Transcranial magnetic stimulation - separating fact from fiction
Transcranial magnetic stimulation (TMS) has been found to be an effective therapy for treatment-resistant bipolar and unipolar depression. We explore the facts about this interesting treatment option.
TMS is a non-invasive treatment used to stimulate small regions of the brain. During a TMS procedure, a magnetic field generator, or coil, is placed near the head. The coil produces and sends a therapeutic electromagnetic pulse to a specific region of the brain.
When people become depressed, their right frontal lobe, which is responsible for feelings of anxiety and avoidance behaviour, becomes more active, while the left frontal lobe, the source of feelings of optimism and approach behaviours, becomes less active. When using TMS to treat depression, doctors send either a high frequency pulse to the left frontal lobe to increase activity, or a low frequency pulse to the right frontal lobe to decrease activity.
“Most of the people we treat have undergone at least two trials of antidepressants with an unsatisfactory response,” says Peter Farnbach, Director of the TMS program at Epworth Clinic. “The results we are seeing with this group of patients are very positive.”
While TMS has been around for some time it’s not a treatment everyone is likely to be familiar with. According to Peter, similar questions arise for most patients considering TMS. They include:
Is TMS related to electroconvulsive therapy (ECT)?
No. The way TMS works is totally unlike ECT. Performed under a general anaesthetic, the aim of ECT is to produce a modified seizure. TMS is performed without the need for anaesthetic and there’s no requirement for a seizure. Most people can get up and walk away quite happily with absolutely no affect on cognition.
Is TMS an experimental technique?
No. TMS has been around since the 1980s and neurologists were using a modified version of the machine long before that. TMS has been a licensed procedure in Australia for the last 10 – 15 years and its safety and efficacy have been very well established.
Does TMS treatment require a hospital stay?
Yes. TMS is currently offered as part of a three week inpatient program for depression at Epworth Clinic. Each individual TMS treatment takes about 45 minutes.
Does TMS have side effects?
TMS has minimal side effects. The procedure does not require anaesthetic and most patients can get up and walk around immediately after treatment. The magnetic pulse does stimulate the muscles of the scalp so there’s a chance this could cause headaches, but the risk is very low. The risk of seizures is also extremely low.
Is TMS treatment ongoing?
Yes. The effects of the initial TMS treatment last for approximately six months. After this time a shorter, top-up or booster TMS treatment is generally required every few months. This shorter treatment can generally be done over a weekend stay in hospital. There’s no limit to the number of treatments a patient can have.
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