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Transcranial magnetic stimulation (TMS) has been studied as a treatment for depression for over 20 years. TMS works by modulating specific brain regions, such as the left dorsolateral prefrontal cortex, with electromagnetic stimulation. In 2008, the FDA approved a TMS device for the treatment of depression in patients who had not responded to antidepressant medication. Active recovery TMS uses Deep Transcranial Magnetic Stimulation (dTMS) which uses the Brainsway H-coil to stimulate the neurons in the dorsolateral prefrontal cortex. This coil provides a deeper and wider stimulation of neuronal networks than other TMS coils. This deeper penetration of cortical and subcortical layers allows for greater stimulation without any increase in side effects.

A recent study* in 2014 (Gaynes et al, Journal of Clinical Psychiatry, 2014) included 18 randomized controlled trials comparing TMS with “sham” TMS. 13 of these trials included only patients with major depressive disorder, while 5 included a mix of patients with major depressive disorder and bipolar depression. All studies included required that patients had failed at least 2 or more antidepressant trials of adequate dose and duration. Patients receiving active treatment had a decrease in their Hamilton Rating Scale of 4.5 points relative to sham, with a response rate of 29% for active treatment (compared to 8% for sham treatment) and a remission rate of 30% for active treatment (compared to 6% for sham treatment). The Brainsway Deep TMS device, which we use at our clinic, was approved on the basis of a 16 week study (available on the FDA website) in which patients had a decrease in their Hamilton Rating Scale of 3.1 points relative to sham at the primary endpoint of 5 weeks. Patients receiving the active treatment had a response rate of 38% (compared to 21% for sham treatment) and a remission rate of 33% (compared to 15% for sham treatment).

 

*Pacific Center for Neurostimulation

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Portland OR 97210

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