What is TMS Therapy?
Pulses, not Pills?
Michael Faraday may not have realized how much impact he would have on psychiatry, psychology, neurology, and neuroscience when he had his hypothesis.
It was by his research on the magnetic field around a conductor carrying a direct current that Faraday established the basis for the concept of the electromagnetic field in physics. Faraday also established that magnetic stimulation can affect rays of light and that there was an underlying relationship between the two phenomena. Mr. Faraday similarly discovered the principles of electromagnetic induction and diamagnetism. His inventions of electromagnetic rotary devices formed the foundation of electric motor technology, and it was largely due to his efforts that electricity became practical for use in technology.
More lately, his principles have led to the discovery of Transcranial Magnetic Stimulation (TMS) approved by the FDA to treat depression, mood troubles, as well as Obsessive Compulsive Disorder (OCD).
TMS (Transcranial magnetic stimulation) is non-invasive, meaning that it does not involve cutting or surgery, nor require any anesthesia or sedation. TMS does not affect other areas of the body like medications or injections does, meaning it is non-systemic.
How does TMS work? The electromagnet delivers a magnetic pulse that stimulates nerve cells in the region of your brain involved in mood control and depression. It’s thought to activate regions of the brain that have decreased activity in depression as well as anxiety. The patient is awake and remains awake and alert during the treatment.
TMS is proven effective for depressive disorders as well as OCD. For depression, the magnetic coils are placed near the prefrontal cortex of the brain. These magnetic fields work to create electrical activity in the nerve cells. At the present time, it is unclear how exactly how TMS (as well as many other medication treatments for depression) works. It is believed that it is related to how the direct electric activity or indirect neurotransmitter effects in the brain. Regardless of the mechanism, it is well accepted by Scientists and psychiatric practitioners that the magnetic stimulation affects not only the targeted area the prefrontal cortex but also the areas connected to the brain, involving many brain functions.
Michael Faraday’s principles led to the discovery of TMS, approved to treat depression and OCD in the USA but approved for other conditions in Europe and in Canada. So why is TMS not yet approved for anxiety? Why SSRIs such does has paroxetine fluoxetine and citalopram approved for both anxiety and depression and TMS is not? The answer lies somewhere between the controls of policy-making between the FDA, powerful drug companies with political influence.
TMS success rate in treating resistant depression has been as high as 80% in some studies.
The success of using antidepressants alone can be as low as 30% for patients to be completely symptom free. In addition, the likelihood that patients will stop using antidepressants as treatment continues due to side effects also favors the use of TMS over antidepressants. Adding that to the fact that medications cause systemic side effects (as it has to be taken orally, absorbed, metabolized and excreted), we are not sure why TMS has not been more widely embraced.
TMS is not ECT. With ECT, you need to apply an electrical stimulus to both sides of the brain or the right side of the brain. TMS does not require sedating, ECT does. TMS does not lead to memory loss, ECT does. TMS is significantly cheaper than ECT and arguably cheaper than most antidepressant medications. TMS is covered by most insurances.
Why are we not using TMS as much as we should? I think this is because the public is not aware of the efficacy and safety of TMS. In addition, the advocates for TMS are not as well funded as the big pharma company. The clinical TMS society will continue to work to help the public make more informed decisions about treatment for depression.
It is up to be TMS practitioners to spread the word and showing the public that there are reasonable alternatives to medications and ECT.
More to come from this blog: Success stories of TMS, ideal candidates, picture of what TMS treatment looks like, decision tree on how to decide if TMS is worth considering.
Adekola Alao MD