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Deep TMS vs. Deep Brain Stimulation: What’s the Difference?


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Differences between deep brain stimulation (DBS) and deep TMS

Major depressive disorder affects more than 16 million adults in the United States.(1) Standard therapies for major depression include antidepressant medications and talk therapy. However, many patients don’t find relief from depressive symptoms with traditional treatments — this is referred to as treatment-resistant depression (TRD). The acknowledgment that treatment-resistant depression is a reality for many patients has led scientists to explore other treatment options besides the standard use of medication and psychotherapy.(2)


Deep transcranial magnetic stimulation (TMS) and deep brain stimulation are two different therapies used to treat TRD. Although these therapies share some similarities, there are major differences between the two.

What Is Deep Brain Stimulation?

Deep brain stimulation is a treatment that involves sending continuous electrical currents to specific areas of the brain in order to regulate certain electrical circuits, and therefore mood.

Deep Brain Stimulation Procedures

Deep brain stimulation requires a procedure to implant small electrodes (a material that conducts electricity) in the brain. The electrodes are introduced and carefully placed in the brain through tiny holes made in the skull. In another procedure, about one week later, an electrical pulse generator is implanted under the skin, near either the collarbone or the chest. The electrodes and the implantable pulse generator (IPG) are then connected with thin, insulated wires that are passed under the skin from the head, down the neck and shoulder, to the device. Once connected, the impulse generator works continuously to send electrical currents through the electrodes to the brain.(3,4) The procedure to implant a deep brain stimulation device is fully reversible.

Recovering from a Deep Brain Stimulation Procedure

After surgery, full recovery time is generally four to six weeks before heavy or strenuous activity, such as jogging or swimming, is permitted. The stimulation device is activated a few weeks after surgery and remains implanted for as long as the treatment is deemed necessary, which could be years.(4)

For the first four to six months, the doctor customizes the stimulation to the patient’s needs. The stimulator is controlled by the patient using a handheld remote. The doctor may suggest 24-hour stimulation or may recommend the device be turned off at night during sleep.(5,6)

Deep brain stimulation is approved by the FDA for treating various disorders, including medically refractory epilepsy, Parkinson’s disease, and obsessive-compulsive disorder.(4,5,6) Currently, the use of deep brain stimulation is still being studied for its use in treating major depression and is only offered to patients on an experimental basis. (2,7,8)

How Does Deep Transcranial Magnetic Stimulation Differ from Deep Brain Stimulation?

Deep transcranial magnetic stimulation (TMS) is a noninvasive procedure that can be performed at a doctor’s office, without any anesthesia. During deep TMS, electrical coils are placed just above the scalp. An electrical current is passed through the coil, which then creates a magnetic field. This magnetic field stimulates deep neural networks in the subgenual anterior cingulate cortex of the brain (the part of the brain involved in motivation). The magnetic field induced during deep TMS is continuous and is of the same strength throughout the duration of the session. Deep TMS sessions last roughly 20 minutes.(9)

Contact Us to Learn More about Deep TMS

TMS was approved by the FDA as a treatment option for individuals who have not seen changes in their symptoms after completing a course of one antidepressant medication.(11) There are numerous research publications that prove the efficacy and safety of TMS for relieving symptoms of major depressive disorder.(7,12) If you’re interested in learning more about transcranial magnetic stimulation and how it differs from other therapies for treatment-resistant depression, contact our office.


References:

1. Major depression. National Institute of Mental Health. Updated January 2022. https://www.nimh.nih.gov/health/statistics/major-depression. Accessed May 06, 2022. 

2. Delaloye S and Holtzheimer PE. Deep brain stimulation in the treatment of depression. Dialogues in Clinical Neuroscience. March 2014; 16(1): 83–91. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984894/. Accessed May 06, 2022.

3. Deep brain stimulation. American Association of Neurological Surgeons. https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Deep-Brain-Stimulation. Accessed May 06, 2022.

4. Deep Brain Stimulation. Cleveland Clinic. Publication Date Unknown. Updated April 29, 2019. https://my.clevelandclinic.org/health/treatments/21088-deep-brain-stimulation. Accessed May 6, 2022.

5. Deep brain stimulation. Mayo Clinic. Published September 3, 2021. https://www.mayoclinic.org/tests-procedures/deep-brain-stimulation/about/pac-20384562. Accessed May 6, 2022.

6. Deep brain stimulation (DBS). Mayfield Brain & Spine. Updated April 2022. https://mayfieldclinic.com/pe-dbs.htm. Accessed May 6, 2022. 

7. FDA approval: medtronic deep brain stimulation for medically refractory epilepsy. Epilepsy Foundation. Published May 01, 2018. https://www.epilepsy.com/stories/fda-approval-medtronic-deep-brain-stimulation-medically-refractory-epilepsy. Accessed May 6, 2022. 

8. Vercise deep brain stimulation (DBS) system – P150031. U.S. Food and Drug Administration. Publicaton Date Unknown. Updated January 27, 2021. https://www.fda.gov/medical-devices/recently-approved-devices/vercisetm-pc-and-vercise-geviatm-deep-brain-stimulation-dbs-system-p150031s028. Accessed May 6, 2022.

9. Deep brain stimulation: A way to rebalance neural circuits. International Neuromodulation Society. Published July 06, 2018. Updated December 13, 2019. https://www.neuromodulation.com/deep-brain-stimulation. Accessed May 6, 2022. 

10. Levkovitz Y, Isserles M, Padberg F, Lisanby SH, Bystritsky A, Xia G, Tendler A, Daskalakis ZJ, Winston JL, Dannon P, Hafez HM, Reti IM, Morales OG, Schlaepfer TE, Hollander E, Berman JA, Husain MM, Sofer U, Stein A, Adler S, Deutsch L, Deutsch F, Roth, Mark S, George Y, and Zangen A. Efficacy and safety of deep transcranial magnetic stimulation for major depression: a prospective multicenter randomized controlled trial. World Psychiatry. 2015;14(1):64–73. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4329899/. Accessed May 6, 2022.

11. Deep brain stimulation (DBS) for depression using directional current steering and individualized network targeting (DBS). U.S. National Library of Medicine. Published February 19, 2018. Updated November 30, 2021. https://clinicaltrials.gov/ct2/show/NCT03437928. Accessed May 6, 2022.

12. How long does Deep TMS treatment take? Brainsway. https://www.brainsway.com/patients-faqs/how-long-does-deep-tms-treatment-take/. Accessed May 6, 2022.

Dr. Woo has been seeing patients in private practice since 2002, always with the goals of combining evidence-based medicine with psychodynamic psychotherapy and collaborating with other mental health professionals to ensure the best possible outcomes for his patients. He has been certified to administer TMS at his practice since 2017. His greatest clinical interests include helping patients suffering from depression, anxiety, and obsessive compulsive disorder.


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