We researched the currently available TMS devices and found that the deep TMS provided by the Brainsway unit was more effective in clinical trials due to its ability to provide deeper and broader stimulation to the appropriate areas of the brain. They are also the only company with an FDA approved indication for OCD.
Brainsway is also involved in excellent research for other applications of dTMS including smoking cessation, other addictions, trauma/PTSD, ADHD and certain neurologic disorders.
Our TMS team will work to create a comprehensive treatment plan for you. This may include psychotherapy or medication adjustments to achieve the best treatment outcomes.
Treatment involves sitting comfortably in a chair and wearing the treatment helmet for 20-minutes. The coil in the helmet stimulates the brain in the areas that affect mood and OCD symptoms by creating a temporary magnetic field.
Approximately 50% to 60% of people with depression who have tried and failed to receive benefit from medications experience a clinically meaningful response with TMS. About one-third of these individuals experience a full remission, meaning that their symptoms go away completely. It is important to acknowledge that these results, while encouraging, are not permanent. Like most other treatments for mood disorders, there is a high recurrence rate.
Most TMS patients feel better for many months after treatment stops, with the average length of response being a little more than a year. Some will opt to come back for subsequent rounds of treatment. For individuals who do not respond to TMS, other treatments such as ECT (Electroconvulsive Therapy) are effective options to consider.
A course of treatment with TMS is usually 37 treatments. You will have the first 20 treatments over 4 weeks, with treatments occurring 5 weekdays per week. You will see your psychiatrist weekly during this time to assess the progress of treatment. A tapering phase then follows for 8-16 weeks with treatments occurring 2x a week. During the tapering phase you will see your psychiatrist every 2 weeks.
After treatment is completed, you will see your psychiatrist as recommended. If symptoms recur, you may benefit from another course of TMS treatment.
TMS is being studied extensively across disorders and even disciplines with the hope that it will evolve into new treatments for neurological disorders, pain management, and physical rehabilitation in addition to psychiatric disorders. There are currently large clinical trials looking at the effectiveness of TMS in conditions such as pediatric depression, bipolar disorder, smoking cessation, post-traumatic stress disorder and ADHD. Studies are also being designed to look at the efficacy of TMS to treat certain addictions. While promising avenues for research, TMS for these conditions is not yet approved and would be considered “off-label.”
Antidepressant medications and psychotherapy are the first line treatments for major depression. These treatments, however, do not work for all patients. In these instances, TMS might be used as an alternative treatment, or to augment antidepressant medications or psychotherapy. Patients who have failed to achieve an adequate response from antidepressants, or who are unable to tolerate medications, might consider TMS therapy. (Every insurance company’s prior authorization requirements are different. Many require that you have failed 2 adequate trials of antidepressants in different classes at the highest FDA approved, tolerated dose and 2 trials of augmentation – medications of a different class added to your regimen – and, 1 trial of appropriate psychotherapy).
Certain medications (and drugs) may reduce the effectiveness of TMS and should be discussed with your doctor prior to starting treatment. Also any new medications started during treatment should be reviewed.
TMS is well-tolerated and associated with few side-effects and only a small percentage of patients discontinue treatment because of these. The most common side-effect, which is reported in about half of patients treated with TMS, is headaches. These are mild and generally diminish over the course of the treatment. Over-the-counter pain medication can be used to treat these headaches.
About one third of patients may experience painful scalp sensations or facial twitching with TMS pulses (during treatment). These too tend to diminish over the course of treatment although adjustments can be made immediately in coil positioning and stimulation settings to reduce discomfort.
The TMS machine produces a loud noise and because of this earplugs are given to the patient to use during the treatment. However, some patients may still complain of hearing problems immediately following treatment. No evidence suggests these effects are permanent if earplugs are worn during the treatment.
TMS has not been associated with many of the side-effects caused by antidepressant medications, such as gastrointestinal upset, dry mouth, sexual dysfunction, weight gain, or sedation.
The most serious risk of TMS is seizures. However, the risk of a seizure is exceedingly low. Overall, TMS is a very safe procedure.
Certain medications, drugs, caffeine and alcohol may increase the risk of seizures or impact the effectiveness of TMS or require a TMS dose change and should be discussed with your doctor prior to starting treatment or if any changes in your medication/drug/alcohol or caffeine use should occur during treatment.
Patients with any type of non-removable metal in their heads (with the exception of braces or dental fillings), should not receive TMS. Failure to follow this rule could cause the object to heat up, move, or malfunction, and result in serious injury or death. The following is a list of metal implants that can prevent a patient from receiving TMS:
- Aneurysm clips or coils
- Stents in the neck or brain
- Deep brain stimulators
- Electrodes to monitor brain activity
- Metallic implants in your ears and eyes
- Shrapnel or metal fragments in or near the head
- Facial tattoos with metallic or magnetic-sensitive ink
- Other metal devices or objects implanted in or near the head