Depression is a common and serious medical illness that negatively affects how you feel, the way you think and how you act – and it is the leading cause of disability in the United States among people aged 15 to 44.
While there are many effective treatments for depression, first-line approaches such as antidepressants and psychotherapy don’t work for everyone. According to reports, some two-thirds of people still struggle despite the first antidepressant they try. After two months of treatment, some sufferers continue to experience symptoms, and each subsequent medication can become less effective than the one prior.
In these cases, doctors may suggest other treatments or therapies to help those suffering from depression, such as Transcranial Magnetic Stimulation (TMS).
TMS involves a series of short magnetic pulses directed to the brain to stimulate nerve cells, and since its inception in 1985, it has been used to treat a number of neurological conditions such as migraine, Parkinson’s disease and tinnitus as well as psychiatric conditions including depression, auditory hallucinations, cognitive disorders, obsessive-compulsive disorder and post-traumatic stress disorder.
The treatment is pain-free and non-invasive and it has been approved by the US Food and Drug Administration (FDA) for severe depression when other avenues have failed.
How Does TMS Work?
Rapid magnetic pulses cause neurons to change their firing pattern within the brain, which then triggers changes within specific areas of the brain that affect dysfunctional brain patterns. Because the treatment delivers repetitive magnetic pulses, it is sometimes called repetitive TMS or rTMS.
The treatment usually takes place while guests are seated or reclining. Using an electromagnetic coil placed close to the brain areas that regulate moods, magnetic pulses are generated to the brain. In turn, these pulses produce electrical currents that stimulate nerve cells.
Guests remain awake throughout the procedure, which can last anywhere between 30 and 60 minutes, and they can return to normal daily activities immediately following treatment including driving a car. A typical course of treatment will be between four and six weeks.
Who should have TMS?
The people who benefit most from this treatment have typically tried medication for depression along with other therapies, with little or no success. TMS is also sometimes used as a substitute for electroconvulsive therapy (ECT), if general physical health is a concern.
However, it is not a treatment suitable for those struggling with substance or alcohol issues or anyone with aneurysm clips or coils, shrapnel lodged near the head, cardiac pacemakers or implantable cardioverter defibrillators (ICD), facial tattoos that have magnetic ink or ink that’s sensitive to magnets, implanted stimulators, metal implants in the ears or eyes or stents in the neck or brain.
While TMS is non-invasive and pain-free, some people do experience mild side effects such as face tingling, dizziness and headache.
How Does TMS Compare to ECT?
For several decades, electroconvulsive therapy – or “shock therapy” – was the gold standard for treatment-resistant depression. In fact, ECT is still considered to be the most effective treatment for this illness, and it continues to be used regularly throughout the world. However, for many people with depression, ECT can be difficult to tolerate due to side effects on memory and cognition.
ECT involves placing electrodes directly on strategic areas of the brain. An electric current is then generated, essentially causing a seizure to occur in the brain. Doctors perform the procedure under general anaesthetic and use a muscle relaxant to stop patients from shaking during the stimulation part of the treatment.
In contrast, TMS requires no sedative medication. Another key difference is the ability to target certain areas of the brain. When the TMS coil is held over a certain area, the impulses travel only to that part of the brain. ECT doesn’t target specific areas.
While doctors use both TMS and ECT to treat depression, ECT is usually reserved for treating severe and potentially life-threatening depression.
According to Adam P. Stern MD, of the Harvard Medical School, “approximately 50% to 60% of people with depression, who have tried and failed to receive benefit from medications, experience a clinically meaningful response with TMS. About one-third of these individuals experience a full remission, meaning that their symptoms go away completely.”
As with all treatments for depression, long-lasting results often rely on good digestive health, so therapies for the digestive tract are highly recommended because of the strong gut-brain connection. Vitamin and other nutrient supplementations can also prove highly beneficial. It is further recommended that guests undergo a thorough thyroid check to discard hormonal reasons for depression. For more on this subject, see the links below.
Most treatment sessions last anywhere from 30 to 60 minutes and typically take place about five times a week.
You Are Not Alone
Depression used to be an illness rarely talked about and greatly misunderstood, creating feelings of shame around it. Thankfully, those days are largely gone, which might explain why the illness appears to be on the increase; people now feel more comfortable about accepting they are struggling and reaching out for help.
Another reason for the current increase in depression is clearly due to the extraordinary times we live in. According to a recent survey, more than 42% of people interviewed reported feelings of anxiety or depression – an increase from 11% the previous year. Experts believe that much of this mental distress is caused by the pandemic and the continuing lockdowns that have severely limited people’s social interactions and created tensions within households, not to mention having to live with the constant fear of illness.
Further reading:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5641835/
https://www.hindawi.com/journals/jtr/2012/590648/
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