TMS is an engineering marvel shown to be an effective means to stimulate the brain non-invasively (Barker et al. 1985). It was studied for decades prior to clearance by the FDA as a safe, non-medication treatment for depression based upon a large, double-blind sham controlled study (O' Reardon et al. 2007). In 2018, TMS was cleared for the treatment of OCD. There are multiple studied and FDA cleared protocols for delivering TMS for care. During the consultation process we will determine the best care for you based upon your personal needs. We use FDA cleared devices (NeuroStar & MagVenture) and evidence based care when offering TMS to patients.
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The TMS device generates a rapidly changing magnetic field which in turn generates an electrical field in the brain through electromagnetic induction. When this procedure is given to the patient five days per week for many weeks, the patient can reach remission from the symptoms of depression. The current theory is that TMS improves depression by multiple mechanisms of action; particularly it seems to entrain the brain circuitry which is 'depressed' (lower) in functioning when a patient is suffering from Major Depressive Disorder.
We treat depression in TMS patients from multiple locations, including Nashville, Franklin, and Brentwood. Most patients receive their treatment and are in and out of the office within 30 minutes. The actual TMS treatment could be between 3 minutes and 60 minutes depending on the doctor's orders. The time depends on the patient's personal "Motor Threshold" which must be determined at the first treatment. TMS sessions are given 5 times per week for 5-9 weeks; daily sessions are tapered over 3 weeks. The average number of TMS sessions is 36, however, some patients remit sooner and others take longer just as the published scientific literature has shown (Avery et al 2008; McDonald et al 2011, Yip et al 2017).
Research reports clinical TMS for depression yields 60% response and 30% remission. In our office, we optimize outcomes with clinically proven modalities which gives much higher results than even those reported in the literature by combining TMS with CBT and behavioral activation techniques like those in recent literature (Donse et al 2018). We are publishing our results from a recent poster presentation for CTMSS 2020.
Our team wrote the first TMS specific workbook to help fight depression symptoms initially for patients in our offices (Nashville, Brentwood, & Franklin). We use it with all our patients to improve outcomes, and we launched the online version in 2019, making it available for all clinicians and their patients everywhere, TMSworkbook.com.
We have been offering TMS as one of many depression treatments since 2011. We have been using our experience to train other clinicians world-wide on the use of TMS for clinical depression as part of the Clinical TMS Society's PULSES workshop. Dr Cochran is the co-chair for the Education Committee for this organization. Look at our Blog for more information. We regularly are consulted from other offices because of our experience.