Transcranial Magnetic Stimulation, Depression, And How Treatment Works

Reviewed by Whitney White, MS CMHC, NCC., LPC

Published 12/23/2020

The standard treatments for depression are usually very effective. A doctor or therapist can generally find the right combination of medication and therapy to decrease your symptoms and set you on the road to good mental health. But what if the usual treatments don't work for you? One solution might be transcranial magnetic stimulation (TMS). Here's what it is and how it works.

Do You Need Extra Help For Dealing With Depression?

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Depression medications typically begin to work after a few weeks. Therapy can take longer, but you might be seeing significant improvement in just a few months. For some people, though, these treatments aren't enough. If your symptoms linger no matter what you do, you might need a little extra help to overcome depression.

That's where TMS comes in. This treatment has been proven effective for people that don't get enough benefit from antidepressant medications. 

Depression Screening Quiz

Suppose you're unsure of whether depression is a problem for you. If so, you can easily find out if you have something to be concerned about with an online depression screening quiz. After you answer a few easy questions, you might realize that you need to seek for depression. But even if you know you've had depression in the past, this test may be helpful to you now. Why? It will give you an objective assessment of whether you're currently having symptoms of depression.

Symptoms Of Depression

Recognizing these signs of depression is essential if you want to get the best treatment when you need it. Here are some things that might continue to bother you if depression treatments don't work.

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  • Sad or "down" mood
  • Fatigue
  • Irritability
  • Feelings of guilt or worthlessness
  • Hopelessness
  • Restlessness
  • Trouble making decisions or concentrating
  • Loss of interest or pleasure in activities once enjoyed
  • Eating or sleeping too much or too little
  • Dwelling on thoughts of suicide or death

The symptoms of depression don't go away when you have treatment-resistant depression. They may improve for a short time only to come back full force. That's when you need to consider additional treatments like transcranial magnetic stimulation.

Treatments To Try Before TMS

Your doctor or therapist probably won't recommend TMS until you've already tried other treatments. What treatments usually work for depression? In most cases, antidepressants and therapy are the first treatments used.

Antidepressants

Sometimes, the first antidepressant your psychiatrist prescribes doesn't seem to be helping. If so, there are several things they might change your medication regimen, such as:

  • Give it more time to work
  • Prescribe a higher dose of the same medication
  • Try a different antidepressant
  • Add another antidepressant
  • Add a different type of medication

Psychotherapy

Therapy usually helps people with depression. But if you don't see results, TMS may be a helpful addition to your treatment. In most cases, you will still need to be in therapy. That's how you learn to deal with your stressors and manage your depression symptoms. Your therapist teaches you new ways of approaching your problems. After successful therapy, you may be less susceptible to depression in the future.

Electroconvulsive Therapy

In many cases, electroconvulsive therapy is used when antidepressants and psychotherapy aren't helping enough. And your psychiatrist might suggest trying ECT before you consider TMS. So, what is the electroconvulsive treatment? ECT is a procedure in which small electric currents are passed through your brain. It causes a very short seizure, which changes your brain chemistry and may relieve symptoms of depression. You're under anesthesia while it's done, so you don't feel any discomfort.

What Is Transcranial Magnetic Stimulation?

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When you've tried other treatments, it may be time to consider transcranial magnetic stimulation. So, what is that, anyway? It's a treatment that uses magnetic pulses directed at the parts of your brain that control your mood. It can create powerful changes in your brain function and relieve the symptoms of depression.

What Happens During Treatment?

For TMS treatment, you go to an outpatient center or office. The sessions are relatively short, and the procedure is noninvasive. You don't have to be under sedation or anesthesia. In fact, you can be awake for the entire process. The magnetic pulses are painless.

Here's how the procedure typically goes. You relax in a comfy chair and put in the earplugs provided. The doctor places the magnetic coil device gently on your head. They position it near the prefrontal cortex of your brain, which is where mood regulation probably happens in depression.

Next, short electromagnetic pulses come through the coil and pass through your skull. The pulses create a tiny bit of electrical current, which stimulates the nerve cells in that part of your brain. If you've ever had an MRI, you've experienced the same type of electromagnetic pulses.

During all this, you'll hear some clicking noises. You may experience a tapping or tingling feeling on your head. Your scalp may be a little uncomfortable during and right after the treatment. When the session is finished, you'll be able to get back to whatever you planned to do for the day with no further interruption.

How Long Does Treatment Last?

Transcranial magnetic stimulation is an effective depression treatment, but it isn't an instant cure. Usually, you need to go about five times a week for a period of four to six weeks. The sessions last between 20 and 40 minutes, depending on the specific TMS device being used. But some of the newer devices can complete a session in as little as three minutes.

You might need to go back later on for additional rounds of treatment. It's common for people to have a four to six-week course of treatment about once a year.

Benefits Of Transcranial Magnetic Stimulation

Transcranial magnetic stimulation has many advantages over other types of treatments. Some of them include:

  • It's one of the most effective treatments for treatment-resistant depression.
  • It's extremely safe.
  • It's a noninvasive procedure with no surgery or even anesthesia involved.
  • It doesn't cause memory problems.
  • It doesn't have the severe side effects that often come with antidepressants.
  • TMS can reduce symptoms of depression quickly.
  • Once the depression begins to lift, therapy is often more successful.
  • You don't have any downtime after the session.

Are There Any Risks?

TMS is a relatively low-risk procedure. The only serious risk is that you might have a seizure. But seizures are extremely rare with this treatment. In fact, one scientific survey found that TMS caused seizures fewer than one time per 60,000 sessions.

It does have a few mild side effects. However, most people tolerate them well. You might have an uncomfortable feeling in your scalp, or your face might twitch a bit during and immediately after your session. You might have a headache, especially after your first few sessions. But the headaches are generally mild enough that over the counter pain medication takes care of them.

Can Anyone Get Treatment With TMS?

Most people can get TMS treatments safely. Suppose a mental health professional recommends this treatment for major depression. In that case, it will likely be after they've exhausted other treatment options. But chances are, if you need the additional help you can get from TMS, you will be able to have it.

However, two issues may make this procedure too dangerous for you. First, if you have a history of seizures, it's probably best not to have transcranial magnetic stimulation. The same is true if you have a family history of epilepsy.

The other reason you might not have TMS is if you have some type of metal in your body that can't be removed. Examples include stents, metallic ear implants, shrapnel, or a pacemaker.

There are some other factors your mental health professional will consider. For example, if you have a history of psychosis or substance abuse, this treatment might not be right for you. And, if you have had a brain injury or a stroke, your doctor may decide it's best to avoid TMS. However, it's not certain that these other factors will keep you from having TMS. That depends on many individual elements that your doctor needs to assess and consider.

Talking To A Mental Health Professional About TMS

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Perhaps transcranial magnetic stimulation sounds like the perfect solution to your ongoing depression. If so, it's a good idea to start by talking to a mental health professional. You can discuss with them the symptoms you're having and how long they've been going on. Be sure to let them know about any medications, therapy, and self-help methods you've already tried. Ask if they recommend TMS for your mental health condition. And if they don't or want to wait, be open to trying other treatments.

Good mental health is one of the most precious things in the world. So, if you need help overcoming depression, don't hesitate to ask a qualified professional. Perhaps TMS is the ideal treatment for you. It might relieve your depression more effectively than any other method you've tried.

TMS is not for everyone, but if it's right for you, it might be the best choice you ever made. Start by taking an online screening quiz for depression. If it shows that you have symptoms of depression, get the help you need to feel better, and live a more satisfying life.