TMS

Depression is the top cause of disability in the U.S. among individuals between the ages of 15 and 44 years old. While several treatments, such as psychotherapy and antidepressants, treat depression effectively, not everyone benefits from first-line approaches. Around two-thirds of individuals with depression aren’t receiving enough relief from the first antidepressant prescribed to them. After a couple of months on antidepressant medication, individuals may still experience some depressive symptoms, and each subsequent medicine seems to work less effectively in treating their symptoms than the ones before.

Fortunately, there are alternative treatment options ― such as transcranial magnetic stimulation (TMS) ― helping many individuals manage the symptoms of their depression or anxiety when medication isn’t enough. Patients who aren’t responding to first-line treatments or are looking for an alternative can turn to TMS.

Introducing Transcranial Magnetic Stimulation (TMS)

For many decades, electroconvulsive therapy (ECT), also called shock therapy, was the standard treatment for resistant depression. Many patients with depression, however, could not tolerate this treatment because of the side effects on cognition and memory.

Fortunately, for individuals receiving an inadequate response to medicines and therapy alone, there’s another newer option to help treat their depression — transcranial magnetic stimulation therapy.

Transcranial magnetic stimulation stimulates nerve cells in the brain using magnetic fields in a noninvasive procedure. Comprehensive Behavioral Health (CBH) provides TMS therapy in a caring environment and private space.

What Is Transcranial Magnetic Stimulation?

TMS is a neuromodulation technique used to help modulate brain activity. It involves the use of magnetic devices that stimulate the parts of the brain related to mood. An electromagnetic field changes the electrical environment in your brain to improve the action of certain sections.

Since patients with depression have decreased activity in these areas, TMS aims to relieve symptoms by increasing the activity. During a treatment procedure, the TMS machine applies short pulses to the relevant parts of the brain. Research shows that this treatment has a high level of effectiveness in reducing depression symptoms.

TMS for depression is non-invasive and doesn’t require anesthesia. It’s a drug-free alternative to antidepressants and offers individuals who aren’t responding to their current medicines or can’t tolerate the side effects another treatment option.

One particular large clinical trial that used repetitive transcranial magnetic stimulation (rTMS) to treat depression showed 47 percent of the patients responded to the treatment after they failed to notice any improvement with their current antidepressant medicine. Nearly 30 percent received remission, meaning they were no longer clinically depressed.

Benefits of TMS Therapy

Transcranial magnetic stimulation therapy at Comprehensive Behavioral Health has:

  • FDA approval: The Food and Drug Administration considers TMS a valid treatment because of the clinical evidence showing its effectiveness. TMS has the same legitimacy as other approved therapies for depression.
  • Tolerable side effects: If a patient has side effects from TMS involve, it will likely be discomfort at the stimulation site that goes away over time. Serious side effects are rare.
  • A high chance of success: Research suggests that more than half of patients who receive TMS therapy feel the benefits for months. Receiving regular maintenance treatment can extend the results even longer.

Who Can TMS Help?

Patients who don’t get full relief from medication and therapy can try TMS treatment for depression and comorbid anxiety. TMS does not cause the same side effects as antidepressants. As a result, it works as an excellent alternative for individuals who can’t tolerate typical medication side effects. Patients who receive TMS therapy can use it on its own or combine it with other treatment strategies.

Repetitive Transcranial Magnetic Stimulation (rTMS)

rTMS is the main type of TMS treatment. A magnet is used in rTMS for brain activation. It helps treat anxiety, depression and other types of disorders by targeting specific brain locations, which scientists think decreases the risk of side effects.

An rTMS session generally lasts around 30 to 60 minutes and doesn’t require anesthesia or sedation. The doctor places and holds an electromagnetic coil against the patient’s forehead near the area of the brain believed to be involved in mood regulation. They then administer short electromagnetic pulses through the coil which cause small electrical currents, stimulating nerve cells in the regions of the brain being targeted. These electrical currents carry around the same strength as a magnetic resonance imaging (MRI) scan.

Scientists aren’t quite sure yet if rTMS works better when combined with psychotherapy, medicine or both, or as a single treatment on its own. Additional research continues so researchers and scientists can determine its safest and most effective uses.

According to studies on rTMS’s safety, researchers found most of the side effects like scalp discomfort or headaches were mild to moderate, and occurred in a small percentage of individuals.

Why Is TMS Effective in Treating Depression?

The most common depression symptoms are the presence of sad, empty or irritable mood combined with both somatic and cognitive changes that may affect the patient’s capacity to function significantly.

These functional and behavioral effects of depression are due to brain activity alterations. Depression affects an entire distributed brain area network. TMS is applied to treat depression under the idea of precisely targeting the brain areas involved in depression.

The brain area being stimulated is situated at the left side of the brain, or more specifically, the Left-DLPFC or dorsolateral prefrontal cortex. This area is the primary target for FDA-approved TMS treatment since it’s a focal point that connects all the various areas of the brain involved in the pathology of depression.

How to Prepare for TMS Therapy

Before TMS therapy at CBH, you might need lab tests and a physical exam or a psychiatric evaluation for discussing your depression.

The practitioner performs these evaluations simply to ensure TMS is safe and a good match for you.

Let your mental health provider or doctor know if you have any implanted or metal medical devices inside your body. Sometimes, individuals with metal implants or devices may still have TMS, but because of the strong magnetic field TMS produces, this treatment isn’t recommended for some individuals who have the following implants or devices:

  • Stents
  • Aneurysm coils or clips
  • Deep brain or implanted vagus nerve stimulators
  • Implanted stimulators
  • Implanted electrical devices like medication pumps or pacemakers

The list may include others, so be sure to consult with your doctor about any metal implanted object or device in your body, no matter what it is. You’ll also want to let them know if:

  • You’re taking any medicines, including over-the-counter (OTC) or prescription medicines, vitamins, herbal supplements or other supplements.
  • You have another mental health disorder like bipolar disorder, substance misuse or psychosis.
  • You have a family history of epilepsy or a history of seizures.
  • You have severe or frequent headaches.
  • You have brain damage from injury or illness like a traumatic brain injury, stroke or brain tumor.
  • You have had TMS therapy before and whether or not it helped with your depression.
  • You have any other type of medical condition.

TMS therapy isn’t invasive and is usually done on an outpatient basis. You won’t have to arrange for another person to drive you home following your treatment, although you may want to for the first treatment since you can’t be sure how it’s going to affect you afterward.

In addition, you’ll want to call your health insurance provider if you’re considering TMS treatment to see if it’s covered. At CBH, we accept Blue Cross Blue Shield, CareFirst, Blue Cross Federal Employee Program, Anthem, Aetna, Aetna Innovation, Cigna and Tricare Select.

What to Expect During TMS Treatment

A typical recommended course of treatment for TMS therapy at CBH involves 36 sessions which is approximately seven weeks. However, patients may experience relief in some of their symptoms within just a few weeks of starting treatment. Each TMS appointment will last for approximately 30 minutes. Your care team will work with you to manage your treatment schedule.

When you arrive, you will briefly check in with the doctor or technician and then start the stimulation process. Your doctor or technician will determine the ideal anatomical target and stimulation intensity by targeting your brain’s motor cortex.

By initially targeting this brain area, the technician can determine where to locate the stimulation coil best relating to your brain and how the amount of intensity it must “fire” to achieve proper stimulation. They’ll then come up with calculations and apply them to translate this information toward locating the dorsolateral prefrontal cortex — the area of the brain with the most amount of clinical evidence of effectiveness and also the area involved in depression.

While a recommended treatment is 36 sessions, or roughly 7 weeks, you may experience relief within just a few weeks of starting treatment.

During these appointments, you’ll:

  1. Sit in a chair with an electromagnetic coil placed on your scalp.
  2. The technician will turn on the TMS machine.
  3. It will create magnetic pulses that feel like taps.

A TMS machine’s energy has a similar level of strength to an MRI’s magnetic force. Feel free to let the technician know if you feel any discomfort so that they can make adjustments.

What to Expect After TMS Therapy

Patients typically can return to their regular daily activities immediately following treatment. Patients can usually drive and work as well.

1. TMS Treatment Results

If TMS therapy is effective for you, your symptoms of depression will improve or may go away completely. It may take several weeks of treatment for symptom relief.

As researchers study and learn more about methods, the best areas of the brain to stimulate and the number of stimulations needed, the effectiveness of TMS might improve.

2. Ongoing TMS Treatment

After you’ve completed a TMS therapy series, the doctor may recommend you receive the standard care for depression as an ongoing treatment which could be psychotherapy and medication.

Whether or not maintenance TMS sessions will be beneficial for your depression is still not yet known. It involves continuing therapy when you’re free of symptoms in the hopes it prevents the return of your symptoms. But, if you do see improvement in your depression with TMS and you experience another episode of symptoms later on, your TMS therapy can be repeated or re-inducted. Some insurance providers will cover re-induction.

If you notice an improvement in your depression symptoms after undergoing TMS, talk with your doctor about ongoing or maintenance treatment options.

TMS Side Effects

TMS has minimal side effects and is considered a safe procedure. A common side effect of TMS is a headache which you can treat with OTC medicine. Some individuals might experience a slight burning sensation during the procedure under the magnet in their scalp. A few individuals might experience facial twitches during their TMS therapy session. However, to relieve the twitches, the technician can simply move the machine slightly.

Does My Insurance Cover TMS?

As an insurance-based practice, Comprehensive Behavioral Health strives to make all services here available for coverage. Your insurance may cover our TMS treatment if you have one of the plans we accept. Call our Arlington Location at 703-812-4642 or our Bethesda location at 240-531-2802 to learn about insurance coverage for our TMS therapy. Let us work with you to find an affordable solution.

Schedule a TMS Appointment Today

CBH serves patients in or near Washington, D.C., Northern Virginia and Maryland. Our multidisciplinary team provides quality care in a compassionate environment. We have an office in Arlington, Va., and one in Bethesda, Md.

We provide a team of child and general psychiatrists, licensed therapists and psychiatric nurse practitioners to help patients with mental health concerns. We work with many adults, young adults, adolescents and children. Our providers have extensive education and training, and we make it a priority to provide a supportive and positive environment for all our patients. You can feel safe in our compassionate setting and find treatment options that will fit your individual needs.

Our providers have experience treating a variety of mental health concerns. Each individual has their own unique brain, so we provide a truly customized treatment plan tailored specifically for you and your specific needs. Along with TMS therapy, we also offer services like:

  • Psychotherapy
  • Medication management
  • Substance abuse treatment
  • Evaluation and diagnosis

We aim to help you enjoy a more satisfying and fulfilling life. You can feel confident we will do everything possible to ensure you’re comfortable when you step foot into our offices. To schedule an appointment, contact our Arlington or Bethesda office using our online form or give us a call to discuss your TMS needs.