Transcranial Magnetic Stimulation (TMS) is a non-invasive therapy that uses magnetic pulses to target the dorsolateral prefrontal cortex (DLPFC) of the brain. The DLPFC is associated with mood regulation. The TMS device, similar in power to an MRI scanner, delivers gentle pulses that target brain circuits that control the experience of emotions. Over a course of treatments, TMS 'resets' brain activity by altering both the electrical firing pattern of brain cells and the release of chemicals that pass information between brain cells. Over time, TMS corrects charges in the brain structure that can be caused by depression. It is through these effects that TMS offers the probability of providing lasting relief.
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People report a steady tapping on the head. Most people quickly adapt to the treatment within the first few sessions.
There are 20 treatment sessions. Active treatment time is 20-30 minutes. You'll need to allow 30-45 minutes for each appointment.
There may be temporary sensitivity at the treatment site and transient headache or fatigue. Most people report no side effects. There is a very rare risk of seizure (1:30000) equal to the risk from antidepressant medications.
We use bilateral TMS. This involves a combination of right sided low frequency repetitive TMS (rTMS) and left sided theta-burst stimulation (iTBS). Theta-burst stimulation is a recently developed innovation in TMS treatment which is at least as effective as traditional protocols and cuts treatment time down to 3 minutes. The advantage of our bilateral treatment protocol is that it increases the chance of successful outcome, while also significantly reduces the treatment duration.
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The below graph, based on the STAR*D (Sequenced Treatment Alternatives to Relieve Depression) study, shows that with each successive treatment step, individuals with treatment-resistant depression—those who do not respond to standard antidepressant medication or talk therapy—experience progressively lower rates of remission, dropping from 36.8% at Initial Treatment Attempt to just 6.9% by 4th Treatment Combination (Rush et al., 2006).
In contrast, Transcranial Magnetic Stimulation (TMS) has been shown to achieve remission rates of approximately 30–40% in treatment-resistant populations (O’Reardon et al., 2007; Carpenter et al., 2012), making it a promising alternative after conventional treatments have failed.
Rush, A.J., Trivedi, M.H., Wisniewski, S.R., et al. (2006). Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. American Journal of Psychiatry, 163(11), 1905–1917.
O’Reardon, J.P., Solvason, H.B., Janicak, P.G., et al. (2007). Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biological Psychiatry, 62(11), 1208–1216.
Carpenter, L.L., Janicak, P.G., Aaronson, S.T., et al. (2012). Transcranial magnetic stimulation (TMS) for major depression: a multisite, naturalistic, observational study of acute treatment outcomes in clinical practice. Depression and Anxiety, 29(7), 587–596.
