Charles Surette, MD
No two cases of depression, and no two people with depression, are exactly the same. Some patients may benefit from psychotherapy, also called talk therapy, alone, while others may benefit from medications such as an antidepressant alone. Other patients may benefit from a combination of medications and talk therapy together.
Some patients, however, may not benefit from conventional treatments for depression. For example, patients may report bothersome side effects from medications, or may find that medications have been ineffective or only partially effective, even when taken correctly and combined with talk therapy. Other patients may simply not want to take medications to treat their depression, and talk therapy alone may not be enough to adequate control symptoms of depression. In these and other situations, many patients and their mental health providers may look to other options for treatment of depression.
Transcranial magnetic stimulation, or TMS for short, is a method of treating depression and other mental health concerns without the use of additional medications. TMS works by creating a magnetic current using a special coil that is attached to a special machine that regulates the intensity and frequency of the current. The magnetic coil is placed close to the head, near to a part of the brain that is thought to be less active in people with depression compared to people without depression. The magnetic current then produces in electrical current in the brain, which in turns stimulates cells in the brain called neurons, which communicate with each other to control the body’s functions including thinking and experiencing emotions.
By stimulating neurons in a particular part of the brain, it is thought that neurons are better able to form new connections which may help to alleviate symptoms of depression, such as feeling sad or blue, having little energy to accomplish everyday tasks, or no longer enjoying hobbies or interests.
Research into TMS has been ongoing since the 1980s, and has been approved for use in the United States by the Food and Drug Administration (FDA) since 2008.
You and your mental health provider will decide together on the most appropriate treatment options for you, including TMS, based on your current symptoms and concerns following a complete mental health evaluation. Typically, however, patients who have tried at least two (2) different antidepressants from two (2) different classes of medication (such as a selective serotonin reuptake inhibitor [SSRI] or a serotonin norepinephrine reuptake inhibitor [SNRI]) and either continue to have symptoms of depression or have had intolerable side effects are considered good candidates to receive TMS treatment for depression.
You and your mental health provider will review your complete medical and mental health history in order to determine if TMS or another treatment is right for you for the treatment of depression; however, certain medical conditions and procedures require special attention when considering TMS as a treatment option, including a history of epilepsy or another seizure disorder, a history of brain tumor or other structural abnormality of the brain, a history of any implanted medical device, such as cochlear implants for hearing or a pacemaker for the heart, or a history of any metal hardware such as plates or screws in the body. Certain mental health conditions also require special care and attention, including bipolar disorder (a condition in which a person may experience severe changes in mood including both depression and euphoria) and psychosis (a condition in which a person may have difficulty distinguishing what is real and what is not).
After you and your mental health provider decide that TMS is right for you, you will first undergo a mapping procedure. During the mapping procedure, your provider will several measurements of your head in order to locate the dorsolateral prefrontal cortex (DLPFC), a part of the brain that is thought to be highly associated with depression. After taking measurements of your head, your mental health provider will utilize a magnetic coil, placed on your head, to send a series of single bursts of magnetic current known as test pulses in order to locate the part of the brain that controls the muscles of the hand; this is because this part of the brain is located close to the DLPFC and thus is helpful in determining where to place the magnetic coil during treatment.
Once you have completed the mapping portion of treatment, your mental health provider will fine-tune the strength of the magnetic coil in order to ensure that you receive the appropriate amount of stimulation in order to treat your depression while minimizing side effects as much as possible.
Once the fine-tuning of the magnet is complete, you will undergo treatment with TMS. During each treatment session, you will sit in a chair similar to a dentist’s chair, but with the magnet and its controls attached. Your mental health provider and a dedicated TMS technician will help to position you in the chair in order to ensure your comfort as well as to ensure the magnet is appropriate positioned next to your head.
TMS treatment for depression is administered Monday through Friday. Depending on the specific protocol that you decide on with your mental health provider, treatment may be once per day for approximately 20 minutes for approximately 4-6 weeks total, or treatment may be offered multiple times per day for approximately 10 per session for one week total. During your course of treatment, your mental health provider will check in with you at regular intervals, and your symptoms as well as side effects will be tracked. Your mental health provider may also elect to map your brain a second time to ensure that the placement of the magnet remains accurate. Finally, your mental health provider will schedule a follow-up appointment with you at the end of your course of treatment to discuss next steps.
Most side effects of TMS are mild and go away on their own following each treatment session. Side effects include pain or discomfort near to where the magnet is placed, headache, and fatigue. You may also experience twitching of the muscles in your face during treatment, as the magnet may stimulate some of the nerves in your face. Your mental health provider will review other potential side effects with you prior to starting treatment.
If you are interested in learning more about TMS, contact Principium Psychiatry today by calling 212 – 335 – 0236 to make an appointment to speak with a mental health provider about which treatment is right for you. Principium Psychiatry is a cutting edge mental health clinic with offices in:
Grand Central/Midtown Manhattan in NYC
Wall Street/Downtown Manhattan in NYC
Greenwich, Connecticut
Santa Monica in Los Angeles, California
