Doctor

Transcranial magnetic stimulation (TMS) is a noninvasive treatment for difficult to treat depression. It is considered noninvasive because it does not involve a surgical procedure or anesthesia, and no instruments are used inside the body. Instead, this treatment uses a device that generates magnetic pulses to affect activity in specific parts of the brain.

What Is “Difficult to Treat” Depression?

The American Psychiatric Association defines depression as “a common and serious medical illness that negatively affects how you feel, the way you think, and how you act. The condition is considered “treatment-resistant” or “difficult to treat” when traditional treatments such as medicine and counseling don’t work or have limited success. Patients with this type of depression are at an increased risk of suicide, according to a 2018 literature review published in the Journal of Affective Disorders.

The U.S. Food and Drug Administration approved TMS for use in people who have unsuccessfully tried four different types of antidepressants.

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What Is TMS Treatment Like for Patients?

TMS treatments are usually performed 5 times per week for 4 to 6 weeks. The treatment is done while the patient is awake and seated in a chair. The TMS device has an adjustable arm containing the magnetic coils, with the arm placed so that the magnetic coils are specifically positioned near the patient’s head. The technician calibrates or adjusts the device settings for individual patients.

The magnetic beam only reaches a small area of the brain (the prefrontal cortex, part of the frontal lobe) — not the whole brain. The magnetic impulses help to create electrical activity in this part of the brain. While experts are not entirely sure how TMS therapy works, current data suggests that it helps to modify activity in that specific part of the brain.

When treatment starts, the patient may feel a tapping sensation on their head. Patients wear earplugs because the machine is loud. The treatment session lasts for 20 to 45 minutes.

After treatment, the patient leaves the clinic without any restrictions.

Rates of response to TMS vary depending on age, severity of depression, and additional behavioral health challenges or symptoms. The effects usually last about 1 year.

Does TMS Have Side Effects?

TMS does have some side effects, but they are usually mild. The most common side effects include:

  • Headache
  • Discomfort where the machine touches the head
  • Facial twitching during treatment
  • Feeling dizzy or light-headed

A small portion of patients may experience more severe side effects including:

  • Seizures
  • Hearing loss, if ear protection is not worn during treatment

People who have bipolar disorder may experience manic episodes during or after treatment.

How Do I Know if I Can Receive TMS?

Generally, people who have tried four different types of antidepressants without success are eligible for this treatment. When talking to your doctor about TMS, make sure to mention if you have any of the following:

  • One or more stents in your body, whether in the brain or heart.
  • Devices implanted in your body, like pacemakers or other devices that contain metal.
  • A history of epilepsy or seizures.
  • Other psychiatric illnesses such as bipolar disorder or psychosis.
  • A history of substance abuse.
  • A history of traumatic brain injury.
  • A tattoo with metallic ink.
  • Headaches.

You should be evaluated by a psychiatrist with TMS expertise before beginning this type of treatment. You should be prepared to discuss your health (both physical and mental) and talk about any medical procedures you have had. You should also be familiar with any family history of epilepsy.

For more information, call UPMC Western Psychiatric Hospital at 1-877-624-4100 or 412-624-1000.

For immediate counseling and support, call the resolve Crisis Services hotline at 1-888-796-8226. Trained crisis clinicians answer the phone 24/7, 365 days a year.

Sources

Help With Depression. American Psychiatric Association. Link

TMS Therapy. Clinical TMS Society. Link

Treatment-resistant depression and suicidality. Journal of Affective Disorders. Link

About UPMC Western Behavioral Health

UPMC Western Psychiatric Hospital is a nationally recognized leader in mental health clinical care, research, and education. It is one of the nation’s foremost university-based psychiatric care facilities through its integration with the Department of Psychiatry of the University of Pittsburgh School of Medicine. UPMC Western Psychiatric is the hub of UPMC Western Behavioral Health, a network of nearly 60 community-based programs providing specialized mental health and addiction care for children, adolescents, adults, and seniors throughout western Pennsylvania.