Deep transcranial magnetic stimulation, also known as Deep TMS, is a non- pharmaceutical, non-invasive treatment for depression. It is a type of brain stimulation technique where magnetic fields are generated by a coil placed on the scalp. This current essentially activates the neuronal circuits at the stimulation site, resulting in lessened symptoms, and in some cases remission.
Deep TMS uses a special combination of coils that are capable of reaching 4cm beneath the surface of the skull, called H coils, which are manufactured by Brainsway. Different H coils are designed to target different areas in the brain. Deep TMS with the H1 coil is FDA approved for the treatment of depression in patients who have failed to improved after multiple medication trials. It is the safest option with the least side effects for patients with treatment resistant depression.
Deep TMS entails 5 daily sessions for 20 minutes, for a total of 36 sessions. Many patients schedule their sessions during a lunch break, and the patient can drive home independently after each session to resume his/her daily activities.
This technology was initially developed in 2000 at the NIH and in 2013 the Brainsway H1 coil received FDA approval for use in patients with Major Depression. In 2018, the H7 coil received FDA approval for use in patients with Obsessive-compulsive disorder.
What happens once I decide to seek treatment at Evolve Psychiatry?
Before you begin Deep TMS treatment, you’ll need a thorough evaluation performed by our psychiatrist who will help to determine if this procedure is right for you and for your treatment plan. Our psychiatrist will make this determination based on your history, previous medications, and the risks of the procedure in regards to your personal health. If our psychiatrist approves the treatment, the next step is determining treatment frequency, treatment duration, and treatment location.
During the actual Deep TMS procedure, you will be awake and alert. There is no need for any type of anesthesia or hospitalization due to the treatment’s noninvasive nature. You will also undergo regular follow-up visits with your psychiatrist, as well as a daily assessment of side-effects by the technician, and complete weekly follow-up measures to assess symptom progress.
What are the side effects of TMS?
The side effects of TMS include:
- Temporary scalp tenderness
- Temporary headache
- Temporary jaw pain
- Temporary tooth pain
- Rare incidence of seizure
Most side effects are temporary and appear only during the treatment session.
What you can expect – Your first treatment
Before treatment begins, your doctor will need to identify the best place to put the magnets on your head and the best dose of magnetic energy for you. Your first appointment typically lasts about 60 minutes.
- You’ll be taken to our treatment room, asked to sit in a chair and given earplugs to wear during the procedure.
- An electromagnetic coil will be placed against your head and switched off and on repeatedly to produce stimulating pulses. This results in a tapping or clicking sound that usually lasts for a few second, followed by a pause. You’ll also feel a tapping sensation on your forehead. This part of the process is called mapping.
- Your doctor will determine the amount of magnetic energy needed by increasing the magnetic dose until your fingers or hands twitch. Known as your motor threshold, this is used as a reference point in determining the right dose for you. During the course of treatment, the amount of stimulation can be changed, depending on your symptoms and side effects.
How you prepare
Before having dTMS, you may need a:
- Psychiatric evaluation to discuss your depression or obsessive compulsive disorder. You will also need to bring a list of your medication history to this evaluation.
Tell your doctor or mental health provider is:
- You’re pregnant or thinking of becoming pregnant.
- You have metal or implanted devices in your body. In some cases, people with metal implants or devices can have dTMS. However, due to the strong magnetic field produced during dTMS, the procedure is not recommended for some people who have the following devices:
- Aneurysm clips or coils
- Implanted stimulators
- Implanted electrical devices, such as pacemakers or medication pumps
- Electrodes for monitoring brain activity
- Cochlear implants for hearing
- Any magnetic implants
- Bullet Fragments
- Any other metal device or object implanted in your body
If dTMS works for you, your depression symptoms may improve or go away completely. Symptom relief may take a few weeks of treatment.
The effectiveness of dTMS may improve as researchers learn more about techniques, the number of stimulations required and the best sites on the brain to stimulate.
After completion of a dTMS treatment series, standard care for depression – such as medication and psychotherapy – may be recommended as ongoing treatment. It’s not yet known if maintenance dTMS sessions will benefit your depression. This involves continuing treatment when you are symptom free with the hope that it will prevent the return of symptoms.
However, if your depression improves with dTMS, and then later you have another episode of symptoms, your dTMS treatment can be repeated. This is called a booster session, or re-induction. Some insurance companies will cover re-induction, or a short booster session.
If your symptoms improve with dTMS, discuss ongoing or maintenance treatment options for your depression with your doctor.
If you would like to learn more about TMS Therapy and the various treatments we provide, call (631) 229-4227 to schedule a consultation.