TMS Treatment: What Is It?
Repetitive Transcranial Magnetic Stimulation (rTMS) is a recognised treatment for depression and other neurological conditions.
Clinical studies have demonstrated the effectiveness of TMS in the treatment of depression, particularly in patients who have not responded well to anti-depressant medication.
TMS is a non-invasive treatment delivered by an external magnetic coil placed lightly touching the scalp. The coil sends repetitive electromagnetic pulses to stimulate neuron activity in specific surface areas of the brain that regulate mood.
TMS is a recognised treatment for depression by the Royal Australian and New Zealand College of Psychiatrists (RANZCP Position Statement 79 – Repetitive Transcranial Magnetic Stimulation).
What Conditions Does TMS Treat?
The most common condition for TMS treatment is depression.
TMS has also been used to treat:
- obsessive-compulsive disorder (OCD),
- auditory hallucinations,
- post traumatic stress disorder (PTSD),
- attention deficit hyperactivity disorder (ADHD),
- Alzheimer’s disease (AD),
- tinnitus (ringing in the ears).
What is TMS Therapy for Depression?
The most common target of TMS treatment is depression. Magnetic therapy for depression dates back to the 1980s.
Increasing evidence of TMS effectiveness, especially the TMS depression success rate, has recently led to a much wider availability of TMS therapy.
An initial course of TMS therapy consists of around 30 to 35 sessions at a TMS clinic, each visit taking 30-60 minutes.
How Does TMS Treatment Work?
Our brains help manage our thoughts via electrical and chemical messengers. Each thought is associated with certain pathways that these signals travel along. The more our brain practices certain pathways the better it gets at whatever we practice.
In depression, the brain has significantly less activity in the frontal lobe and limbic system. We can actually see this in CT scans. In depression you could say the limbic system is way out of practice.
In TMS therapy, a coil is placed over the head and uses an electromagnetic field to induce an action potential in the neurons of the brain, a clinical term which basically means it activates the neuron. An action potential in one neuron causes others around it to fire, and so on.
Repeated stimulation reaches deep areas of our brain using this neuron roadway. Specifically, the limbic system trains the known pathways that are associated with being happier, more relaxed, content and less anxious.
While a single positive thought can train a particular pathway once, a single TMS treatment session can practice that same pathway 3000-5000 times.
A typical TMS course of 30 to 35 sessions can stimulate positive pathways 90,000-150,000 times.
It is thought that this practice is what leads to the improvement in mood that we see clinically. Just imagine practicing kicking a football or practicing a golf swing 150,000 times, you would become very skilled. It is just like this, practice makes perfect. It’s like muscle memory for your brain.
Why TMS Therapy Is Effective?
TMS therapy is effective because it subtly corrects the neural pathways that underlies depression, as well as boosting levels of deficient neurotransmitters.
TMS side effects are generally minimal, which means that fewer patients need to stop treatment before it has a chance to work.
How Long Does TMS Treatment Last?
After a full course of TMS treatment, most patients will experience improved symptoms for 6-12 months.
One study of patients who completed TMS depression treatment showed that a year later, 68% were still improved, and 45% had no symptoms. Another study was even more encouraging, with almost two thirds of patients showing no symptoms of depression a full year after treatment.
Note also that these patients have been unsuccessful with at least two antidepressants.
How is TMS Treatment Performed?
To undergo TMS therapy, there is no need for fasting or an anaesthetic.
The patient sits comfortably in a reclining armchair and is awake throughout each treatment. The patient’s head is carefully measured by a trained technician to determine the optimal location for treatment.
TMS treatment is non-invasive. The stimulating coil is placed beside the head, lightly touching the scalp. The patient will hear a ticking sound and may feel a mild tapping sensation on the side of their head.
TMS treatment is provided on an outpatient basis or can be part of a treatment plan for hospital in-patients.
How Long Does TMS Treatment Take?
TMS treatment is generally administered as a course of 30 treatments over six weeks.
Regular psychometric testing is conducted to monitor your response to treatment. At the end of the course of treatment, a NeuroCentrixTMS psychiatrist will discuss the psychometric test results with you and report to your treating physician.
When patients have achieved significant improvement in their condition, a maintenance course of treatment is often recommended.
Are There Any Side Effects?
TMS therapy is generally well tolerated but may produce some side effects such as:
- tension headache,
- lightheadedness,
- nausea,
- a tingling sensation in the face or discomfort at the application site.
Headache is the most common side effect which responds to over the counter painkillers. Most people find that side effects lessen as treatment progresses.
Unlike some other depression therapies, TMS treatment does not cause memory loss, weight gain or loss of libido.
There is a small risk of seizure. If you suffer from epilepsy or have had a head injury, you may not be suitable for TMS treatment.
To date, there have been no recognised long-term negative effects reported from TMS treatment. However, it should be noted that TMS is a relatively new treatment and research into long-term effects is on going.
Is TMS Right for Me?
TMS is only offered after a thorough assessment and discussion with one of our psychiatrists. However, TMS may be right for you if:
- You suffer from symptoms of depression
- Anti-depressants have failed to remove your symptoms
- Anti-depressants have caused unpleasant side effects
- You cannot take anti-depressants because of another condition.
On the other hand, TMS is unlikely to be suitable if you have a metal implant, such as a pacemaker or defibrillator.
Do I Need a Referral for TMS Treatment?
You need a referral from a psychiatrist or a GP to access TMS treatment at NeuroCentrixTMS.
A TMS referral form is available on our website.
What Does TMS Cost?
TMS treatment for depression at our TMS clinic typically consists of 30 to 35 sessions delivered as an outpatient over 4 to 6 weeks.
Outpatient treatment allows you to stay at home with family and friends during treatment rather than being admitted to hospital. Following your initial course of TMS therapy, your doctor may recommend maintenance treatment.
TMS treatment costs may be met in full for serving military, DVA, and WorkCover patients upon successful application. After referral to NeuroCentrixTMS, we look after the paperwork and prepare the application on your behalf.
Private treatment is available at $196 per session.
As of November 2021, Federal Government announced funding to provide access to Medicare-subsidised repetitive Transcranial Magnetic Stimulation for the treatment of medication resistant major depressive disorder.
Is TMS Therapy Covered by Medicare?
To be eligible for an acute course of up to 35 TMS treatments, patients must:
- Be an adult (18+) diagnosed with major depression
- Have tried two different classes of antidepressant medication without satisfactory improvement
- Have undertaken psychological therapy
- Have not received rTMS therapy previously
To be eligible for a maintenance course of up to 15 TMS treatments, patients must:
- Have responded positively to an initial course of Medicare funded TMS treatment
- Have been in remission for four months following treatment but have since relapsed
- Have not had TMS therapy for depression in the last 4 months
How to Prepare for TMS Therapy?
You will have a psychiatrist assessment to ensure that TMS treatment is an appropriate option for you.
You should tell your doctor if you:
- Are pregnant or planning to be
- Have any medical devices or metal objects in your body
Long Term Results of TMS Treatment
TMS treatment provides lasting benefits without long-term side effects such as weight gain or sexual dysfunction. Short-term side effects of TMS, such as headache, usually resolve within the first week of treatment.
Studies have shown that a course of TMS therapy usually produces substantial benefit even one year later. Meanwhile no long-term adverse effects have been found.