What Is Transcranial Magnetic Stimulation (TMS)?

Patient in transcranial magnetic stimulation (TMS) experiment
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What Is Transcranial Magnetic Stimulation (TMS)?

Transcranial magnetic stimulation (TMS) is a type of noninvasive deep brain stimulation that may be used to treat severe depression or OCD when other treatments have not been effective.

Transcranial magnetic stimulation, or TMS, has received considerable attention as a possible alternative treatment for certain conditions. Although first developed nearly 30 years ago as a tool to treat major depression, TMS has now been widely investigated for effectiveness in treating a variety of mental illnesses.

Signs You Should Try TMS

There are currently a number of effective medical and psychological treatments for obsessive-compulsive disorder (OCD), depression, and other mental health conditions. If you have treatment-resistant OCD or depression you may be looking for new ways to treat your symptoms. Some signs that TMS might be right for you:

  • You've tried standard treatments for depression but haven't noticed enough improvement.
  • Psychotherapy and medications have not done enough to relieve your symptoms of OCD.
  • You've tried other treatments for chronic migraine pain but haven't obtained sufficient relief.

There are currently ongoing clinical trials looking at the effectiveness of TMS for the treatment of other conditions including childhood depression, smoking cessation, post-traumatic stress disorder, and bipolar disorder. However, the use of this procedure in the treatment of these conditions has not yet received FDA approval and would be considered off-label use.

Talk to your doctor about whether this treatment might be appropriate for you or what other alternatives you might consider to treat your symptoms.

Types of Transcranial Magnetic Stimulation

The two types commonly used are repetitive transcranial magnetic stimulation (rTMS) and deep transcranial magnetic stimulation (dTMS).

Repetitive Transcranial Magnetic Stimulation

Repetitive TMS is the predecessor to dTMS and is a relatively non-invasive procedure that involves placing a small device directly on the skull. This sealed device contains a coil of wire that carries electricity through the magnetic field that it generates. It's called repetitive because it pulses rather than remaining steady.

The flow of electricity through the device stimulates cells in the brain called neurons, changing their activity levels. The activity level of neurons has been linked to symptoms of mental illness, like OCD. How many rTMS treatments you would need depends on the treatment protocol, and would be discussed by you and your doctor prior to starting your treatment. 

Deep Transcranial Magnetic Stimulation

Like rTMS, deep transcranial magnetic stimulation also uses a coil placed directly on the skull, which creates a magnetic field penetrating the brain. The biggest difference between the two types is that the coil used with dTMS, called an H-coil, allows the pulse to penetrate more deeply into the brain.

Uses

In the United States, TMS is approved as a treatment for major depression. In 2013, the Food and Drug Administration (FDA) expanded their approval of the procedure for treating the pain associated with migraine headaches. In 2018, the FDA also approved the use of deep transcranial magnetic stimulation for the treatment of OCD.

Other conditions that may sometimes be treated with TMS include:

Other off-label uses include the treatment of autism, fibromyalgia, and tinnitus. While there is some promising research pointing to potential benefits for the treatment of these conditions, further clinical research is needed to better evaluate how transcranial magnetic stimulation can be used for such purposes.

Impact of Transcranial Magnetic Stimulation

The impact of TMS may depend on the type that is used and the condition that is being treated. For example, while research suggests that rTMS can be effective in the treatment of depression, it may be less useful in the treatment of OCD.

Impact of rTMS

While there have been some reports of rTMS being effective in reducing OCD symptoms, the majority of research findings indicate that rTMS is not effective in reducing OCD symptoms alone or in combination with medication.

Repetitive TMS may indirectly improve the psychological well-being of people coping with OCD by reducing the symptoms of depression that often go along with OCD.

A 2019 consensus recommendation published in the Journal of Clinical Psychiatry suggested that rTMS can be a safe and appropriate treatment for medication-resistant depression that is accompanied by significant anxiety.

Impact of dTMS

Deep TMS has shown greater potential over rTMS in treating mental illness. The Food and Drug Administration (FDA) has approved both rTMS and dTMS for the treatment of major depressive disorder and studies are being done on their efficacy for OCD and other mental illnesses, like bipolar disorder, as well.

Deep TMS might have the most to offer in cases where OCD is difficult to treat. One study showed that people with treatment-resistant OCD who received dTMs had significant improvements in their symptoms. The results were steady for three months.

Tips/Tricks

There are some things you can do to make sure that you get the most out of your TMS sessions. These include:

  • Be consistent. You may need several treatments over a certain period of time before you begin to notice any effects.
  • Check with your insurance. Some insurance plans may cover the cost of your treatment, but you should always check with your policy provider first. Costs can range from $230 to $334 per session and it is not unusual for people to receive 20 to 30 sessions of treatment per year.
  • Follow your doctor's recommendations. Be sure to follow any guidelines or preparation needed prior to and during the procedure.

Potential Pitfalls

There are a few things to watch for if you decide to have TMS. These include:

  • Contraindications: Be aware of any precautions or contraindications associated with TMS. Some people should not undergo the procedure, including those with metal implants in the head. Tell your doctor if you have any implantable devices, stents, bullet fragments, or aneurysm clips near your head or neck area.
  • Lack of standardized protocols: Although TMS has been looked at in a number of studies, there is not necessarily a clear consensus on the exact procedures (such as the stimulation parameters used, the brain areas targeted, and the length of treatment) that should be used.
  • Potential side effects: TMS is generally considered safe when used in accordance with established guidelines. After undergoing TMS, you may have headaches, feel sleepy, and experience other mild, short-term symptoms. Epileptic seizures are a rare but serious side effect of rTMS. 

A Word From Verywell

TMS appears to be a safe and effective treatment option for depression and shows great promise in the treatment of other conditions as well. Further research is needed to explore which symptoms respond best to different types of TMS and to look at the long-term effects that the procedure may have. If you think you might benefit from transcranial magnetic stimulation, talk to your doctor to learn more and explore your options.

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Article Sources
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  2. Food and Drug Administration (FDA). FDA permits marketing of transcranial magnetic stimulation for the treatment of obsessive-compulsive disorder. Published August 17, 2018.

  3. Blom RM, Figee M, Vulink N, Denys D. Update on repetitive transcranial magnetic stimulation in obsessive-compulsive disorder: different targetsCurr Psychiatry Rep. 2011;13(4):289–294. doi:10.1007/s11920-011-0205-3

  4. McClintock SM, Reti IM, Carpenter LL, et al. Consensus recommendations for the clinical application of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depressionJ Clin Psychiatry. 2018;79(1):16cs10905. doi:10.4088/JCP.16cs10905

  5. FDA. FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder. Updated August 17, 2018.

  6. Voigt J, Carpenter L, Leuchter A. Cost effectiveness analysis comparing repetitive transcranial magnetic stimulation to antidepressant medications after a first treatment failure for major depressive disorder in newly diagnosed patients - A lifetime analysisPLoS One. 2017;12(10):e0186950. doi:10.1371/journal.pone.0186950

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