Frequently Asked Questions About TMS

Most standard rTMS machines use a figure 8 magnetic coil to induce electrical charges within the cells of the brain. These electromagnetic pulses reach about 0.7cm below the scalp into the brain. The dTMS system stimulates the neurons about 1.7cm below the skull and over a wider area than the standard rTMS system. Patient sessions with dTMS machines are also shorter, approximately 20 minutes compared to 37 minutes on a standard rTMS system.

TMS has been used since the mid 1980s in research settings to investigate the functioning of different parts of the brain. TMS began to be investigated for use as an antidepressant therapy in the 1990s. Neuronetics, the makers of the Neurostar TMS device, sponsored a study in 2007 (O’Reardon, et al 2007) that showed the efficacy of TMS in treating Major Depressive Disorder. Because the efficacy of TMS was only demonstrated in post-hoc analyses instead of the primary outcome, the FDA did not initially approve the device out of concern for bias. However, the device was eventually approved in 2008 in part based on post hoc analyses that suggested that TMS was particularly more effective for patients with treatment resistant depression. A subsequent NIH study (George, et al 2010) largely replicated the industry sponsored study (O’Reardon, et al 2007). Since then multiple studies including multiple metaanalyses, have shown TMS is effective in treating Major Depressive Disorder. Other studies have also shown promising results in other psychiatric and neurologic disorders. In 2013, Levkovitz, et al published a clinical trial that led to FDA approval of the deep TMS (dTMS) device made by Brainsway. Since then multiple studies have confirmed the efficacy of dTMS.

No. Multiple clinical trials have not shown any increase in memory loss with TMS treatment. This is an important difference from ECT where there is a risk of memory loss.

Most trials indicate that patients experience improvement by the 4th week of treatment. However, some patients may experience improvement before or after the 4th week.

The TMS technician will note any side effects the patient experienced during the treatment. Because there is no sedation or anesthesia, patients can leave immediately after their treatment and resume normal activities including driving.

Patients are seated comfortably in a chair and will feel a tapping sensation on their scalp during the treatment. Patients also hear a “clicking” noise. To prevent discomfort from the clicking noise, earplugs should be worn (and are provided). However, the risk of any permanent hearing loss is extremely low.

While the overall efficacy of TMS is still being investigated, clinical studies seem to indicate that 67% of patients have a good response to TMS and that 45% of patients with a good response maintain remission 12 months after treatment. Those who do have recurrence of their depressive symptoms usually respond to repeat or “maintenance” sessions of TMS.

No, these treatments work on very different principles. The main difference is that ECT causes a generalized seizure and this is repeated usually on alternating days for several weeks. While ECT is overall more effective in treating depression, it is also associated with significant side effects including memory loss (which is usually sort-term but can be longer lasting). ECT also requires the patient to be under anesthesia which carries its own risks. Because of the confusion that usually occurs after ECT, patients undergoing ECT must have someone to care for them after their treatment. TMS patients can receive their treatment and return to their usual activities, including driving, immediately after their treatment.

Most other medications can also be taken before, during and after a course of TMS. There are some medications that can increase the seizure risk with TMS and these should be discussed with your TMS physician. However, it is rare that a medication would preclude a patient from getting treatment with TMS.

While it is not known whether taking antidepressants during or after TMS treatment increases the likelihood of treatment success, TMS trials have regularly included patients taking antidepressant medications. There is no indication that there is any safety risk to patients who take antidepressants before, during or after treatment with TMS.