Transcranial Magnetic Stimulation (TMS) Definition And Benefits

Research conducted by the National Institutes of Health found that in 2020, almost 15 million U.S. adults – or 6% of the population – had been severely impaired by at least one major depressive episode in the past year. Approximately 77% of those individuals received treatment. 

In most cases of major depressive disorder, medications and/or talk therapy can make a significant positive impact. In situations where traditional treatments do not work, which may be referred to as treatment-resistant depression, newer treatments can still offer hope. One promising treatment for treatment-resistant depression is transcranial magnetic stimulation, or TMS.

How transcranial magnetic stimulation works

With TMS therapy, a powerful magnetic field generator, usually in the form of a magnetic coil, is placed near a patient’s head, emitting currents to help stimulate the brain. This brain stimulation can help ease symptoms of depression, as well as help to diagnosis and treat other health concerns. 

TMS is an outpatient procedure. You do not have to stay in the hospital to undergo the process, and no recovery time is needed. You can go about your day after your treatment.

While there are still unknowns about TMS, such as what other kinds of mental disorders it can treat, this noninvasive form of brain stimulation therapy was approved by the Food and Drug Administration (FDA) back in 2008 as an effective way to treat depression. Repetitive transcranial magnetic stimulation (rTMS), which involves repeated magnetic pulses, is sometimes used for treating major depression, particularly in cases where traditional treatments like medications and psychotherapy have little to no effect.

Effectiveness 

The exact reasons behind the effectiveness of TMS are not entirely understood. The brain is a complex organ, with many different parts, and research has shown that stimulating certain parts – such as the prefrontal cortex – can help reduce the symptoms of depression. Clinical trials and research indicate TMS may be part of an effective treatment plan for other mental health disorders and psychiatric disorders as well, such as post-traumatic stress disorder (PTSD) or obsessive-compulsive disorder (OCD). In 2018, the FDA approved TMS for the treatment of OCD. This form of TMS is called deep transcranial magnetic stimulation (dTMS).

Are there any side effects?

Perhaps the most important question to ask yourself when undergoing a treatment like transcranial magnetic stimulation is whether it’s safe. TMS is safe to use, but as with many types of treatments, there is a slight chance of some side effects.

Some of side effects may include:

Discomfort/pain: You may feel achy after the procedure, but the pain should not last very long.

Hypomania: You may feel some euphoria after the procedure.

Hearing loss: You may temporarily experience some hearing difficulties.

Memory loss: You have a hard time with memory, but typically only briefly.

Fainting: You may feel faint or faint altogether.

Seizures: Though it is rare, there is a risk that TMS may induce a seizure.

Although some of these side effects may sound scary, most of them are uncommon. No procedure is 100% safe, so you might talk to your doctor if you have any concerns about long-term side effects.

How much does TMS cost? What about health insurance?

When doing TMS, or any procedure for that matter, the question that comes up is the cost. Is transcranial magnetic stimulation an affordable procedure, or something that would cost me tens of thousands of dollars?

With any of these procedures, there is no straight answer. It will depend on you, your doctor, and a few other factors. Luckily, TMS cost is cheaper than electroconvulsive therapy (ECT). You may pay $500 per treatment session for TMS. While that may not sound too bad, you may need multiple sessions for TMS to work. For 10 sessions, you may pay around $5,000.

Insurance coverage

The good news is that many insurance providers are starting to see the importance of TMS and have decided to cover it. A few providers that often cover it include Anthem, Health Net, Blue Cross Blue Shield in a few states, and a few others. In some states, Medicare honors TMS, but not in others. As healthcare is always changing, talking to your doctor and insurance company directly before having the procedure done. 

Preparation

You may require a physical and psychiatric evaluation to be sure that transcranial magnetic stimulation (TMS) is right for you. When you begin your first appointment, it will mostly be about the doctor figuring out which TMS treatment is right for you. You'll sit down in a comfortable chair, wear earplugs, and then the electromagnetic generator will be over your head. The doctor will determine which position works best for you and how much magnetic energy is needed. A TMS technician may assist the doctor.

Session duration can vary according to the pattern used. Repetitive TMS sessions used to take more than 35 minutes, but they can now be completed in approximately 20 minutes. A newer form of treatment called "intermittent theta burst stimulation" can be completed in just 3.5 minutes.

Who can't have TMS?

With any brain stimulation treatment, there are certain groups of people who are more at risk for side effects. While these may not totally bar you from being able to do transcranial magnetic stimulation (TMS), you should still talk to your doctor if any of the following apply to you:

You’re pregnant or thinking of getting pregnant: TMS is typically safe for women who are pregnant, and there don't appear to be any adverse effects on the baby. However, it's still worth talking to your doctor about if you're not sure.

You have implants or metal devices: Since transcranial magnetic stimulation (TMS) uses magnetism, you should worry a bit if you have any metal devices in your body, especially if they're used for medical reasons. This is another case-by-case basis; some people who have metal implants may be able to have TMS without any risk. 

You have a history of seizures: As it can (rarely) induce seizures, it's worth mentioning too that if you or your family has had seizures or epilepsy.

Talking to your doctor

You should tell your doctor about your complete medical history and medical conditions (both mental and physical). You should also feel comfortable asking your doctor any questions you might have. 

Should I try TMS treatment?

After reading about this, you may wonder if TMS is the right way to go. This can only be determined on a case by case basis. If you're depressed and nothing seems to work, you may qualify. There may be other mental disorders and injuries that could benefit from treatment as well.

The answer, ultimately, is to speak to a professional. A TMS physician (a physician experienced and trained in TMS) should be able to tell you if TMS is right for you, give you a frame for how much it will cost, and be able to go through the process along with you. Your doctor can help you find an individualized treatment that will work for you. If it includes TMS, your doctor will further individualize your treatment by measuring your motor threshold to determine the right amount of energy for you.

Talk with a counselor

While repetitive transcranial stimulation (rTMS) is showing promise for the treatment of major depressive disorder, it is usually not recommended until other avenues have been exhausted. For most patients, medication and/or counseling can help improve MDD symptoms. Meta-analyses looking at both medication and psychotherapy treatments have found that psychosocial interventions (i.e., counseling) may be as effective as antidepressants for those with severe depression, and a combination of both generally have “superior effectiveness.” 

Online talk therapy 

Many people with depression fail to get help, partly because it’s difficult to muster the energy get out and go see a counselor in person. With online therapy through BetterHelp, you don’t have to. In many cases, online counseling has proven to be just as effective as in-person therapy. 

Research shows that online therapy is effective for a number of mental disorders. One study from 2017 found that online cognitive behavioral therapy was effective for depression, anxiety, and bipolar disorder, among other mental illnesses.