Everything You Wanted to Know About TMS (Transcranial Magnetic Stimulation)

There is a common treatment for depression that we all tend to think of: going to the office, sitting in a comfy chair, and… having the nerve cells in your brain stimulated with repetitive magnetic pulses.

Actually, that’s probably not what you were thinking of!

Unlike talk therapy, which often involves weekly visits to the therapist’s office to sit in the chair and talk through your issues, transcranial magnetic stimulation – or TMS – usually requires a daily office visit, is often shorter than a therapy session, and does not include very much talking.

Like talk therapy, TMS is a well-established treatment for depression that is starting to be used for other mental health conditions too. It is often used when first-line treatments such as medications and psychotherapy are not having the desired impact.

The mystery behind how TMS works

TMS is a non-invasive procedure (meaning your skin will not be broken) that uses a magnetic field to stimulate the cells in your brain.

It has been shown to reduce depressive symptoms, but we don’t know exactly how or why it works. Some theorize that the antidepressant effects of TMS have to do with the increase in Brain Derived Neurotropic Factor (BDNF), which has a broad range of functions in maintaining your brain health.

Studies have also focused on the impacts that TMS has on the neurotransmitter systems for Serotonin and Dopamine, which have both been linked to depression. Other ideas revolve around how TMS impacts the brain’s plasticity.

While there is still no consensus on the exact mechanism for how TMS improves depression, what we do know is that an electromagnetic coil – or magnet – in the machine creates a localized and concentrated magnetic field, similar to those produced by an MRI machine. The magnetic field reaches a few centimeters into the brain, right where it is placed on your head.

The TMS machine is situated to stimulate certain areas of the brain that tend to have reduced activity with depression. This seems to help restore balance in the brain and allows us to improve our capacity to regulate various moods.

Different types and combinations of stimulation in varying parts of your brain have also been shown to treat other issues like nerve pain, fibromyalgia, and potentially multiple sclerosis, recovery from a stroke, and Alzheimer’s or substance addiction treatment.

What it’s like to get TMS

It can be scary to start something new, especially when you don’t know what to expect.

You’ll most likely start with a psychiatric evaluation to ensure that transcranial magnetic stimulation is the best treatment option for you at this time in your life. The treatment center or psychiatrist may also ask if you have any metal, implanted medical devices, or metallic ink tattoos that could interact with the magnetic field.

Once you are approved for the procedure and decide to go forward with it, you might be wondering what the experience is going to be like.

Your first visit will be longer than usual because you’ll need to get fitted for a TMS cap, which looks a lot like a swim cap but with numbers on it. Your brain will also get “mapped.” This just means they’ll move the machine around to different parts of your head, and you’ll feel a gentle tap from the magnet. They’ll then watch for an indicator, such as a jerk in your pinky finger.

Your doctor will use the mapping to select your treatment dose and location, which is how the machine will be placed each day so that the magnetic pulse focuses on the correct area.

You’ll usually start your first treatment right then and there and will get your first taste of what is to come. As the process is about to begin, you’ll likely hear the sound of the fan as it is turned on. It sounds like a loud white noise machine right next to your ears. The treatment center should offer you earplugs to prevent any damage to your hearing.

Next, the TMS technician might give you a countdown: “three, two, one…” and your first pulse train will begin. The treatment itself lasts between 15-40 minutes, and you can listen to a podcast, meditation, or audiobook that inspires you or makes you feel grounded and at peace during that time.

You’ll remain completely conscious throughout treatment and ready to return to your regular activities once the session is over.

Often, treatments occur five days per week – Monday through Friday – and last anywhere from four to nine weeks.

When you should expect results

Up to 50-60% of people experience a positive result from transcranial magnetic stimulation for treatment-resistant depression. And almost one-third of these people have all of their symptoms go away completely. On average, these results last for about a year.

It usually takes 10 days to four, five, or even six weeks for people to experience the beneficial results of TMS. Psychiatrists often describe it as the experience of a very small improvement that builds on itself over the weeks until you start to feel some real and meaningful relief.

You’ll have a few recalibration sessions throughout your weeks of treatment when your doctor will re-check your dosage and mapping and ask you about how you’ve been feeling. You may even score yourself on a series of questions that measure your moods and experiences in a numerical way to help track your progress over time.

If you experience an improvement in your depressive symptoms and later have another episode of depression, some insurance companies will cover another round of treatment, which is called re-induction.

Pros and cons of TMS therapy

TMS is non-invasive and considered safe and well-tolerated. The first week is usually the most unpleasant. As the magnetic pulses come, you’ll probably feel discomfort on your scalp in that location, and your jaw might clench, your teeth might hurt, your eyes might tear up, your hand and face might twitch, and you might also feel a tingling sensation in your face.

Some people say that they also feel extra tired during the first couple of weeks of treatment, but you’ll likely have the weekends off to rest and recover.

The good news is, TMS side effects are generally considered mild to moderate and typically only last during the actual session. They also tend to ease up after the first week or two of treatment.

Uncommon and more serious side effects include seizures and also hearing loss if you are not given adequate ear protection for the loud fan in the TMS machine.

Also, unlike Electroconvulsive Therapy (ECT), which uses electric currents to create mini seizures to reset the brain, TMS is not associated with cognitive or memory impairments.

While the side effect profile and risks are low, TMS treatment does require commitment: five days a week over a period of several weeks. It can also be expensive, even when covered by your insurance company, and it does not work for all people.

As it is a relatively new treatment, more research is needed to understand how to personalize TMS treatments and create more individualized approaches depending on each person’s biology, environment, and specific struggles.

All of that said, TMS therapy benefits include potentially reducing or eliminating your depression symptoms. It might be well worth exploring as an option if it helps you to feel better.

Combining TMS with your online therapy

TMS treatment has been shown to have improved outcomes when combined with psychotherapy. This includes a greater and sustained reduction in symptoms as well as a decrease in the number of TMS sessions needed to achieve a response.

While undergoing the TMS treatment, you may want to come up with a list of achievable goals with your online therapist. One study found that setting goals during the course of TMS treatment led to a 77% completion rate.

There’s almost nothing worse than feeling stuck in a persistent or recurring depression. It gets in the way of your work, your social life, and your ability to be yourself, thrive, and offer your unique gifts to the world.

Transcranial magnetic stimulation is generally known to be a safe and promising treatment option if your depression hasn’t responded adequately to first-line treatments. It has also been used successfully to treat other mental health conditions.