May 17, 2023

Learn how this non-invasive procedure could provide relief for depression symptoms that haven’t improved with medication and talk therapy.

Major depression is one of the most common mental health conditions. An estimated 21 million people in the United States have had at least one major depressive episode. Medications and talk therapy can often help. However, some people have treatment-resistant depression, in which these solutions don’t ease symptoms as much as desired. In these cases, a non-invasive procedure may be able to help. It’s called transcranial magnetic stimulation, or TMS.

“There are other options out there for the treatment of depression,” said Dr. Elizabeth K. Shultz, medical director of Neuromodulation Services for Vanderbilt Behavioral Health. “If someone is not experiencing a full response or maybe can’t tolerate medications very well, TMS is something they could definitely take into consideration.”

What is TMS and how does it work?

TMS uses magnets to generate a small electrical current to stimulate specific targeted areas of the brain. Although researchers are still working to understand exactly why transcranial magnetic stimulation works, they have a theory.

“It may help by increasing some neurotransmitters, or chemicals in the brain, that are involved in mood,” Shultz said. “By having more of those chemicals, you can improve some of the pathways in the brain that are involved in mental health.”

Is TMS right for me?

TMS is a treatment used for major depressive disorder.

“It’s usually used after someone has had a couple of trials with medications and psychotherapy,” Shultz said.

“It’s always worth getting an evaluation to see if TMS might be a good fit or you.”

However, the treatment may not be right for everyone. For example, TMS typically cannot be used in people who have a history of seizures or brain injury or who have a metal implant in their head.

“Although, it’s always worth getting an evaluation to see if TMS might be a good fit or you,” Shultz said.

Different transcranial magnetic stimulation devices have been approved by the Food and Drug Administration for use in other conditions, such as obsessive-compulsive disorder, or to help someone quit smoking.

What is a TMS treatment session like?

During a session, you will sit in a chair like those used in dental clinics. The magnet rests on top of your head, but a mechanical arm holds it up so that the full weight of the magnet does not cause pressure.

“You can go about your day as you normally would.”

You do not need to do any special preparation before the procedure.

“You can go about your day as you normally would,” Shultz said. “You can drive yourself to and from treatment.”

The first treatment may take slightly longer than later sessions, simply because your doctor will need to find the exact placement for the magnet and will need to determine the right strength of stimulus for you.

You’ll be awake for the non-invasive treatment, which lasts 20 to 30 minutes each session.

“Typically, a series of treatments is done consecutively, followed by a six-treatment taper,” Shultz said.

The consecutive treatments are performed daily, while the taper sessions will likely involve a few sessions per week for a few weeks.

“If someone responded well to a course of TMS previously, oftentimes they would be a candidate for a course later on if they have symptoms that return,” Shultz added.

Are there any side effects?

During the treatment, while the magnet is sending pulses, you may experience twitching in your facial muscles — for example, around the eyes or the jaw. After a session, you may notice scalp tenderness or a headache.

“There is a rare risk of seizures with TMS,” Shultz said. “But it’s about 1 in 10,000 people. It’s a possibility, but it’s very uncommon.”

What are the outcomes?

The goal of TMS is to try to help the person achieve remission from their depression symptoms.

“It’s more the exception than the rule that people will come off their medications after doing TMS, but it is possible,” Shultz said.

Transcranial Magnetic Stimulation at Vanderbilt

Vanderbilt Health treats a range of mental health conditions for which medication or psychotherapy have not been helpful. The Behavioral Health team combines advanced technology with personalized care to create a plan individualized to each patient, and offers alternative treatments, including electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS).

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