Transcranial magnetic stimulation (TMS) is a procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of several psychiatric disorders. It works by delivering electromagnetic pulses to specific areas of the brain, which can adjust neuronal activity and improve symptoms associated with conditions such as depression, anxiety, and OCD to name a few. TMS has a cumulative effect, meaning that the positive benefits should grow with each completed session. While the effects of TMS are not permanent, studies have shown that symptom reduction often lasts for between 6-12 months post-treatment [1,2], and sometimes even longer.
The U.S. Food and Drug administration approved TMS treatment in 2008 and the UK’s National Institute for Health and Care Excellence (NICE) approved TMS in 2015. Both organisations have cited its safety and efficacy in the treatment of treatment-resistant psychiatric and neurological conditions [3,4].
In 1985, Dr Anthony Barker and his team at the University of Sheffield developed the first TMS device for research purposes, highlighting its potential to study and treat various conditions. Barker noted that magnetic stimulation could effectively reach deep brain structures, unlike electrical stimulation. Over time, TMS technology has evolved, leading to innovations like the Hesed coil (H-coil), which is designed to target deeper areas of the brain [5].
One of the advantages of TMS is that, unlike some other treatments for neurological and psychiatric conditions, it is non-invasive. This means that it does not require surgery or anaesthesia. Patients can typically resume their normal activities immediately after a session, although some may experience mild side effects such as headache, fatigue, or scalp discomfort. These side effects are not permanent and will usually reduce in frequency and severity as patients get used to the treatment.
During a TMS session, the patient sits in a comfortable chair while a device containing an electromagnetic coil is placed against their scalp. The coil generates magnetic pulses that pass through the skull and into the brain, where they can influence neuronal activity. These pulses are typically administered in repetitive patterns known as repetitive transcranial magnetic stimulation (rTMS). The treatment is usually administered over several sessions, with each session lasting about 20-30 minutes. The typical TMS prescription will be for 15-30 sessions, usually taking place on consecutive weekdays. Following completion of the initial prescription, a continuation phase will often be offered in which patient’s will come in for less regular treatments in order to prolong the beneficial effects of TMS.
There are currently many different TMS systems in use around the world, some of which use different coils and treatment protocols. At Atrom Mindcare, we use the latest and most advanced Brainsway Deep TMS (dTMS) machine with its patented H-coil system. This machine uses cutting-edge technology to stimulate deeper regions of the brain that other systems cannot reach, and boasts the best remission rates available to patients [6].
In conclusion, TMS is a safe and effective treatment option for various psychiatric disorders, endorsed by both the FDA and NICE. Since its creation in 1985, advancements in technology, such as the Brainsway Deep TMS (dTMS) machine used at Atrom Mindcare, mean that patients can benefit from targeted neurostimulation without the need for invasive procedures. While TMS effects may not be permanent, studies demonstrate sustained symptom reduction post-treatment, providing hope for individuals seeking relief from psychiatric conditions.
References
1. Dunner DL;Aaronson ST;Sackeim HA;Janicak PG;Carpenter LL;Boyadjis T;Brock DG;Bonneh-Barkay D;Cook IA;Lanocha K;Solvason HB;Demitrack MA; (2014) A multisite, naturalistic, observational study of transcranial magnetic stimulation for patients with pharmacoresistant major depressive disorder: Durability of benefit over a 1-year follow-up period, The Journal of Clinical Psychiatry. Available at: https://pubmed.ncbi.nlm.nih.gov/25271871/ (Accessed: 08 February 2024).
2. Janicak, P.G. and Dokucu, M.E. (2015) Full article: Transcranial magnetic stimulation for the treatment of ..., Transcranial magnetic stimulation for the treatment of major depression. Available at: https://www.tandfonline.com/doi/full/10.2147/NDT.S67477 (Accessed: 08 February 2024).
3. NICE (2015) Recommendations: Repetitive transcranial magnetic stimulation for depression: Guidance, National Institute for Health and Care Excellence. Available at: https://www.nice.org.uk/guidance/ipg542/chapter/1-Recommendations (Accessed: 08 February 2024).
4. Cohen, S.L. et al. (2021) A visual and narrative timeline of US FDA milestones for transcranial magnetic stimulation (TMS) devices, Brain Stimulation. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8864803/#:~:text=a%20separate%20window-,Fig.,(k)%20pathway%20in%202009. (Accessed: 08 February 2024).
5. Hamlin, D. et al. (2023) A brief history of transcranial magnetic stimulation, American Journal of Psychiatry Residents’ Journal. Available at: https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp-rj.2023.180303 (Accessed: 08 February 2024).
6. Gellersen, H.M. and Kedzior, K.K. (2019) Antidepressant outcomes of high-frequency repetitive transcranial magnetic stimulation (rtms) with f8-coil and deep transcranial magnetic stimulation (dtms) with H1-coil in Major Depression: A systematic review and meta-analysis - BMC Psychiatry, SpringerLink. Available at: https://link.springer.com/article/10.1186/s12888-019-2106-7 (Accessed: 08 February 2024).
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