding the use of TMS to improve cognitive function in older adults. (12)

TMS is a Novel Treatment That is Gaining Popularity

The nature of TMS as a noninvasive and nonsystemic treatment means that it does not have the side effects nor the invasive treatment process associated with other depression treatments like antidepressant medications, electroconvulsive therapy (ECT), and deep brain stimulation.

Antidepressants are known to cause uncomfortable side effects that often lead patients to stop taking their medications, jeopardizing their treatment plan and their health. ECT and deep brain stimulation require anesthesia and a surgical procedure to implant electrodes in the brain.

TMS has been noted to have very mild and very few side effects, including scalp discomfort and tingling or twitching of the face muscles. Moreover, TMS is an outpatient treatment that allows patients to return to work immediately following their appointment. For this reason, many patients diagnosed with depression are opting for TMS and prefer not to take antidepressants or try invasive treatments such as ECT or deep brain stimulation. 

Resources:

1. Avery DH, Isenberg KE, Sampson SM, et al. Transcranial magnetic stimulation in the acute treatment of major depressive disorder: clinical response in an open-label extension trial. J. Clin Psychiatry. 2008; 69:441-451. Click Here. Accessed August 27, 2018.

2. Carpenter, et al. Transcranial magnetic stimulation (TMS) for major depression: a multisite, naturalistic, observational study of acute treatment outcomes in clinical practice. Depress Anxiety. July 2012;29(7):587-96. Click Here. Accessed August 27, 2018.

3. Horvath JC, Mathews J, Demitrack MA, Pascual-Leone A. The NeuroStar TMS device: conducting the FDA approved protocol for treatment of depression. The Journal of Visualized Experiments. 2010;12(45):2345. Click Here. Accessed August 26, 2019.

4. Ionescu DF, Rosenbaum JF, and Alpert JE. Pharmacological approaches to the challenge of treatment-resistant depression. Dialogues in Clinical Neuroscience. 2015; 17(2):111–126. Click Here. Accessed August 27, 2019.

5. Basil B, Mahmud J, Mathews M, Carlos Rodriguez C, and Adetunji B. Is There Evidence for Effectiveness of Transcranial Magnetic Stimulation in the Treatment of Psychiatric Disorders? Psychiatry (Edgmont). November 2005;2(11):64–69. Click Here. Accessed August 28, 2019.

6. Kozyrev V, Staadt R, Eysel UT, and Jancke D. TMS-induced neuronal plasticity enables targeted remodeling of visual cortical maps. Proceedings of the National Academy of Science (PNAS). June 2018;115(25):6476-6481. Click Here. Accessed August 28, 2019. 

7. Dunner DL, Aaronson ST, Sackeim HA, et al. A multisite, naturalistic, observational study of transcranial magnetic stimulation for patients with pharmacoresistant major depressive disorder: Durability of benefit over a 1-year follow-up period. J Clin Psychiatry. 2014;75(12):1394-401. Click Here. Accessed August 27, 2018.

8. Rebecca Voelker, MSJ. Brain Stimulation Approved for Obsessive-Compulsive Disorder. The Journal of the American Medical Association. 2018;18;320(11):1098. Click Here. Accessed August 26, 2019.

9. Namgung E, Kim M, and Yoon S. Repetitive transcranial magnetic stimulation in trauma-related conditions. Neuropsychiatric Disease and Treatment. 2019;15:701–712. Click Here. Accessed August 28, 2019.

10. Weistreich T. Veterans with PTSD treated with Transcranial Magnetic Stimulation. US Department of Veterans Affairs. Published June 1, 2018. Click Here. Accessed August 28, 2019.

11. Paulesu E, Sambugaro E, Torti T, Danelli L, Ferri F, Scialfa G, Sberna M, Ruggiero GM, Bottini G, Sassaroli S. Neural correlates of worry in generalized anxiety disorder and in normal controls: a functional MRI study. Psychological Medicine. 2010;40(1):117-124. Click Here. Accessed August 28, 2019.

12. Nilakantan AS, Mesulam MM, Weintraub S, Karp EL, VanHaerents S, and Voss JL. Network-targeted stimulation engages neurobehavioral hallmarks of age-related memory decline. Neurology. May 2019;92(20). Click Here. Accessed August 28, 2019.