Transcranial Magnetic Stimulation

Consider TMS For Treatment-Resistant Depression

What is TMS (Transcranial Magnetic Stimulation)? TMS uses magnetic pulses aimed at specific targets in the brain that can help achieve remission of major depressive disorders. TMS is an FDA-approved treatment for patients who do not benefit from antidepressant medications.Certus is on of just a few practices that offers TMS therapy in Winston-Salem, and we have helped the majority of patients we have treated realize great outcomes.

According to the World Health Organization, more than 300 million people of all ages suffer from depression worldwide. Depression results from a complex interaction of social, psychological and biological factors. People who have gone through adverse life events (unemployment, loss of child, parent or spouse, psychological trauma, etc.) are more likely to develop depression.*

What happens when traditional therapies don’t work? TMS is an approach that uses magnetic pulses to accurately stimulate neural activity. It is approved for treatment when all other treatments are deemed ineffective by your care provider.
* WHO.int/mediacentre/factsheets/fs369/en

How TMS Works

Although many different forms of drug therapies exist, not everything works for everyone, and some side effects can be worse than the conditions they are supposed to work to fix. TMS can help achieve remission for major depressive disorders that do not improve through medications. TMS is an approach which uses magnetic pulses to accurately stimulate neural activity.

If you live in or around Winston-Salem, contact Certus Psychiatry to learn if TMS treatment is right for you. 

TMS treatment is:

  • Non-invasive, meaning it does not involve surgery, anesthesia or sedation of any kind.
  • Non-systemic, meaning it is not a pill that has to be swallowed and does not circulate in the bloodstream.

The technology is similar to that of MRI scanners – short magnetic pulses are emitted from a butterfly-like coil, which can painlessly pass through the intact skull to the outer regions of the brain. Here, very short and very small electric fields are induced, which in turn can influence neural activity.

By stimulating with several pulses over several treatment sessions, TMS can have lasting effects on the brain, inhibit overactive areas in the brain or, as is the case in a depression treatment, excite under-active regions.

Limited, if any, side effects
TMS is a proven and safe treatment method with very few side-effects. The most common side effects are transient pain, transient headaches, discomfort at the treatment-site or short uneasiness or dizziness. TMS is free of most side effects that are typically associated with antidepressant medications such as weight gain, sexual problems or upset stomach.

Incredible results

Each TMS treatment session takes approximately 20 to 40 minutes. Before and right after treatment, the patient can directly come and go through their normal everyday activities. In total, the patient receives 5 therapy sessions per week for 4 to 6 weeks. Patients are alert and awake during treatment.

Controlled clinical trials applying TMS on patients who had failed to achieve satisfactory improvement from one prior antidepressant medication showed that:

  • Approximately 1 out of 2 patients experienced significant improvement in depression symptoms.
  • Approximately 1 out of 3 patients experienced complete symptom relief after the full TMS therapy.

Is TMS right for you?

TMS is a safe form of treatment that has been cleared by the FDA since 2008 for patients with depression who have failed to achieve satisfactory improvement from one prior antidepressant medication, at or above the minimal effective dose and duration, in the current episode. If you are unsatisfied with your current depression medication or worry about its side effects and are looking for a proven, drug-free alternative, talk to your Certus care provider about TMS.

TMS is not for everyone. if any of the following conditions apply, you don’t qualify for this treatment:

  • You have cochlear implants, or internal pulse generators, medication pumps, pacemakers or other
    implanted devices.
  • You have metal of any kind in the head or brain area.
  • You have a history of epilepsy.
  • You have had a vascular, traumatic, tumoral, infectious, or metabolic lesion of the brain.
  • You are pregnant.

What to expect
When you schedule your appointment with Certus, be sure to have your care history complete with your medication treatment plan ready for review.

If you are approved for TMS Treatment:

  • Allow 19 to 37 minutes treatment duration, 5 days per week for 4-6 weeks in a row.
  • You are awake for each treatment.
  • You may resume your everyday activities after each session.
  • Most insurance providers have approved TMS treatment for those who qualify.

TMS Frequently Asked Questions

What Is TMS?

TMS stands for transcranial magnetic stimulation. It is a technique where magnetic pulses are emitted and can pass noninvasively and nearly painlessly through the scalp and into the cortex. There the magnetic pulses induce an electric field, which in turn can influence neural activity. Strictly speaking, the name TMS is used for single pulse applications, for instance in the diagnosis of nerve damage.

Why Does TMS Work?

TMS has been shown to produce changes in neuronal activity in regions of the brain implicated in mood regulation, such as the prefrontal cortex. As each magnetic pulse passes through the skull and into the brain, this induces brief activity of brain cells underlying the treatment coil.

TMS causes nerve cells to fire, which then leads to the release of neurotransmitters. So it does both. You can think of TMS as ‘focal pharmacology.’ It changes neurotransmitters in specific regions. This is unlike a pill, which you take by mouth and goes to your stomach, some of which goes to your whole body, some of which then goes to the brain, and a little bit gets to where it is needed.

When Is TMS Used?

Antidepressant medications and psychotherapy are the first line treatments for major depression. These treatments, however, do not work for all patients. In these instances, TMS might be used as an alternative treatment, or to augment antidepressant medications or psychotherapy. Patients who have failed to achieve an adequate response from antidepressants, or who are unable to tolerate medications, might consider TMS therapy.

What Happens During A TMS Procedure?

Because TMS uses magnetic pulses, before beginning a treatment, patients are asked to remove any magnetic-sensitive objects (such as jewelry, phones, etc). Patients are required to wear earplugs during treatment for their comfort and hearing protection, as TMS may produce a loud clicking sound with each pulse, much like an MRI machine. Patients are seated during each session of TMS.

During the first TMS session, several measurements are made to ensure that the TMS coil will be properly positioned over the patient’s head. Once this is done, the TMS coil is suspended over the patient’s scalp with our exclusive HANS system (Head And Neck Support). The TMS physician then measures the patient’s motor threshold, by administering several brief pulses. The motor threshold is the minimum amount of power necessary to make the patient’s hand twitch and varies from individual to individual. Measuring the motor threshold helps the physician personalize the treatment settings and determine the amount of energy required to stimulate brain cells.

Once the motor threshold is determined, the coil is then brought forward so that it rests above the front region of the patient’s brain. Treatment is then commenced. During the treatment, patients will hear a series of clicking sounds and will feel a tapping sensation under the treatment coil.

Motor threshold is not checked at every treatment but may be reassessed if there is concern it may have changed, for example, because of a change in medication.

Will TMS Disrupt Other Areas Of Brain Functioning Or Change My Personality?

One of the benefits of TMS, relative to other depression treatments, is the accuracy it achieves in working on the desired brain region, or “target.” TMS allows clinicians to target very specific parts of the brain, leaving other areas alone. TMS does not lead to memory difficulties or other impairments in thinking. It does not change a person’s personality, though when patients experience relief from symptoms of the depression, their ability to think and function typically improves.

When Will I Feel Better?

The most successful TMS treatments for depression occur when patients undergo TMS treatments every weekday for four to six weeks, or a total of 20-30 treatments. Naturally every person is different and responses to treatment too. Some begin noticing an improvement as early as the second week, others in week 4 or 5.

Is TMS The Same As ECT?

No, TMS is not the same as electroconvulsive therapy (ECT). ECT, commonly referred to as “shock therapy,” is a treatment for depression that uses electricity to produce seizure-like activity in the brain while a patient is “asleep” under anesthesia. ECT is considered one of the most effective treatments for severe depression, but the side effects can be substantial. TMS is similar to ECT by virtue of its direct brain stimulation method to relieve depression. However, TMS is a treatment performed in the awake/alert patient; no anesthesia or sedation is needed. Magnetic energy, rather than electricity, is applied to the scalp during TMS.

Who Administers TMS?

The initial motor threshold is always determined by a TMS prescriber. The treatment itself is administered by an experienced TMS technician under the supervision of the TMS physician or by the TMS prescriber.

The TMS technician or physician will always be present to monitor the patient during the treatment. The patient can stop a treatment at any time simply by asking the staff member present.

How Long Is A TMS procedure?

TMS therapy involves a series of treatment sessions. Treatment sessions vary in length depending on the TMS coil used and the number of pulses delivered but typically last around 20 – 40 minutes. Patients receive TMS 5 days a week. A typical course of TMS is 4 to 6 weeks. However, this can vary depending on an individual’s response to treatment.

Do I Need To Be Hospitalized?

Unlike ECT, TMS does not require any sedation or general anesthesia, so patients are fully awake and aware during the treatment. There is no “recovery time”, so patients can drive home afterwards and return to their usual activities.

What Are The Side Effects?

TMS is well-tolerated and associated with few side-effects and only a small percentage of patients discontinue treatment because of these. The most common side-effect, which is reported in about half of patients treated with TMS, is headaches. These are mild and generally diminish over the course of the treatment.  Over-the-counter pain medication can be used to treat these headaches.

About one third of patients may experience painful scalp sensations or facial twitching with TMS pulses. These too tend to diminish over the course of treatment although adjustments can be made immediately in coil positioning and stimulation settings to reduce discomfort.

Some  TMS machine produces a loud noise and because of this earplugs are given to the patient to use during the treatment. However, some patients may still complain of hearing problems immediately following treatment. No evidence suggests these effects are permanent if earplugs are worn during the treatment.

TMS has not been associated with many of the side-effects caused by antidepressant medications, such as gastrointestinal upset, dry mouth, sexual dysfunction, weight gain, or sedation.

The most serious risk of TMS is seizures. However, the risk of a seizure is exceedingly low. At Certus Psychiatry, we follow up-to-date safety guidelines that are designed to minimize the risk of seizures. While TMS is a safe procedure, it is important to point out that because it is a new treatment, there may be unforeseeable risks that are not currently recognized.

Who Cannot Get TMS Therapy?

Patients with any type of non-removable metal in their heads (with the exception of braces or dental fillings), should not receive TMS. Failure to follow this rule could cause the object to heat up, move, or malfunction, and result in serious injury or death. The following is a list of metal implants that can prevent a patient from receiving TMS:

  • Aneurysm clips or coils
  • Stents in the neck or brain
  • Deep brain stimulators
  • Electrodes to monitor brain activity
  • Metallic implants in your ears and eyes
  • Shrapnel or bullet fragments in or near the head
  • Facial tattoos with metallic or magnetic-sensitive ink
  • Other metal devices or object implanted in or near the head
Who Will Benefit Most?

Existing evidence to date suggests that patients who are less treatment-resistant respond better to TMS than those who are highly treatment-resistant. However, there is much yet to be learned about particular variables that may impact response to TMS.

How Can I Get TMS Treatment?

TMS is the brain stimulation treatments for depression offered at Certus Psychiatry. Before scheduling you for treatment, you must first be evaluated by one of our TMS providers to determine if TMS would be safe and appropriate for you.

Does TMS Hurt?

During the first few treatments, the tapping sensation on your scalp may be uncomfortable. Up to 50 percent of patients who receive TMS will experience some mild to moderate soreness on their head during the first week of treatment. Over-the-counter pain medicines such as aspirin, Tylenol or Motrin can be used, before or after TMS sessions, to manage the discomfort. Over time, the scalp becomes less sensitive to the tapping sensation of the magnetic pulses and the treatment does not produce discomfort.

Do I Stop Taking My Medications?

Not necessarily. This is decided on an individual basis. During your pre-treatment consultation evaluation, the doctor will discuss this with you, provide recommendations about use of medications during TMS therapy.

Does Insurance Pay For TMS Treatment?

Medicare and most commercial insurances cover TMS therapy for patient who meets insurance criteria. Many patients have co-payments for TMS services, and we will provide information to help you determine what y our copays might be.