Recently I have seen the confusion on various types of neuromodulation treatments in articles. Transcranial Magnetic Stimulation (TMS) has been such a part of my life over the years that the confusion is confusing, but it is understandable when I step back and take a look.
ECT (Electroconvulsive Therapy), TMS (Transcranial Magnetic Stimulation) and tDCS (Transcranial Direct-current Stimulation) all have a role in patient care but are not apples to apples:
- ECT requires anesthesia and has the potential of memory loss and stimulates the brain by inducing a seizure.(1)
- tDCS increases the potential of brain cells firing.(2)
- TMS causes an electromagnetic field, which results in an action potential in the brain cells.(3)
Thus, all of these treatments effect the brain. ECT and TMS have substantial research and experience to demonstrate they are effective treatments for depression. Given all this information, I can understand the confusion. However, these treatment paths are different in many ways.
When I first heard about TMS in the 90’s, I was interested to see the research as it evolved as an effective outpatient procedure for depression patients who have not responded to standard treatments. Now, having been a provider of TMS for seven years, I have had the opportunity to see what happens first hand. I wish I could say it is helpful in all instances, but I can say it is well tolerated and has benefitted the vast majority of patients while significantly helping many.
That electromagnetic energy, when focused on a particular part of the brain that is associated with Major Depression, increases activity in that area as well as the connecting neural circuitry perpetuating the increased activity. How this improves depression is a question we are still struggling to answer fully. When you see the improvement and how it is sustained, it is really impressive.
Major Depression is a serious issue. It is the leading cause in the United States of work related decreased functioning as well as suicide, according to research. Any new options are appreciated especially those options that are effective and safe with limited side effects.
Once someone is evaluated and decides to have TMS therapy, the process involves the patient reclining in a comfortable chair, fully awake and aware, then having a magnet device place over the treatment site of the person’s head. The process is relatively painless, and only a small percentage of individuals experience tingling or slight to moderate discomfort. Each treatment lasts about 18 to 37 minutes based on patient variables. The common protocol is 30 treatments over six weeks, though there are some variations.
As of now, most insurance companies have coverage for TMS, and different insurance companies have varying criteria, including:
- One to four failed antidepressants;
- with or without augmentation by other medications;
- and with or without a psychotherapy experience.
Understanding the complex insurance options has been confusing as the process has unfolded, requiring us to look at each patient’s clinical picture, and then deal with the bureaucracy as needed.
The research has been consistently positive, and the clinical experience has been positive. While the other neuromodulation technologies have a role, they are not TMS.
I continue to be amazed what people do not know about TMS since I have been talking about in on TV, radio, CME programs and community forums for nearly a decade. Clearly, my staff and I have more work to do to raise awareness and educate the communities we serve about this powerful treatment path for depression.