TMS (Transcranial Magnetic Stimulation) is a form of brain stimulation and continually gaining attention as an effective strategy for treating depression. Traditional treatments can sometimes provide inadequate relief for as many as 60% of patients with a major depressive disorder.
Located at the front of the skull, the cerebrum is split into the right and left hemispheres. The Prefrontal Cortex is a very important part of the front of the brain that has a number of essential functions. These included emotional regulation and executive functioning (attention, impulse inhibition, prospective memory, and cognitive flexibility.
Neuroscientific research has hypothesised that deduced activity in the left Dorsolateral Prefrontal Cortex and increased activity in their right side is associated with depression. To reverse the effects of under and over excitability, high and low frequency transcranial magnetic stimulation is used.
Unilateral TMS uses high frequency pulses to increase the reduced excitability of the left Dorsolateral Prefrontal Cortex and Bilateral TMS uses low frequency pulses to lower the overexcitability in the right Dorsolateral Prefrontal Cortex in addition to increasing of the reduced excitability in the left.
In general, the most commonly prescribed protocol for TMS for depression is left sided 10Hz treatment of the Dorsolateral Prefrontal Cortex. At Neuralia TMS, our standard practice is for patients to be reviewed around session 20 to ensure that they are starting to demonstrate early signs of improvement. Most of the time, patients are showing signs of improvement. However, if this is not the case, we will usually recommend either right sided unilateral stimulation or bilateral stimulation. One rationale for the use of bilateral stimulation is the notion that a certain subset of patients who have no improvement by session 20 may be late responders to left sided treatment. Your TMS Psychiatrist will make this decision based on a number of unique factor that will be determined during this mid-review session.
Please click here to watch a video about how TMS works.