Transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. TMS can typically be used when other depression treatments have not been effective. Treatment involves the delivery of repetitive magnetic pulses. Therefore, this process is called repetitive TMS or rTMS.
The magnetic pulses used in TMS pass painlessly through the skull and stimulate brain cells that can improve communication between different parts of the brain. How TMS works is not known exactly, but it appears that stimulation has a lasting effect on how the brain works, which can alleviate symptoms of depression and boost your mood.
Magnetic impulses entering your brain can sound terrifying, even animating “shock therapy” images shown in movies like One Flew Over the Cuckoo’s Nest. However, the pulses used in TMS therapy actually have the same type and strength as magnetic pulses used in MRI machines and are considered very safe. Also unlike electroconvulsive therapy (ECT), TMS does not require any sedation or post-treatment downtime and comes without any memory or cognition side effects. In fact, for most people, TMS has fewer side effects than antidepressant medications.
In which diseases can TMS be used?
In the USA to date, transcranial magnetic stimulation therapy has only been approved for the treatment of the major depressive disorder. While depression is a treatable condition, TMS is typically used in situations where standard treatments such as therapy, medication, and self-help techniques are ineffective or, in the case of medication, the side effects are too severe. However, in many European countries, TMS has been approved for many other common conditions, including:
- Anxiety disorders such as OCD
- Post Traumatic Stress Disorder (PTSD)
- Stroke rehabilitation
- Parkinson’s disease
- Alzheimer’s disease
- Chronic pain
- Nicotine addiction
How does it work?
During the RTMS session, an electromagnetic coil is placed on your scalp near your forehead. Electromagnet; It gives a magnetic pulse painlessly, stimulating nerve cells in the area of the brain involved in mental control and depression. It is thought to activate areas of the brain that reduce its activity in depression.
Although the biology of how RTMS works is not fully understood, stimulation affects how the brain works, which can alleviate symptoms of depression and improve mood.
There are different ways of performing the procedure, and techniques can change as experts learn more about the most effective ways to deliver treatments.
Risks in TMS treatment
Recurrent TMS is a non-invasive form of brain stimulation used for depression. Unlike vagus nerve stimulation or deep brain stimulation, rTMS does not require surgery or electrode implantation. In contrast to electroconvulsive therapy (ECT), rTMS does not cause seizures or require sedation with anesthesia. Usually, rTMS is safe and well-tolerated. However, it can cause some side effects.
TMS treatment common side effects
Side effects are usually mild or moderate and improve shortly after an individual session and decrease over time with additional sessions. These can include:
- Scalp discomfort at the stimulation site
- Tingling, spasms, or twitching of facial muscles
Your doctor may adjust the stimulation level to reduce symptoms or suggest taking over-the-counter pain medication before the procedure.
Uncommon side effects
These side effects are rare. These can include:
- Mania, especially in people with bipolar disorder
- Hearing loss if ear protection is insufficient during treatment
How do you prepare?
Before implementing RTMS, you may need:
- Physical exam and possibly lab tests
- Psychiatric evaluation to discuss your depression
- These reviews will help you make sure rTMS is safe and a good option for you.
It may be useful to inform your doctor in the following situations:
- You are pregnant or thinking of becoming pregnant.
- You have any metal or implanted medical device in your body. In some cases, rTMS can be done on people who have metal implants or devices.
However, due to the strong magnetic field generated during rTMS, the procedure is not recommended for some people with the following devices:
Aneurysm clips or coils
Implanted vagus nerve or deep brain stimulators
Implanted electrical devices such as pacemakers or medication pumps
Electrodes to monitor brain activity
Cochlear implants for hearing
Any other metal device or object implanted in your body
- If you are taking any medication, including prescription or over-the-counter drugs, herbal supplements, vitamins, or other supplements and dosages.
- If you have a history of seizures or a family history of epilepsy.
- If you have other mental health disorders such as substance abuse, bipolar disorder, or psychosis.
- If you have brain damage from illness or injury such as a brain tumor, stroke, or traumatic brain injury
- If you have frequent or severe headaches.
- If you have any other medical conditions.
Before your first appointment
Recurrent TMS is non-invasive, does not require anesthesia, and can be treated on an outpatient basis. Someone doesn’t need to take you home after treatment, but for the first treatment, you may choose to go with someone else until you understand how you will feel later.
How about TMS treatment?
Recurrent TMS is usually done in a doctor’s office or clinic. It requires a series of treatment sessions to be effective. Usually, sessions are held daily, five times a week for four to six weeks.
Before treatment begins, your doctor will need to define the best place to put magnets on your head and the best dose of magnetic energy for you. Your first appointment typically takes about 60 minutes.
Most likely, during your first appointment:
You will be taken to a treatment room, asked to sit in a reclining chair, and given earplugs to wear during the procedure.
An electromagnetic coil will be placed in your head and will be turned off and on repeatedly to generate stimulating pulses. This usually results in a tapping or clicking sound that lasts a few seconds followed by a pause. You will also feel a sense of touch on your forehead. This part of the process is called mapping.
Your doctor will determine the amount of magnetic energy required by increasing the magnetic dose until your fingers or hands twitch. Known as your motor threshold, this is used as a reference point in determining the right dose for you. During treatment, the amount of stimulation can be changed depending on your symptoms and side effects.
DURING EVERY TREATMENT
Once the coil placement and dosage have been determined, you are ready to go. What to expect during each treatment:
With the magnetic coil placed on your head, you will be seated in a comfortable chair wearing earplugs.
When the machine is turned on, you will hear clicking sounds and feel your forehead being touched.
The procedure will take about 40 minutes and you will stay awake. You may experience scalp discomfort during and shortly after treatment.
After treatment, you can return to your normal daily activities. Typically, you can expect to work and drive between treatments.
TMS treatment results
If RTMS works for you, your symptoms of depression may improve or go away completely. It may take several weeks for symptoms to subside.
The effectiveness of rTMS may increase as researchers learn more about the techniques, the number of stimulation required, and the best places in the brain to be stimulated.
After completion of an rTMS treatment series, standard depression care such as medication and psychotherapy may be recommended as continuous therapy.
Whether rTMS sessions will benefit your depression with this care is not yet known. This includes continuing treatment in the hope that it will prevent the symptoms from returning.
However, if your depression improves with rTMS and you have another episode of symptoms later, your rTMS treatment may be repeated. This is called re-induction.
If your symptoms improve with rTMS, you can discuss ongoing or maintenance treatment options for your depression with your doctor. Do not neglect to have your health checks done.
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