Table of ContentsView AllTable of ContentsDoes It Work?TMS Session ProceduresNumber RequiredWho Should Avoid It?CostFinding TMS Therapy
Table of ContentsView All
View All
Table of Contents
Does It Work?
TMS Session Procedures
Number Required
Who Should Avoid It?
Cost
Finding TMS Therapy
Transcranialmagnetic stimulation (TMS)is a noninvasive treatment that uses targeted magnetic fields to stimulate specific areas of the brain.There are two types, repetitive TMS (rTMS) and deep TMS (dTMS).
Major depressive disorder is typically treated with medications, psychotherapy, or a combination of both. Some people with depression do not find adequate relief with these measures. When symptoms persist even with standard treatment, this is called treatment-resistant depression (TRD).
Up to 70% of people with treatment-resistant depression who receive rTMS have an improvement in their condition.
Both TMS andelectroconvulsivetherapy (ECT)are brain stimulation therapies that are considered to be safe and effective, but they have key differences. ECT uses electrical current to stimulate a brief seizure. TMS uses a magnetic field and does not involve inducing a seizure.
ECT may be more effective and produce quicker results for some people than TMS, but there is also a higher risk of side effects.
This article will discuss the safety and efficacy of TMS for depression, what happens during a TMS session, how many sessions are needed, who should not get TMS, costs related to TMS, and where to find TMS treatment.
TMS for Depression: Does It Work?
Help Is AvailableIf you or someone you know is having suicidal thoughts, dial988to contact the988 Suicide & Crisis Lifelineand connect with a trained counselor. For more mental health resources, see ourNational Helpline Database.
Help Is Available
If you or someone you know is having suicidal thoughts, dial988to contact the988 Suicide & Crisis Lifelineand connect with a trained counselor. For more mental health resources, see ourNational Helpline Database.
MDD is typicallytreated with medicationand/or psychotherapy. MDD that does not sufficiently respond to these treatments is classified as treatment-resistant depression.
An estimated two-thirds of people with depression do not experience adequate control of symptoms from the first antidepressant medication they try, with at least some symptoms remaining after two months of treatment. Each medication tried after is less likely than the one before to be sufficiently effective.
People with MDD may also initially experience benefits from standard treatments but lose these effects over time or be unable to tolerate standard therapies.
An alternative (or sometimes complementary) treatment for TRD is therapeuticneuromodulation. This approach recognizes the brain as anelectrochemicalorgan and uses devices to alter electrical activity in the central nervous system.
Neuromodulation approaches includeECT, which uses electric current to induce a brief seizure, and TMS, which stimulates the brain using a magnetic field.
ECT vs. TMS
The gold standard neuromodulation device is ECT, which has been used for over 80 years. It is considered the most effectivetreatmentfor TRD and is used regularly throughout the United States.
ECT can have side effects and disadvantages, including:
Since 2008, TMS has been available as a neuromodulation procedure that can be used instead of, or along with, ECT. TMS has several advantages, including the following:
How Effective Is TMS?
About 50% to 60% ofpeople with depressionwho have tried but not experienced adequate benefit from medications report a clinically meaningful response to TMS.About 30% to 35% experience remission (their symptoms go away entirely).
This response is not permanent but can last months to over a year. Further TMS treatments may be initiated ifsymptomsreturn.
What Else Can TMS Treat?The FDA has cleared TMS as a treatment for:Several types of depressionDepression with comorbid (co-occurring) anxietyDepression with suicidalityOCDOff-label uses of TMS include:Chronic painTinnitus (ringing in the ears)TMS is also being studied as a possible treatment for conditions such as:Bipolar disorderSmoking cessationPost-traumatic stress disorder (PTSD)Panic disorderDepersonalization disorderSchizophreniaPerinatal depressionCurrently, TMS is approved only for adults, but research is being conducted to see if TMS may be safe and effective for conditions such as:Pediatric depressionMood disordersin adolescents
What Else Can TMS Treat?
The FDA has cleared TMS as a treatment for:Several types of depressionDepression with comorbid (co-occurring) anxietyDepression with suicidalityOCDOff-label uses of TMS include:Chronic painTinnitus (ringing in the ears)TMS is also being studied as a possible treatment for conditions such as:Bipolar disorderSmoking cessationPost-traumatic stress disorder (PTSD)Panic disorderDepersonalization disorderSchizophreniaPerinatal depressionCurrently, TMS is approved only for adults, but research is being conducted to see if TMS may be safe and effective for conditions such as:Pediatric depressionMood disordersin adolescents
The FDA has cleared TMS as a treatment for:
Off-label uses of TMS include:
TMS is also being studied as a possible treatment for conditions such as:
Currently, TMS is approved only for adults, but research is being conducted to see if TMS may be safe and effective for conditions such as:
What Happens During a TMS Session
Steps taken before the first session include:
Treatments take place in a healthcare provider’s office or hospital. No medication oranesthesiais needed. The person is awake during the session, sitting in a comfortable reclining chair.Earplugs are worn to protect hearing from the loud clicking sounds the TMS device makes.
The rTMS device (using electromagnetic coils in a figure eight shape) is placed against the scalp near the area of the brain believed to be responsible for the symptoms (such as the left prefrontal cortex for depression).
The dTMS device is contained in a helmet placed on the head. It has coils in a letter “H” pattern and transmits deeper into the brain.
The procedure is noninvasive. The magnetic field is generated on the surface of the scalp. The magnetic field is similar in strength to what is used inmagnetic resonance imaging (MRI).
The healthcare provider will give a few test pulses, adjusting the device until the right level is reached. This level can be adjusted during the session if necessary.
Treatment is administered as repeated, short electromagnetic pulses that cause small electrical currents, stimulating brain cells in the targeted area of the brain.
The length of the session varies, with treatment lasting from five minutes to an hour.
Bloomberg / Contributor / Getty Images
What Does TMS Treatment Feel Like?
TMS treatment feels like a series of pricks or pulses. It has been described as feeling like a woodpecker tapping on your head.
Some people may feel discomfort ormuscle twitchesearly on, but this can diminish with more treatments. Levels can be adjusted if they are too strong.
Number of TMS Therapy Sessions to Treat Depression
The number of TMS sessions needed can vary, but a course of treatment is typically one session per day, five days a week, for four to six weeks.
Positive results typically become noticeable between the third and sixth weeks of treatment. It is important to finish the full course of treatment, even if relief is found early in early sessions.
The FDA has recently cleared a rapid-acting form of TMS for thetreatment of TRD. This treatment shows similar effectiveness, but works faster, shortens treatment length, and allows for more rapid symptom relief. Multiple sessions are delivered in a single day, with short breaks taken between sessions.
Maintenance TMS sessions may also be suggested. Some studies have found that additional ongoing TMS treatments a period of time after a successful acute course of TMS treatment may reduce the incidence ofrelapse of symptoms.
Should Anyone Not Do TMS Therapy for Depression?
TMS tends to be well-tolerated. Mild to moderate headache, either during or after treatment, is one of the most common side effects of TMS. These usually subside over the first several treatment sessions and can be managed with medications such as Tylenol (acetaminophen), Advil or Motrin (ibuprofen), or aspirin.
Other more common side effects may include:
Uncommon potential side effects include:
The most serious potential adverse effect isseizure, but this is rare. In fact, seizure occurs in only 1 in 30,000 (0.003%) ordinary clinical use treatments.Only one seizure was reported in three large-scale controlled clinical trials, and it occurred in a participant who had heavy alcohol use the night before the TMS treatment.
The majority of TMS-related seizures have occurred in people with a preexisting risk for seizure or when the stimulation parameters exceeded the recommended safety recommendations.
TMS is not appropriate for everyone. Some factors that may make TMS unadvised include:
Your healthcare provider can help you determine if the benefits of TMS outweigh the risks and if the treatment is right for you,
What Is a TMS Dip?Some people experience a temporary worsening of symptoms or a “dip” in their mood after about 10 to 15 sessions (or the second or third day with accelerated TMS), which may last a few days. Talk to your healthcare provider if you have concerns.
What Is a TMS Dip?
Some people experience a temporary worsening of symptoms or a “dip” in their mood after about 10 to 15 sessions (or the second or third day with accelerated TMS), which may last a few days. Talk to your healthcare provider if you have concerns.
Insurance and Out-of-Pocket Costs
The cost of TMS varies, but a 2018 source noted the cost for an acute course of TMS (20 to 30 sessions) ranged from $6,000 to $12,000.
Mosthealth insurance plansprovide coverage for TMS in the treatment of MDD with a history of no improvement with medication.Insurance coverage for TMS is increasing, so it’s worth checking with your insurance provider to see if it is covered.
Where to Get TMS Therapy If You Have Depression
Summary
TMS is a noninvasive treatment thatstimulates the brainusing targeted, powerful magnetic fields. It is considered to be safe and effective for treatment-resistant depression.
A course of TMS treatment for depression varies but is typically once daily, five days a week, for four to six weeks.
TMS is usually well-tolerated, with minor, temporary side effects such as discomfort orheadache. Seizure is considered a risk with TMS, but is rare. Having risk factors for seizure may mean TMS is not an appropriate treatment for you. Talk to your healthcare provider about the risks vs. benefits of TMS.
13 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Harvard Health.Transcranial magnetic stimulation (TMS): hope for stubborn depression.McClintock SM, Reti IM, Carpenter LL, et al.Consensus recommendations for the clinical application of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression: (consensus statement).J Clin Psychiatry. 2018;79(1):35-48. doi:10.4088/JCP.16cs10905 (doi link doesn’t have full text, so linking to PMC)Janicak P, Dokucu ME.Transcranial magnetic stimulation for the treatment of major depression.Neuropsychiatr Dis Treat. 2015;11:1549-60. doi:10.2147/NDT.S67477Somani A, Kar SK.Efficacy of repetitive transcranial magnetic stimulation in treatment-resistant depression: the evidence thus far.Gen Psychiatr. 2019;32(4):e100074. doi:10.1136/gpsych-2019-100074University of Utah Health.Transcranial magnetic stimulation (TMS).Rizvi S, Khan AM.Use of transcranial magnetic stimulation for depression.Cureus. 2019;11(5):e4736. doi:10.7759/cureus.4736National Institute of Mental Health.Brain stimulation therapies.University of California, Los Angeles.After years of depression, gentle electromagnetic stimulation of the brain may provide relief.Centre for Addiction and Mental Health.What is repetitive transcranial magnetic stimulation (rTMS)?HealthLink BC.Transcranial magnetic stimulation (TMS).Tendler A, Barnea Ygael N, Roth Y, Zangen A.Deep transcranial magnetic stimulation (dTMS) - beyond depression.Expert Rev Med Devices. 2016;13(10):987-1000. doi:10.1080/17434440.2016TMS Institute of Arizona.Can TMS make my symptoms worse?Centers for Medicare and Medicaid Services.Transcranial magnetic stimulation (TMS) in the treatment of adults with major depressive disorder.
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Harvard Health.Transcranial magnetic stimulation (TMS): hope for stubborn depression.McClintock SM, Reti IM, Carpenter LL, et al.Consensus recommendations for the clinical application of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression: (consensus statement).J Clin Psychiatry. 2018;79(1):35-48. doi:10.4088/JCP.16cs10905 (doi link doesn’t have full text, so linking to PMC)Janicak P, Dokucu ME.Transcranial magnetic stimulation for the treatment of major depression.Neuropsychiatr Dis Treat. 2015;11:1549-60. doi:10.2147/NDT.S67477Somani A, Kar SK.Efficacy of repetitive transcranial magnetic stimulation in treatment-resistant depression: the evidence thus far.Gen Psychiatr. 2019;32(4):e100074. doi:10.1136/gpsych-2019-100074University of Utah Health.Transcranial magnetic stimulation (TMS).Rizvi S, Khan AM.Use of transcranial magnetic stimulation for depression.Cureus. 2019;11(5):e4736. doi:10.7759/cureus.4736National Institute of Mental Health.Brain stimulation therapies.University of California, Los Angeles.After years of depression, gentle electromagnetic stimulation of the brain may provide relief.Centre for Addiction and Mental Health.What is repetitive transcranial magnetic stimulation (rTMS)?HealthLink BC.Transcranial magnetic stimulation (TMS).Tendler A, Barnea Ygael N, Roth Y, Zangen A.Deep transcranial magnetic stimulation (dTMS) - beyond depression.Expert Rev Med Devices. 2016;13(10):987-1000. doi:10.1080/17434440.2016TMS Institute of Arizona.Can TMS make my symptoms worse?Centers for Medicare and Medicaid Services.Transcranial magnetic stimulation (TMS) in the treatment of adults with major depressive disorder.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Harvard Health.Transcranial magnetic stimulation (TMS): hope for stubborn depression.McClintock SM, Reti IM, Carpenter LL, et al.Consensus recommendations for the clinical application of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression: (consensus statement).J Clin Psychiatry. 2018;79(1):35-48. doi:10.4088/JCP.16cs10905 (doi link doesn’t have full text, so linking to PMC)Janicak P, Dokucu ME.Transcranial magnetic stimulation for the treatment of major depression.Neuropsychiatr Dis Treat. 2015;11:1549-60. doi:10.2147/NDT.S67477Somani A, Kar SK.Efficacy of repetitive transcranial magnetic stimulation in treatment-resistant depression: the evidence thus far.Gen Psychiatr. 2019;32(4):e100074. doi:10.1136/gpsych-2019-100074University of Utah Health.Transcranial magnetic stimulation (TMS).Rizvi S, Khan AM.Use of transcranial magnetic stimulation for depression.Cureus. 2019;11(5):e4736. doi:10.7759/cureus.4736National Institute of Mental Health.Brain stimulation therapies.University of California, Los Angeles.After years of depression, gentle electromagnetic stimulation of the brain may provide relief.Centre for Addiction and Mental Health.What is repetitive transcranial magnetic stimulation (rTMS)?HealthLink BC.Transcranial magnetic stimulation (TMS).Tendler A, Barnea Ygael N, Roth Y, Zangen A.Deep transcranial magnetic stimulation (dTMS) - beyond depression.Expert Rev Med Devices. 2016;13(10):987-1000. doi:10.1080/17434440.2016TMS Institute of Arizona.Can TMS make my symptoms worse?Centers for Medicare and Medicaid Services.Transcranial magnetic stimulation (TMS) in the treatment of adults with major depressive disorder.
Harvard Health.Transcranial magnetic stimulation (TMS): hope for stubborn depression.
McClintock SM, Reti IM, Carpenter LL, et al.Consensus recommendations for the clinical application of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression: (consensus statement).J Clin Psychiatry. 2018;79(1):35-48. doi:10.4088/JCP.16cs10905 (doi link doesn’t have full text, so linking to PMC)
Janicak P, Dokucu ME.Transcranial magnetic stimulation for the treatment of major depression.Neuropsychiatr Dis Treat. 2015;11:1549-60. doi:10.2147/NDT.S67477
Somani A, Kar SK.Efficacy of repetitive transcranial magnetic stimulation in treatment-resistant depression: the evidence thus far.Gen Psychiatr. 2019;32(4):e100074. doi:10.1136/gpsych-2019-100074
University of Utah Health.Transcranial magnetic stimulation (TMS).
Rizvi S, Khan AM.Use of transcranial magnetic stimulation for depression.Cureus. 2019;11(5):e4736. doi:10.7759/cureus.4736
National Institute of Mental Health.Brain stimulation therapies.
University of California, Los Angeles.After years of depression, gentle electromagnetic stimulation of the brain may provide relief.
Centre for Addiction and Mental Health.What is repetitive transcranial magnetic stimulation (rTMS)?
HealthLink BC.Transcranial magnetic stimulation (TMS).
Tendler A, Barnea Ygael N, Roth Y, Zangen A.Deep transcranial magnetic stimulation (dTMS) - beyond depression.Expert Rev Med Devices. 2016;13(10):987-1000. doi:10.1080/17434440.2016
TMS Institute of Arizona.Can TMS make my symptoms worse?
Centers for Medicare and Medicaid Services.Transcranial magnetic stimulation (TMS) in the treatment of adults with major depressive disorder.
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