As a teenager tackling depression, Breanna Hushaw was prescribed more than 15 different antidepressant medications, which “caused a ton of side effects.”
Her doctor knew she was struggling and suggested Hushaw might be a good candidate for transcranial magnetic stimulation (TMS). Once she started the treatment, Hushaw had one 20-minute session a day for 36 days. By Day 16, she says, “I realized I [was] starting to feel better.” The treatment allowed her to focus better and make progress in therapy.
Today, she adds, “I’m working at a tech company in infrastructure. I love it. I’m doing my life and able to rationalize things extremely well, whereas before, I couldn’t even get out of bed.”
“The long-term goal is for you to be on less medication or no medication and should hopefully not need this [drugs] going forward,” says Sasha Hamdani, a physician who uses TMS in her practice. “[TMS has] got such a low- side-effect profile, and it works so well, that the biggest limitation is scheduling.”
What TMS Is and How It Works
Your neurons normally communicate through chemical and electrical signals. Drugs usually address chemical imbalances, whereas TMS treats diseases with targeted magnetic signals. TMS uses electromagnetic coils embedded in a water-polo like cap worn on a patient’s head and attached to a machine to deliver electric impulses to brain cells. The treatment’s aim is to restore function in certain neural circuits.
It’s not 100% clear how the treatment works, but Hamdani, explains, “What happens with treatment-resistant depression is that your brain is simply not firing the way it should be. Your neurotransmitters are kind of like if you look at PET scans and if you look at MRIs, you’re just not getting good neural transmission. So areas of the brain that should be lighting up with activity are not.”
The goal of the treatment is, she adds, to “physically kickstart the neurons into working.”
What It’s Approved to Treat, and What It Does Experimentally
In 2008, TMS was first authorized by the Food and Drug Administration (FDA) to treat major depression. While it did go through clinical trials, its approval pathway was through the de novo premarket review, which is used for novel, lower-risk devices. Several TMS devices are now on the market to treat depression. In 2013, one TMS device (Brainsway) got the FDA okay to treat migraine pain and, five years later, obsessive-compulsive disorder (OCD).
Researchers believe that TMS may be able to help with a range of other mental illnesses, such as schizophrenia, attention deficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), Alzhiemer’s, Parkinson’s and even stroke rehabilitation.
What the Experience Is Like
Those undergoing treatment with TMS start out by having daily sessions for several weeks. On the first day, the technician will “map your brain,” using the cap to identify areas where your brain cells may not be firing the way scientists expect them to. The tech uses that information to customize your treatment. Throughout treatment, you should maintain your normal routine and continue taking any prescribed medications.
“It’s different for each person,” says Hamdani. “We’re trying to build and cement good neural pathways so that your brain is firing more appropriately.”
Then, you return each day, sit in a dentist-like chair and are instructed to either think positive thoughts or watch happy television while having treatment.
Hushaw’s Deep TMS treatment (which stimulates a broader and deeper area of the brain than TMS) helped her get better. During it, she felt a tapping sensation. “It’s like a woodpecker going ‘boom, boom, boom.’ This may cause pain. If it does hurt, the technician can lower the intensity. She or he later gradually increases the intensity in each session until reaching the correct level for you. “In the beginning I’d say, ‘Hey, this hurts. This is going to be too much at one time,’ ” says Hushaw. The technician lowered the intensity, and “then we would work our way up eventually to hit the max. I did the max for most of my sessions, but for that [first] week, I had to adjust.”
Hushaw says early on, the treatment led her to experience a flood of depressive feelings, which she chalks up to allowing herself to feel things she had buried deep down. Gradually, her mood improved.
For Kelly Dunn, who underwent Deep TMS treatment for OCD, she remembers one day when things just seemed finally to click into place and her obsessive worrying and double- and triple-checking lifted. “I didn’t spend two hours [on] this morning, making sure that I wasn’t smelling bad or scrubbing in the shower. I didn’t spend 30 minutes checking all the lights or 15 minutes, checking the front door to make sure it was locked,” she says. “I was able to walk outside my house [on] this morning. It just [went] really quick.”
Potential Side Effects
Both Hushaw and Dunn say they had headaches during the first week of treatment, which were manageable with over-the-counter pain medicines. Once they grew more accustomed to the treatment, the headaches subsided. “If you get through the first two days of minor headaches, the headaches go away, and you really start noticing a difference in mental health within the first week. At least for me,” says Dunn.
One clinical trial for TMS showed that about a third of patients had headaches. Others experienced muscle spasms, neck or jaw pain or scalp irritation. Fortunately, all symptoms dissipated after treatment.
Many patients receiving TMS struggle with both depression and anxiety. Hamdani warns that at first, it’s possible for the treatment to aggravate anxiety mainly because it increases energy depleted by depression. “Sometimes, as the energy improves, people get a little bit more on the anxious side, but that should subside,” she says. “It’s just something to be mindful about.”
Always consult with your doctor before beginning TMS, because it can possibly lead to such dangerous side effects as seizures, mania in those with bipolar disorder and complications in those with metal inside the body, like implanted electrodes or stents. If you’re considering TMS, the Clinical TMS Society has a tool on its website to help you find a provider. Many are psychiatrists who have expanded their offices and staff to provide TMS. However, TMS technicians themselves do not need to be nurses or physicians. Anyone can take a course and get credentialed to handle the equipment and treat you.
Efficacy and Price
Not all patients respond to TMS, explains George Grossberg, MD, a geriatric psychiatrist at the St. Louis University School of Medicine and member of MedShadow’s Medical Advisory Board. TMS seems to work for about half of the patients with treatment-resistant depression who try it. For 62.5% patients, the effect lasts at least a year, but more than 30% of patients require more treatment within a month of stopping TMS. Unfortunately, doctors don’t yet know how to predict who will respond and for how long. All that means that the treatment, which isn’t always covered by insurance, can be an expensive experiment.