Depression is a serious mental health disorder that affects how you feel, think, and act. While talking therapy and antidepressant medications are used to treat it, some people do not respond to these treatments. It is therefore important to have alternative approaches. Transcranial magnetic stimulation (TMS) is an approach that uses non-invasive brain stimulation to manage symptoms of depression.
We will speak about what transcranial magnetic stimulation is and how it works to reduce and even completely eradicate depressive symptoms. We will also discuss the treatment process, how many sessions you typically have, and what to expect from them. If you or a loved one is suffering from depression TMS treatment may be for you.
Depressive disorders are mood disorders that are characterized by a lack of motivation and persistently feeling low, both of which significantly affect your daily life. While it is normal to feel low at times, this can become a problem when it is particularly intense or when it lasts for a long time. Depression is the most common mental health disorder, with twenty-one million adults in the US having at least one depressive episode in 2020. That is over eight percent of US adults.
Like other mental health disorders, depression is steeped in stigma. Some believe that those who suffer from depression need to just fix their problems by themselves. But this does not help those suffering, sometimes it is not possible to make changes by yourself.
Due to the stigma which surrounds depression, it can be difficult to accept that you or a loved one is suffering from it. You may also struggle to accept that a loved one is struggling with depression because it can seem like a scary and unsolvable problem. However, there is treatment available, and recognizing symptoms early can help you or a loved one recover.
If depression is left untreated it can lead to risky behaviors such as substance abuse and addiction. It can also lead to relationship breakdown, problems at work, and difficulties overcoming a serious illness. People with depression are sixty-four percent more likely to develop coronary artery disease.
Most people with depression do not attempt suicide, but ninety percent of people who die from suicide may have experienced a mental health condition. Understanding signs of suicide could help you notice if a loved one is suicidal. Signs include:
If a loved one is displaying these symptoms you can get support by calling the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255), or texting the Crisis Text Line (text HELLO to 741741).
The risk factors for suicide associated with untreated depression include:
There are several types of depression which include:
Major depressive disorder (major depression) - depression symptoms that last most of the time for two or more weeks
Persistent depressive disorder - typically less severe symptoms of depression that last for much longer, usually at least two years
Depression with symptoms of psychosis - a severe form of depression with symptoms of psychosis such as delusions or hallucinations
Seasonal affective disorder - depressive symptoms which usually start in late fall or early winter and go away by spring or summer
Perinatal depression - major depression following pregnancy. It may also occur after the termination of a pregnancy
Brain stimulation therapies have been used to stimulate nerve cells since the early 20th Century when electroconvulsive therapy was popularized. Later, deep brain stimulators were created which worked by surgically implanting electrodes in the targeted brain area. While both methods are still used they may have adverse side effects and are invasive treatments.
Along came transcranial magnetic stimulation (TMS) with the first stable TMS device developed in 1985. This technique uses an electromagnetic coil placed above the head which is connected to a pulse generator. The pulse generator produces repetitive magnetic pulses which change the excitability of brain cells. Depending on the frequency of the pulse, brain cells can be made more or less excitable.
This method is a painless and non-invasive treatment. Finally, the FDA approved TMS therapy for the treatment of depression in 2008. TMS has also shown promise for the treatment of other disorders such as post-traumatic stress disorder and eating disorders.
TMS treatment is typically used to treat treatment-resistant depression, which is when other treatments such as therapy and antidepressants have not worked. When TMS is used for depression, the magnetic coil is placed above the part of the brain involved in mood control, the dorsolateral prefrontal cortex (DLPFC). The idea is to increase neuronal excitation in parts of the brain which have decreased activity in depression. Stimulation of the left DLPFC has been shown to reduce depression symptoms.
The number of sessions needed to treat your depression will depend on personal factors, your disorder, and the severity of your symptoms. Typically, you will receive five sessions per week for four to six weeks. This is technically known as repetitive transcranial magnetic stimulation (repetitive TMS or rTMS) since it involves multiple TMS sessions, however, the term is often used interchangeably with TMS.
Some people will find that they do not need further TMS treatment after one set of treatment sessions. Others may benefit from another set after a period of remission. Unlike many medications, repetitive transcranial magnetic stimulation therapy does not lead to tolerance the more you use it. If your depressive symptoms return after some time and you get a second set of treatments you are likely to respond just as well the second time as the first. It is important to keep going to sessions even if your symptoms improve before the end of the treatment period. This will ensure that you gain the greatest benefit.
While most treatment programs will include five sessions per week, this is not necessarily needed. A study from 2012 found that having just three TMS sessions per week did not reduce the outcomes for major depression when compared to those who have five sessions a week. However, depressive symptoms did improve faster for those with more frequent sessions.
A 2020 study showed that missing sessions for as long as fourteen days in a row did not have a significant impact on final depression outcomes. Therefore, if you are particularly busy and cannot go to treatment sessions five days a week for four to six weeks, you may be able to receive treatment less frequently for a longer period.
Unlike deep brain stimulation, repetitive transcranial magnetic stimulation is a non-invasive treatment that does not require surgery and implantation of electrodes. This means that it does not come with the increased risk of infection and other risks that come with this technique. It also does not typically cause seizures or require sedation as electroconvulsive therapy can. However, you may experience some mild side effects.
It seems that the frequency of sessions does not increase the side effects of rTMS treatment. A 2018 study looked at the effects of giving people treatment twice per day compared to once. They found that those who had treatment twice per day had a greater response rate than those receiving treatment once per day and did not experience any adverse effects. More research would need to be conducted to determine whether more frequent sessions could have adverse effects.
Before you start TMS treatment you will undergo a physical and psychiatric evaluation to make sure that TMS is a safe and potentially effective option for you. You do not need to prepare for sessions in any way or make sure that someone is available to drive you home as you shouldn't feel any adverse effects due to treatment. You should expect your first treatment to take longer than the following ones, typically about one hour as your doctor works out what frequency works best for you.
During the subsequent treatments, you will have the coil placed over your head and will sit in a comfortable chair wearing earplugs. When the machine is turned on you will hear clicking and feel tapping on your head as it generates magnetic pulses. You will remain conscious throughout the process. Each session will last about twenty to forty minutes. It will generally take a few weeks before your symptoms start to reduce but once they do decrease they will tend to remain this way beyond the treatment period.
Research has shown that the response rate to TMS for treatment-resistant depression is between fifty and fifty-five percent and the remission rate, which is significantly improved symptoms, is between thirty and thirty-five percent. If you have tried all options to treat depression and nothing has worked,, then TMS treatment may be the answer.
At GIA Chicago we are a mental health clinic that specializes in TMS therapy. Recovery is different for everyone, so our treatment programs focus on evidence-based therapies but also flexibility. Our multicultural and multilingual specialists will help you tailor your treatment program to your needs. Our center is a peaceful and stress-free environment so that you have the best chance of recovery.
Our treatment options include:
If you are ready to start healthy and happy life please contact us today at (312) 312-3867. You can also visit our website to find out more about our cutting-edge treatments. We look forward to welcoming you at GIA Chicago.
