Repetitive Transcranial Magnetic Stimulation (TMS) is a useful clinical tool that is effective in patients with treatment-resistant depression.
This noninvasive treatment is an option for patients with depression who have not found relief from other treatments, such as psychotherapy and antidepressants.
TMS technology was developed in 1985 and has been gaining clinical interest since then. Two-thirds of TMS patients experienced either full remission of their depression symptoms or noticeable improvements.
This out-patient procedure does not have serious side effects.
Approved by the US Food and Drug Administration in 2008, TMS uses an alternating current passed through a metal coil placed against the scalp to generate rapidly alternating magnetic fields. These pass through the skull nearly unimpeded and induce electric currents that depolarize neurons in a focal area of the surface cortex.
The magnetic field generated by TMS is comparable to that of a standard magnetic resonance imaging device (MRI), measured at approximately 1.5 to 3 Teslas. However, the TMS field is focal (beneath the coil), whereas the MRI field is large and fills the room housing the MRI device.
One hypothesis on how TMS works is that the stimulation of discrete cortical regions alters pathologic activity within a network of gray matter brain regions, specifically those involved in mood regulation and connected to the targeted cortical sites. Functional imaging studies support this hypothesis by showing TMS can change activity in brain regions remote from the site of stimulation.
TMS has many molecular effects, including increased monoamine turnover and normalization of the hypothalamic pituitary axis. Additionally, in one neuroimaging study of depressed patients, a prefrontal serotonin deficiency at baseline normalized after treatment with TMS.
High-frequency stimulation is thought to excite the targeted neurons and is typically used to activate the left prefrontal cortex.
Theta Burst Stimulation (TBS) is a form of TMS. Here, the magnetic pulses are applied in a certain pattern, called bursts. Research studies with TBS have been shown to produce similar if not greater effects on brain activity compared to standard repetitive transcranial magnetic stimulation ( rTMS).
Conventional TMS procedures typically last up to 37 minutes per session whereas TBS can go down to as little as a few minutes' duration.
I've been in therapy and on antidepressants off and on for almost 30 years, since I was a teen. I've tried inpatient treatment, various kinds of therapy, and myriad antidepressants over the years, and nothing seemed to help for long. I was hopeless, thinking I'd spend the rest of my life trying different combinations of meds to try to k
I've been in therapy and on antidepressants off and on for almost 30 years, since I was a teen. I've tried inpatient treatment, various kinds of therapy, and myriad antidepressants over the years, and nothing seemed to help for long. I was hopeless, thinking I'd spend the rest of my life trying different combinations of meds to try to keep my depression from killing me, without ever actually feeling better. Then Willie suggested that I might be a good candidate for TMS. I researched it and talked it over with my family, and decided I had nothing to lose by giving it a try. After 15 sessions, I was able to discontinue one of my antidepressants. After a couple more, and people started commenting on how different I seemed. Going through TMS has let me feel my emotions again, without worrying that any negative emotions are going to spiral into a depression I can't get out of. The treatments themselves weren't painful. To me, it feels like when you've had your hair in a ponytail all day and when you let it down, it sort of aches for a minute. After a while, I even looked forward to going in because the interactions with Willie and his staff were so much fun (and I wasn't dreading leaving the house anymore). I would definitely recommend this treatment for anyone suffering from long-term depression.
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