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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.
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 30-60 minutes. TMS sessions are daily 5 times per week for 5-9 weeks; daily sessions are tapered over 3 weeks. The total 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).
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 and recently 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 use 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 We offer consultation to other offices as well.
What is the history of TMS Therapy?
In 1982, researchers at the University of Sheffield, Michael Polson, Professor Anthony Barker, and Ian Freeston developed a electromagnetic coil and stimulator which they used on the peripheral nerves of the forearm. A few years later, Professor Barker, Reza Jalinous, and Ian Freeston used the coil and stimulator in a "transcranial" manner to stimulate the brain’s motor cortex. Upon publication of their study in Lancet in 1985, researchers around the world became interested in this new way to help understand the function of different parts of the brain.
Since the mid-1990s, TMS has been studied as antidepressant therapy. Researchers like Mark S. George, MD and Alvaro Pascual-Leone, MD began using TMS devices to see if they could improve depression symptoms for patients with treatment refractory depression. The TMS coils and stimulators have been used by researchers around the world in different ways to help improve psychiatric and neurological conditions.
In 2006, the largest randomized, placebo-controlled study ever conducted with TMS Therapy was completed. This study was sponsored by Neuronetics/NeuroStar. In 2008, the NeuroStar TMS Therapy system was cleared for use by the FDA for the treatment of adult patients with major depressive disorder.
Brainsway Deep TMS received FDA clearance to treat major depression for those who have not improved from prior antidepressant medication treatment in 2013.
Since this time, now five other devices have been FDA cleared for use in the US: MagStim, MagVenture, CloudTMS, NextStim, and Mag and More. There are other devices approved outside of the USA.
In the fall of 2018, Brainsway received FDA clearance to treat OCD with TMS and MagVenture received Theta Burst protocol approval. Multiple other devices now feature this same FDA cleared protocol.
As of 2019, over 17,000 papers have been published regarding the use of TMS in stimulating select regions of the brain. The field of TMS has exploded.
What is TMS Therapy?
TMS Therapy is a non-systemic and non-invasive form of neuromodulation, which stimulates nerve cells by delivering highly focused MRI-strength magnetic pulses to an area of the brain that is linked to depressive symptoms.
Non-systemic means that the treatment does not circulate in the bloodstream of the body like medication therapy. Non-invasive means that the treatment does not involve surgery; nothing is put in the body. Patients being treated by TMS Therapy do not require anesthesia or sedation and remain awake and alert throughout the treatment.
TMS treatment for depression is an outpatient procedure that is prescribed by a psychiatrist and performed in a psychiatrist’s office. Generally, the treatment lasts less than one hour. The treatment is typically administered Monday through Friday, over a period of 4-6 weeks.
Some patients may need additional treatments beyond the typical protocol to reach remission. In our office, patients average a total of 36 TMS treatments; some patients need less treatments, and some have needed up to 60 treatments to get fully well.