What is TMS?

Transcranial Magnetic Stimulation (TMS) is a medical procedure in which coils of wire are placed on the scalp, and the brain is stimulated with electrical charges created by changes of the magnetic field of coils of wire (APA, 2022a). This procedure is considered non-invasive, as it does not require entering the body in any way. During TMS, the electrical stimulation of the brain causes a change in functioning or a response in a specific part of the brain during the procedure (APA, 2022a).

TMS is also sometimes referred to as repeated transcranial magnetic stimulation (rTMS), which is when a series of TMS signals, instead of one signal, are part of the procedure (APA, 2022a). Although the electrical signals are strong, they are quick and do not cause pain (Rossini & Rossi, 2007). The electrical signals used in TMS can have different frequencies. For example, in general, low frequency (LF) rTMS causes brain activity in a certain area to decrease, whereas high frequency (HF) rTMS causes brain activity in a specific area to increase (Brunoni et al., 2017). 

Research on TMS/rTMS indicates that it has potential applicability for a wide range of medical and mental health challenges. TMS and rTMS procedures have been studied and monitored for safety, and research demonstrates that it is a safe technique (Rossini & Rossi, 2007). Some side effects can occur in patients, including headaches and feelings of tingling on the face and/or scalp (Rizvi & Khan, 2019). 

In order to study the efficacy of TMS on various disorders, researchers often use what are called sham-controlled studies. In these studies, there are two groups of participants. One group, the experimental group, is given the TMS treatment. The second group, or control group, goes through almost the exact same procedure, with the exception of actually receiving the treatment. In the case of a TMS study, for example, one group would receive TMS treatment and the other group would go through the procedure of having coils placed on their scalp and, though no electrical current would be present. 

TMS and Major Depressive Disorder 

Major depressive disorder, commonly called depression, is a common mental health disorder with more than 300 million people in the world impacted (Voineskos et al., 2019). Major depressive disorder is the leading cause of disability according to the World Health Organization (Voineskos et al., 2019).

Major depressive disorder may be diagnosed when five or more symptoms exist for a period of 2 weeks (APA 2022b). One symptom must be either depressed mood or loss of interest or pleasure (APA 2022b). Other symptoms may include changes in weight, sleep, body movement, feelings of fatigue, feelings of guilt or worthlessness, difficulty concentrating, and/or thoughts of death or suicide (APA, 2022b). 

Research done on depression indicates that it is largely treatable, and a variety of evidence-based treatments exist. Depression is most commonly treated with talk therapy, medication, or a combination of both treatments. Research has shown that depression can be effectively treated with talk therapy using specific therapeutic modalities, such as cognitive behavior therapy (Cuijpers et al., 2013). A variety of other evidence-based therapeutic modalities for treating depression exist. In situations where the depression is resistant to other types of treatment, such as talk therapy or medication, TMS is considered an acceptable treatment for major depressive disorder (Gellersen & Kedzior, 2019).

Research on the biological and neurological components of depression has demonstrated that an area of the brain called the left dorsolateral prefrontal cortex (DLPFC) is linked to major depressive disorder (Voineskos et al., 2019). Specifically, research shows that activity in the DLPFC that is below typical levels may be involved in depression (Voineskos et al., 2019).

When treating depression with rTMS, high frequency electrical charges are utilized to target the DLPFC in order to increase activity in that specific part of the brain (Voineskos et al., 2019). HF-rTMS treatment for depression usually involves coils of wire with an electrical charge that resemble the shape of an eight (F8) (Gellersen & Kedzior, 2019). This type of TMS has been approved by the Food and Drug Administration (FDA) for treatment-resistant depression since 2008 (Gellersen & Kedzior, 2019).

There is another type of rTMS that involves a coil shaped like the letter H (H-coil), which works very similarly to an F8 coil (Gellersen & Kedzior, 2019). Research suggests that H-coils produce antidepressant effects for individuals with major depressive disorder that are consistent and short-term (Gellersen & Kedzior, 2019). This type of TMS treatment for depression has been FDA-approved since 2013 (Gellersen & Kedzior, 2019).

TMS and Obsessive-Compulsive Disorder 

In order to be diagnosed with obsessive-compulsive disorder, commonly known as OCD, individuals must experience obsessions, compulsions, or both (APA, 2022b). Obsessions are thoughts that are unwanted and recurrent, and can include images or urges; compulsions are mental acts or repetitive behaviors that people feel compelled to do in response to obsessions (APA, 2022b).

OCD can be incredibly distressing and lead to considerable impairment for individuals experiencing this disorder at home, work, relationships, and other areas of life. There are several evidence-based treatments available to treat OCD. Currently, psychotropic medication, often in conjunction with talk therapy, such as cognitive-behavioral therapy, is the recommended treatment for OCD (Berlim et al., 2013). However, sometimes medication and/or talk therapy is not effective, or side effects of medication are bothersome, leading to the need for alternative treatments for OCD (Berlim et al., 2013). 

Although research is ongoing, there is some evidence that specific parts of the brain, including the DLPFC (also linked to depression) may be involved in OCD (Berlim et al., 2013). rTMS has been explored in research as a treatment for OCD when other forms of treatment, such as therapy and medication, have been unsuccessful (Berlim et al., 2013).  

What else is TMS used for?

TMS is FDA approved for treatment-resistant depression, and research indicates TMS may also be an effective treatment for additional mental health disorders if individuals with these disorders have not responded to front-line treatments, including obsessive-compulsive disorder (OCD) (Berlim et al., 2013), post-traumatic stress disorder (PTSD) (Isserles et al., 2013), alcohol dependence (Mishra et al., 2010), and tobacco use disorder (Zangen et al., 2021).

If you think you or someone you know might benefit from treatment for depression or any other mental health challenge, you can contact one of our New York Behavioral Health therapists to discuss treatment options. 

References

American Psychological Association (2022a). APA dictionary of psychology: Transcranial magnetic stimulation (TMS). American psychiatric association. https://dictionary.apa.org/transcranial-magnetic-stimulation.

American Psychiatric Association (2022b). Diagnostic and statistical manual of mental disorders (5^th ed., Text Revision). 

Berlim, M. T., Neufeld, N. H., & Van den Eynde, F. (2013). Repetitive transcranial magnetic stimulation (rTMS) for obsessive-compulsive disorder (OCD): An exploratory meta-analysis of randomized and sham-controlled trials. Journal of Psychiatric Research, 47(8), 999–1006. https://doi.org/10.1016/j.jpsychires.2013.03.022

Brunoni, A. R., Chaimani, A., Moffa, A. H., Razza, L. B., Gattaz, W. F., Daskalakis, Z. J., & Carvalho, A. F. (2017). Repetitive transcranial magnetic stimulation for the acute treatment of major depressive episodes: A systematic review with network meta-analysis. JAMA Psychiatry, 74(2), 143–152. https://doi.org/10.1001/jamapsychiatry.2016.3644

Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. S. (2013). A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Canadian Journal of Psychiatry, 58(7), 376–385. https://doi.org/10.1177/070674371305800702

Gellersen, H. M., & Kedzior, K. K. (2019). Antidepressant outcomes of high-frequency repetitive transcranial magnetic stimulation (rTMS) with F8-coil and deep transcranial magnetic stimulation (DTMS) with H1-coil in major depression: A systematic review and meta-analysis. BMC Psychiatry, 19(1), 139. https://doi.org/10.1186/s12888-019-2106-7

Isserles, M., Shalev, A. Y., Roth, Y., Peri, T., Kutz, I., Zlotnick, E., & Zangen, A. (2013). Effectiveness of deep transcranial magnetic stimulation combined with a brief exposure procedure in post-traumatic stress disorder–A pilot study. Brain Stimulation, 6(3), 377–383. https://doi.org/10.1016/j.brs.2012.07.008

Mishra, B. R., Nizamie, S. H., Das, B., & Praharaj, S. K. (2010). Efficacy of repetitive transcranial magnetic stimulation in alcohol dependence: A sham-controlled study. Addiction (Abingdon, England), 105(1), 49–55. https://doi.org/10.1111/j.1360-0443.2009.02777.x

Rizvi S., & Khan, A. M. (2019). Use of transcranial magnetic stimulation for depression. Cureus, 11(5), e4736. https://doi.org/10.7759/cureus.4736

Rossini, P. M., & Rossi, S. (2007). Transcranial magnetic stimulation: Diagnostic, therapeutic, and research potential. Neurology, 68(7), 484–488. https://doi.org/10.1212/01.wnl.0000250268.13789.b2

Voineskos, D., Blumberger, D. M., Zomorrodi, R., Rogasch, N. C., Farzan, F., Foussias, G., Rajji, T. K., & Daskalakis, Z. J. (2019). Altered transcranial magnetic stimulation-electroencephalographic markers of inhibition and excitation in the dorsolateral prefrontal cortex in major depressive disorder. Biological Psychiatry, 85(6), 477–486. https://doi.org/10.1016/j.biopsych.2018.09.032
Zangen, A., Moshe, H., Martinez, D., Barnea-Ygael, N., Vapnik, T., Bystritsky, A., Duffy, W., Toder, D., Casuto, L., Grosz, M. L., Nunes, E. V., Ward, H., Tendler, A., Feifel, D., Morales, O., Roth, Y., Iosifescu, D. V., Winston, J., Wirecki, T., Stein, A., Deutsch, F., Li, X., & George, M. S. (2021). Repetitive transcranial magnetic stimulation for smoking cessation: A pivotal multicenter double-blind randomized controlled trial. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 20(3), 397–404. https://doi.org/10.1002/wps.20905