Hope for a Brighter Future: Potential Indications for TMS (Part 1)

Transcranial magnetic stimulation (TMS) is an FDA approved treatment for major depressive disorder that has not improved with other antidepressant treatments, migraine, and obsessive-compulsive disorder. However, there have been studies performed and anecdotal evidence indicating that there may be other conditions that would benefit from TMS. In this three-part series, we will talk about the non-FDA approved conditions for TMS.

The following conditions may improve from TMS treatments as the primary condition or a co-occurring condition. When are you talk to your doctor, please note that these are non-FDA approved and would be considered an “off-label” use of TMS.

Bipolar Affective Disorder (depressed)

  • Bipolar Affective Disorder affects about 1 to 2% of the population. It is characterized by mood fluctuation and mood lability, elevated or irritable mood can also occur. There are studies that have evaluated the effectiveness of TMS in Bipolar Depression. In one of these studies, the researchers stimulated the left DLPFC (left side of the brain). In this study, patients with bipolar affective disorder depressed type show significant improvement in their mood.
  • In another study of 50 patients, researchers found that TMS may be effective in treating Bipolar Affective Disorder, depressed type.   Most significantly, none of the patients exhibited mania or hypomania which can be a side effect of traditional antidepressant treatment for bipolar disorder.  As with any treatment of patients with Bipolar Affective Disorder, clinicians administering TMS need to watch out for any manic or hypomanic symptoms during o after the treatment.

Generalized Anxiety Disorder (GAD)

  • There have been studies using TMS to treat GAD. In one study, TMS was used to the slow the right side of the brain down using lower frequency stimulation which is inhibitory to the brain. This study shows significant improvement in anxiety in patients who were treated with real TMS versus placebo TMS.

Insomnia (Inability to have a restful night’s sleep)

  • Insomnia or lack of sleep can occur initially, in the middle or at the end of sleep. Most providers of TMS also observe that sleep is improved among patients with TMS.  In a study evaluating sleep cycle in patients with TMS, there was significant improvement in the quality of sleep. This study suggests that TMS may improve sleep quality among patients who have insomnia being treated with TMS.

In summary, TMS has been FDA-approved for the treatment of Major Depression, Obsessive Compulsive Disorder and for migraines. However, there are case studies and controlled studies that show that   TMS maybe useful in other conditions described above. It is important that if TMS providers are treating non-FDA approved indications, the provider needs to document this in the patient’s charts and obtain informed consent. If providers are treating FDA approved conditions and notice improvement in other symptoms, these should be documented and the information should be passed on the makers of the TMS machine.  

We at Upstate Psychiatry believe that your health is too valuable to simply give up.

For more information, please call Chelsea at 315-202-4157 or visit us at Upstatepsychiatry.org.

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