Educational Video on Transcranial Magnetic Stimulation (Note: You will need RealPlayer to view this film from your computer.)

Living Well: A Treatment Series
The Research of TMS
This educational video is included in a five-part series of films on treatment options for depression. The films were developed by the Fuqua Center for the purpose of educating patients and care providers on available treatments for depression. In this short video, physicians and nurses discuss transcranial magnetic stimulation (TMS), a new treatment for depression. It features a patient receiving the treatment and follows with an interview with the patient. You can view the video free of charge at our E-Learning Center or download a form to purchase your own copy.

What is transcranial magnetic stimulation?
Transcranial magnetic stimulation is an investigational procedure used to treat major depression. The technique involves use of an electromagnetic coil to create electromagnetic pulses in the brain which have an antidepressant effect.  Both the treatment and the machine used to deliver the treatment are experimental. The fact that they are experimental means that the Food and Drug Administration (FDA) has not yet approved TMS as a treatment for major depression. TMS is, however, approved for other medical uses. Studies involving TMS are being done to evaluate its safety and effectiveness as a treatment for depression.

How is TMS administered?
TMS is offered in the United States both in private practice and through research studies. While most studies are free or of low cost, treatment in private practice can be more expensive and will not be covered by insurance. The treatment is typically administered five times per week at the same time of day for up to six weeks. The patient is awake and alert during the treatment; there is no anesthesia involved.

At the beginning of each TMS session, the healthcare professional that is administering the treatment will find the motor threshold of the patient. The motor threshold is the minimum amount of brain stimulation that will cause the patient’s finger to twitch involuntarily. This is done by placing the magnet on the top of the patient’s head over the brain’s motor strip in the area that affects the hand, and then stimulating, first at a low intensity, then higher until the finger twitch is seen. This threshold differs in each person, and can vary somewhat day to day. Each treatment is given at an intensity relative to the motor threshold (for example, 110% of motor threshold).

Who should get TMS?
Usually, TMS is considered after a person has tried one or more antidepressant medication trials and still has significant depressive symptoms. It can also be used for those patients who cannot tolerate antidepressant medications because of the side effects.

Women who are pregnant and patients who have metal in the brain (such as a surgical cup) or a pacemaker are usually excluded from studies.

How does TMS work?
TMS works by stimulating neurons through electromagnetic pulses. The TMS machine delivers a brief magnetic field when positioned over the head, which passes through the skull. This field is sufficient to induce an electrical current in brain tissues. With TMS, it is possible to stimulate a small, targeted brain region. This is in contrast to electroconvulsive therapy (ECT), which induces a generalized seizure and requires anesthesia.

Is TMS a safe treatment?
Transcranial magnetic stimulation can be given safely to adults of nearly all ages. The FDA oversees studies using TMS and defines the safe parameters for treatment. Although some doctors have treated children with TMS, more work on its effects in adults needs to be done before it is widely studied in children.

How effective is TMS?
Studies have concluded that the current method for administering TMS is effective in about half of the patients who receive it. Research is now underway to evaluate alternative ways to administer a similar treatment in order to make it more effective. An alternative to TMS, ECT, is between 60% and 90% effective in the treatment of major depression.

How often are treatments given?
TMS is given in a series of treatments. Usually it is given five times per week on Monday through Friday for up to six weeks. TMS is an outpatient procedure, which means that no hospitalization is necessary, and patients receiving TMS can continue working throughout the treatment schedule. After a course of TMS treatments, the patient then takes medications to help prevent a relapse of depressive symptoms. Unfortunately, due to many factors, there is a high relapse rate after TMS. Individuals who have relapsed after TMS may have an opportunity to come back for another acute course of TMS, and then receive once weekly, or maintenance, treatments.

What side effects can be expected from TMS?
Side effects reported from TMS are minimal. Some patients experience a brief headache and pain or tingling at the treatment site. If you experience these symptoms, it is recommended that you take acetaminophen (Tylenol) to relieve the pain. No adverse memory effects have yet been reported as a result of receiving TMS. The stimulator can emit a loud clicking sound when the treatment is administered, so patients may be asked to wear protective ear inserts.

Seven subjects worldwide have suffered a seizure while undergoing magnetic brain stimulation. All of those treatments were done at higher parameters than that which the FDA allows us to do in studies in the United States. Patients who are at high risk for having seizures are excluded from receiving treatment in studies.

The long-term effects of TMS are unknown.

Who can I contact for more information on TMS?
For more information or to be considered for entry into a TMS study, please call (404) 728-6957.

Where can I read more about TMS?
The Fuqua Center can send you an informational packet on TMS that includes recent articles about the treatment. Please call 1-877-498-0096. The following books may be available in your local library and can also be helpful:

Transcranial Magnetic Stimulation in Neuropsychiatry, edited by Mark S. George and Robert H. Belmaker. American Psychiatric Press, Washington DC 2000.

Handbook of Transcranial Magnetic Stimulation, edited by Alvaro Pascual-Leone, Nick Davey, John Rothwell, Eric Wasserman, and Basant K. Puri. Oxford University Press, New York NY 2002.

Click here to go to the Fuqua Center Home Page