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How Does TMS Work?

For people struggling with mental health challenges like depression, traditional treatments like medication or talk therapy may not always provide enough relief. In these cases, therapies like Transcranial Magnetic Stimulation (TMS) may be more beneficial. For those wondering how TMS works, this non-invasive therapy can help to restore chemical imbalances in the brain and improve mental health without the use of medication.

The Science Behind TMS

TMS works by using magnetic fields to gently stimulate certain areas of the brain. The treatment focuses on regions associated with mood regulation, like the prefrontal cortex. By placing a magnetic coil on the scalp, small magnetic pulses are sent into the brain, generating electrical currents that activate brain cells. This helps to improve communication between neurons which is often disrupted in people dealing with conditions like depression.

One of the ways TMS helps is by boosting the levels of neurotransmitters like serotonin and dopamine. These neurotransmitters play a major role in how we feel and process emotions. Over time, this treatment can normalize brain activity and offer relief to those whose mental health has been affected by imbalances in these chemicals. TMS is also non-invasive, meaning it doesn’t require any sedation or anesthesia. This allows patients to return to their regular activities right after a session.

How The TMS Procedure Works

While the TMS procedure is a simple process that doesn’t require any anesthetics or downtime, there is a process that must be followed to ensure effectiveness and safety. Here’s a step-by-step breakdown of what to expect during a session:

  • Step 1: You’ll be seated comfortably in a chair, similar to the kind you’d find in a doctor’s office or clinic.
  • Step 2: A trained technician will place a magnetic coil on your scalp near your forehead This is done to target the specific brain areas related to your treatment.
  • Step 3: The machine will send a series of magnetic pulses through your scalp. These pulses pass painlessly through the skull and stimulate brain activity in the targeted region.
  • Step 4: During the session, the technician may adjust the coil’s position to make sure that it’s targeting the right areas. You’ll remain fully conscious and can communicate throughout the procedure.
  • Step 5: The treatment typically lasts 20-40 minutes. Once it’s over, you can immediately go about your day. There’s no recovery time needed.
  • Step 6: TMS treatment usually requires multiple sessions over several weeks. Many patients receive treatment five times a week for 4-6 weeks.

Types of TMS Treatment

There are six types of TMS treatments available. While all forms of TMS use magnetic pulses to stimulate brain activity, they vary in the intensity and depth of the stimulation. The six types of TMS include:

  • Single Pulse TMS (sTMS) delivers one brief magnetic pulse to a specific brain area. This is often used to study brain processes and assess cortical excitability.
  • Paired-Pulse TMS (ppTMS) uses two magnetic pulses in quick succession to explore intra-cortical connections. This provides insights into brain communication pathways.
  • Repetitive TMS (rTMS) administers repeated magnetic pulses at rhythmic intervals. This is used therapeutically to treat conditions like depression, anxiety, and migraines.
  • Deep TMS (dTMS) targets deeper brain regions with wider magnetic field pulses.
  • Theta Burst Stimulation (TBS) delivers bursts of three pulses at 50 Hz every 200 ms. TBS can be applied continuously (cTBS) or with intervals (iTBS).
  • Quadripulse Stimulation (QPS) delivers four TMS pulses every five seconds for 30 minutes.

What Conditions Does TMS Treat?

TMS has been approved by the U.S. Food and Drug Administration (FDA) to treat mental health and neurological conditions. Currently, TMS is FDA-approved for the treatment of four conditions: depression, obsessive-compulsive disorder (OCD), migraines, and smoking cessation.

Depression

TMS is used for people suffering from major depressive disorder (MDD). This treatment uses electromagnetic pulses to stimulate neurons in the prefrontal cortex. Over the course of four to six weeks of daily sessions, TMS rewires abnormal brain activity, which can help alleviate depressive symptoms.

Recent research from Stanford Medicine has shown that TMS may work by reversing abnormal brain signals. This opens up new possibilities for using brain activity patterns as potential biomarkers for diagnosing depression.

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder affects over 2% of the global population. For those with treatment-resistant OCD, TMS and deep TMS have been shown to be effective treatment options. Deep TMS targets deeper parts of the brain, including the anterior cingulate cortex and medial prefrontal cortex. These parts of the brain are thought to contribute to OCD symptoms.

In a multicenter clinical study, deep TMS was shown to reduce OCD severity by more than 30% in over a third of participants. This provides hope for people who have not found success with other OCD treatments.

Migraines

Migraines can be debilitating for those who suffer from them regularly, but TMS is showing promise as a preventive and acute treatment option. In one study, patients using a single-pulse TMS device were able to reduce their headache days significantly, especially when used preventively.

Repetitive TMS has also been explored as a preventive treatment for migraines by altering brain excitability and neurotransmitter activity. With newly developed portable devices for home use, patients can now access this treatment more conveniently. This can help reduce the impact migraines have on their everyday lives.

Smoking Cessation

Smoking remains one of the leading causes of preventable death in the U.S., but TMS can potentially help people quit. The FDA approved the H4 coil specifically for smoking cessation. This coil targets both sides of the brain simultaneously to reduce cravings and increase the ability to resist smoking.

In one study, participants under going TMS therapy for smoking cessation saw higher quit rates and reduced cigarette consumption after 13 sessions over three weeks. By stimulating areas of the brain responsible for cravings, TMS helps reduce the urge to smoke.

How Does TMS Differ from Other Treatments?

TMS stands out when compared to other treatment options for mental health conditions due to it’s ability to directly stimulate brain activity. Unlike medications or electroconvulsive therapy (ECT), TMS is a non-invasive and drug-free alternative.

TMS vs. Medications

Medications are often the first line of treatment for depression. Antidepressants work by balancing serotonin and dopamine levels. However, for those with treatment-resistant depression medications may not always be effective, and side effects can vary from person to person. Here’s a closer look at how TMS compares to medications:

  • Medications introduce chemical compounds into the body.
  • Antidepressants often come with mild to severe side effects.
  • Effectiveness varies based on individual response to the medication.

On the other hand, TMS changes brain activity without introducing chemical into the system. This can help reduce the risk of adverse reactions. Additionally, TMS can be more cost effective than medications.

TMS vs. Electroconvulsive Therapy

While both TMS and electroconvulsive therapy are designed to treat severe depression, the two therapies are quite different. ECT is typically used for patients with very severe depression or when there is an immediate risk of suicide, making it a last-resort option. Here’s a breakdown of how the two therapies compare:

  • TMS uses magnetic pulses to stimulate the brain.
  • ECT uses electrical currents to induce a seizure.
  • TMS is an outpatient procedure with no anesthesia required.
  • ECT requires general anesthesia and is performed in a hospital.

After a TMS session, patients can immediately resume their daily activities, while ECT patients often need days or even weeks to recover. Although ECT has been shown to be highly effective, TMS offers a less intensive alternative for those who are looking for treatment without the need for hospitalization or recovery time.

With minimal side effects and no need for sedation, TMS is a safe option for people looking for relief from depression, OCD, migraines, and more. Whether you’re considering it as a standalone treatment or as an additional part of your treatment plan, understanding how TMS works and its benefits can help you make the best decision for your health. For questions or more information on TMS, reach out to your healthcare provider.

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Dr. Kevin Simonson

Dr. Kevin Simonson, an esteemed Medical Director at Cura Behavioral Health, brings over 15 years of experience in psychiatry. A graduate from a top medical school, he specializes in the treatment of mood disorders and anxiety, employing a patient-centered approach. His dedication to evidence-based care and his commitment to advancing mental health practices have made him a respected figure in the field. Dr. Simonson’s leadership ensures the highest standard of care for the community at Cura Behavioral Health.