TMS therapy’s use of magnetic fields to stimulate nerve cells in the brain offers an alternative treatment for various mental health disorders, including depression, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), among others.
At Neuralia TMS in Perth, WA, we believe in holistic mental health care, and making it accessible. Our team of experienced healthcare professionals puts your well-being at the forefront of our services. We pride ourselves on our commitment to personalised TMS treatment plans that can positively change your mental health.
In this article, we’ll cover the basic science behind TMS therapy, the treatment process, TMS uses and applications, as well as TMS benefits, risks and limitations.
How does TMS Therapy Work?
It’s essential to understand that TMS uses magnetic fields, distinguishing it from other forms of brain stimulation. Unlike electroconvulsive therapy (ECT), TMS therapy harnesses the power of magnetic fields generated by a magnetic coil placed close to the head.
This coil produces a changing magnetic field that penetrates the skull, targeting specific areas of the brain, notably the dorsolateral prefrontal cortex. The repetitive transcranial magnetic stimulation (rTMS) technique involves sending repeated magnetic pulses to this region.
Regular (up to five times per week) left rTMS, or more specifically, low-frequency rTMS has been shown to have therapeutic effects. The underlying principle of TMS and rTMS technology is based on electromagnetic therapy, which changes brain cell activity through magnetic brain stimulation.
TMS therapy, sometimes called electromagnetic transcranial stimulation, offers a non-invasive, long-lasting approach to brain therapy.
TMS Treatment Process
The initial course of TMS typically involves a series of treatment sessions carried out 5 times a week, for 4 to 6 weeks. These sessions take place in a specialised TMS suite using dedicated TMS devices. Your response to the treatment is continuously monitored and adjusted where necessary.
During a TMS session, an electromagnetic coil is placed above the patient’s head in the correct position or against the scalp. The coil supplies magnetic pulses to stimulate nerve cells in the region of the brain involved in depression and mood control, specifically targeting the dorsolateral prefrontal cortex. This method activates areas of the brain that have decreased activity due to depression or other conditions.
After each session, patients can return to their normal daily activities. There are no restrictions on eating before or after a session, and no medications are prescribed. You’ll be awake for the entire session, and you’ll be able to drive yourself home. Some individuals may experience a headache briefly after treatments, but between treatments, most patients can work and drive as usual.
While the original rTMS pattern took 37 minutes but has since been optimised to between 5 and 20 minutes. The stimulation intensity (dose) is carefully calibrated during the treatment to ensure optimal results.
The effects of TMS are profound. Many patients report significant improvements after their course of treatment.
Adam Stern from Harvard Health reports that “50% to 60% of people with depression who have tried and failed to receive benefit from medications experience a clinically meaningful response with TMS”, while Mandy Erickson of Stanford Medicine indicates that accelerated TMS “caused remission in 79% of trial with severe depression”.
What diseases can TMS treat? Uses and Applications
TMS uses and applications include, but are not limited to:
- Depression: TMS is primarily known for its effectiveness in treating major depressive disorder, especially in cases where traditional treatments and pharmacological interventions have failed.
- OCD: Some studies suggest that TMS can be beneficial for those suffering from OCD. The use of TMS for the treatment of OCD involves targeting specific areas of the brain, often identified through MRI scans, to modulate neural activity.
- Migraine: TMS can be used as a treatment for migraines, particularly those with aura (sensory disturbances).
- Stroke Rehabilitation: TMS has been explored as a tool to aid in the recovery of motor skills after a stroke.
- Tinnitus: Some patients with chronic ringing in the ears, or tinnitus, have found relief through TMS therapy.
- PTSD: Preliminary research indicates that TMS may be effective in alleviating the symptoms of PTSD.
- Parkinson’s Disease: There is ongoing research into the potential of TMS to improve motor symptoms in Parkinson’s patients.
Benefits of TMS as a Treatment for Depression
In the realm of mental health treatments, TMS stands out as a promising and effective treatment for depression. TMS offers a hopeful alternative to those who haven’t found relief through traditional methods or pharmacological interventions. It’s especially beneficial for patients with medication-resistant (drug-resistant) or treatment-resistant depression (TRD), where standard antidepressant medication and psychotherapy haven’t yielded the desired results. Moreover, the process has been approved as a treatment for depression by regulatory bodies, making it a viable treatment option for many.
Patients undergoing TMS for depression often report significant improvements in their mental health. The treatment is particularly effective for those with long-term depression or refractory depression, which hasn’t responded to other treatments.
History of TMS & Deep TMS
Since its public introduction in 1985, TMS has not only stood its ground as a formidable contender in treating depression but has also evolved, notably with the advent of Deep TMS, which utilises a cushioned helmet to regulate wider and deeper brain regions, enhancing precision in modulating neural activity.
The effectiveness of TMS, underscored by consistent findings from studies and meta-analyses, is particularly pronounced in addressing treatment-resistant depression (TRD) and OCD, achieving response and remission rates that are compellingly comparable to psychotherapy and medication. Furthermore, the safety profile of TMS is commendable, typically presenting mild side effects, and without the risk of dependence or withdrawal symptoms often associated with antidepressant medications.
An integrative approach, combining TMS with psychotherapy, has been spotlighted for its superior clinical outcomes, achieving up to a 55% remission rate, thereby not positioning TMS as a standalone treatment but rather a pivotal component in a comprehensive, multimodal treatment plan for depression.
This holistic approach, which also encompasses Deep TMS – approved in several countries for conditions like major depressive disorder and obsessive-compulsive disorder – further broadens the therapeutic landscape, providing enriched, patient-centric treatment pathways for managing mental health conditions.
Clinical Trials and Approvals
Navigating through the labyrinth of clinical trials and approvals, TMS has carved out a notable position in the therapeutic landscape. The Therapeutic Goods Administration (TGA) in Australia regulates and permits the marketing of transcranial magnetic stimulation devices, underscoring its recognition as a viable treatment modality.
This approval followed rigorous clinical trials, ensuring the safety and efficacy of TMS machines and systems in treating certain mental health conditions. For example, in 2020, the TGA approved Neurosoft’s Neuro-MS/D for its use in stimulating the central or peripheral nervous system through magnetic stimulation. This tried and trusted machine is our device of choice here at Neuralia TMS.
Another example of the success of TMS therapy comes from the TGA-approved Brainsway Deep TMS machine. In a pivotal clinical trial, a 38% response rate was present in patients using the Brainsway device, which the FDA (Food and Drug Administration) has acknowledged the Brainsway machine for its efficacy and safety in treating diverse conditions, notably OCD.
The National Institutes of Health (NIH) and the Institute for Health and Care Excellence have also acknowledged the potential of TMS, further propelling its adoption across various TMS clinics. rTMS devices and machines have undergone their own set of trials, validating the technology and its application in the realm of neuropsychiatric treatment.
TMS training for healthcare professionals ensures the safe and effective deployment of this technology, enhancing its reach and impact in the clinical setting.
TMS in Australia
The use of TMS in Australia has witnessed a surge, with clinics offering this innovative treatment in major cities like Perth, Melbourne and Sydney. TMS treatment cost in Australia can vary, and while it might be a consideration for some, the potential benefits of this non-invasive therapy often outweigh the financial aspect, especially when considering its efficacy in managing mental health. Notably, TMS treatments have been approved and are covered by Medicare, so be sure to speak to your qualified healthcare professional about financing options.
The multifaceted utility of TMS, from treating psychiatric conditions to exploring its potential in neurological rehabilitation, underscores its versatility and efficacy in the realm of neurotherapeutic research and application.
Risks and Potential Side Effects of TMS
While TMS therapy is generally considered safe and well-tolerated, it can cause some side effects. Common side effects include:
- scalp discomfort
- pain at the treatment site
- spasms or twitching of facial muscles
However, these side effects are typically mild to moderate and improve shortly after a session. More serious side effects, although rare, can include fainting, seizures, emotional highs (mania), and hearing loss if the ears aren’t well-protected during treatment. Seizures are extremely rare and recent studies have shown that most antidepressants have a higher rate of seizure than TMS.
The average risk is believed to be 1 seizure per 50,000 to 60,000 sessions in patients without seizure risk factors such as brain lesions or epilepsy (Rossi et al., 2009; Lerner et al., 2019). Safety considerations, such as thorough pre-assessment and ongoing monitoring, are paramount and involve a thorough assessment to mitigate any potential risks associated with TMS side effects.
It is crucial for patients and healthcare providers to engage in a detailed discussion regarding these aspects to ensure that the treatment is not only effective but also safely administered.
The TMS journey is not without its limitations. While it is a suitable and effective treatment option for many, there are scenarios where a patient may not be a suitable candidate for TMS. For example, individuals with non-removable metal in or near the head (excluding braces and dental fillings), or those with a history of seizures.
Your TMS team will conduct a thorough review of your medical history and consult with your referring GP and/or psychiatrist before designing your tailored TMS treatment plan. Based on your initial evaluation, your TMS consultant will let you know if it’s safe for you to proceed with TMS treatments.
Neuralia TMS is a leading TMS specialist, operating six clinics throughout metropolitan and regional Perth. TMS is an effective, alternative, drug-free treatment for depression, PTSD, OCD, and chronic pain. It leverages high-strength magnetic fields to stimulate nerves in specific brain areas, often underactive in mental illness or pain, providing a safe, non-invasive, and long-lasting solution, more efficacious than traditional medications like antidepressants. Neuralia’s vision is to provide access to TMS and other next-generation effective treatments (e.g., tDCS, ketamine, psychedelics) to as many Australians as possible.
Neuralia TMS is proud to announce that as of March 2023, we will be the first multi-site TMS specific service to offer a no out-of-pocket Medicare option for treatment-resistant depression. With Neuralia TMS, Medicare will cover 100% of the cost of treatment for eligible patients. This is applicable for all TMS treatment sessions and TMS psychiatrist reviews.
How to be referred?
Your GP can refer to us for TMS therapy. A team member will contact you to book your first appointment. GPs can refer via healthlink, fax or email using a standard referral letter. GPs can also access a secure online referral form via the QR code or our website: neuraliatms.com.au/referrals