Since the 1980s, transcranial magnetic stimulation (TMS) has been used to study the nerve fibers that carry information about movements from the brain to the spinal cord and on to the muscles. In the late 1990s, physicians began to explore the therapeutic potential of transcranial magnetic stimulation for the treatment of a variety of diseases, with depression being the most thoroughly studied to date. Since then, hundreds of randomized, controlled trials studying transcranial magnetic stimulation as a treatment for depression have been conducted by investigators throughout the world.
Transcranial magnetic stimulation (TMS) Therapy was FDA-cleared in October 2008 for patients suffering from depression who have not achieved satisfactory improvement from prior antidepressant medications. Using pulsed magnetic fields, transcranial magnetic stimulation therapy stimulates the part of the brain thought to be involved with mood regulation. TMS Therapy is a short outpatient procedure, performed in your psychiatrist’s office under his or her supervision while you remain awake and alert. The typical initial course of treatment is about 20 minutes, daily over 4-6 weeks.
How does TMS Work?
During the procedure a powerful electromagnet is placed over an area of the brain associated with mood regulation. Magnetic pulses are then delivered consecutively to stimulate nerves and depolarize superficial cortical neurons in the brain. TMS treatment requires no surgery or sedation of any kind and patients can resume regular activity immediately after each treatment session. Through a magnetic coil, TMS Therapy generates highly concentrated, magnetic fields which turn on and off very rapidly. These magnetic fields are the same type and strength as those produced by a magnetic resonance imaging (MRI) machine. TMS works by stimulating brain cells in the prefrontal cortex of the brain, prompting the electrical signal to travel through the neuron to its synapse and trigger the release of neurotransmitters across the synaptic cleft. These electrical currents activate cells within the brain which are thought to release neurotransmitters like serotonin, norepinephrine, and dopamine. The more neurotransmitters are released into the synaptic cleft, the more receptor sites are needed on the receiving synapse. As a result, neurons begin to develop more connections with each other. As the stimulation is repeated, the rate of electrical signaling increases and this neuronal activity eventually becomes self-sustaining. Since depression is thought to be the result of an imbalance of these chemicals in the brain, TMS can restore that balance and, thus, relieve depression.
Clinical studies have shown that one in two patients treated with TMS had a 50% reduction in their symptoms, and after six weeks of treatment, one-third (33%) of patients had no symptoms of their depression or were in “remission”. While there has not been a head-to-head trial that compares TMS to antidepressants, a landmark study (called STAR*D) explored the efficacy of medication to treat patients suffering from MDD and less than 15% achieved “remission”.
It is also important to note that TMS treatment may not eliminate the need to continue taking antidepressant medication, but it could reduce the amount of medication needed by the patient and, thereby, minimize the side effects associated with them.
As seen in the graph below, patients treated at True North TMS at Willow Medical have shown an almost 60% improvement on their PHQ-9 scores during and after their treatment.
TMS Safety and Side effect:
Treatment with TMS Therapy caused very few side effects and was generally well tolerated by patients. The most common side effect reported during clinical trials was scalp discomfort—generally mild to moderate and occurring less frequently after the first week of treatment.
Fewer than 5% of patients discontinued treatment with TMS Therapy due to adverse events.
- No systemic side effects
- No weight gain
- No sexual dysfunction
- No sedation
- No nausea
- No dry mouth
- No adverse effects on concentration or memory
- No drug interactions
- TMS Therapy should not be used in patients with implanted metallic devices or non-removable metallic objects in or around the head. This does not include metallic fillings in teeth.
- TMS Therapy should not be used in patients with implants controlled by physiological signals. This includes pacemakers, implantable cardioverter defibrillators (ICDs), and vagus nerve stimulators (VNS).
OUR TMS TECHNOLOGIES:
Neurostar 8 coil TMS Therapy and Brainsway H-coil Deep TMS Therapy
FDA Approved for MDD and OCD:
Major Depressive Disorder (MDD):
FDA-cleared, non-invasive Transcranial Magnetic Stimulation (TMS) therapy for patients suffering from clinical depression. TMS therapy is a proven, effective option for treating clinical depression.
Obsessive Compulsive Disorder (OCD):
Over two million adults are diagnosed with Obsessive Compulsive Disorder (OCD) each year. Approximately 30-50% of those with OCD are resistant to first-line treatments such as medications (SSRIs) and Exposure Response Prevention (ERP). In addition, at least 30% of OCD patients struggle with co-occurring depression.
The treatment delivers magnetic stimulation to the frontal brain structures and networks, targeting previously unreachable areas of the brain with its proprietary H7-coil. BrainsWay OCD has many advantages over other treatment options, as it is an outpatient procedure that is generally well-tolerated and has no systemic side effects.
BrainsWay OCD therapy can significantly improve OCD symptoms, as was demonstrated in the positive results of BrainsWay’s Deep-TMS study, the only multicenter trial in OCD patients ever conducted. The multicenter study demonstrated that after six weeks of treatment, there was a statistically significant improvement in the primary endpoint results for the active treatment group when compared to sham (p=0.0127).
The improvement was maintained one month after the end of treatment at week 10. The primary outcome measure of this study was the OCD Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the gold standard measure of OCD symptom severity. Importantly, 38.1% of patients in the active group achieved a response of more than 30% reduction in symptom severity as measured by Y-BOCS, compared with just 11.1% in the sham group (p=0.0033). Moreover, 54.8% of patients in the active group achieved a partial response of more than 20% reduction in symptom severity, versus just 26.7% in the sham group (p=0.0076).
Other exciting applications being studied (off-label at this time) include:
- Bipolar depression
- Adolescent depression
- Smoking Cessation