By Dr. David Woo - October 23, 2023
Updated on October 23, 2023
Major depressive disorder (MDD) 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 such as pharmaceuticals — 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).
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 the organ’s electro-chemical activity and, therefore, the patient’s mood.
Deep Brain Stimulation Procedures
Deep brain stimulation requires an invasive medical 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 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. Following the settings adjusted by the doctor, the stimulator is then 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 (Food and Drug Administration) for treating various disorders, including medically refractory epilepsy, Parkinson’s disease, and obsessive-compulsive disorder (7,8,9). Currently, the use of deep brain stimulation is still being studied in clinical trials for its use in treating major depression and is only offered to patients on an experimental basis (2,10,11).
How Does Transcranial Magnetic Stimulation Differ From Deep Brain Stimulation?
How TMS Works
In contrast to DBS, which requires surgery, TMS is a noninvasive procedure that can be performed at a doctor’s office without any anesthesia. During TMS, electrical coils contained in a head-mounted medical device, sometimes called a “depression helmet,” are placed just above the scalp. An electrical current is passed through the coils, 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 TMS is continuous and is of the same strength throughout the duration of the session. TMS sessions last roughly 20 minutes (12).
Is TMS Better Than DBS For My Condition?
Unlike DBS, TMS is FDA-approved for the treatment of depression, and studies show that it has a success rate of around 75% when it comes to relieving patients’ depression symptoms, with results lasting at least a year after treatment for many patients (13,14). TMS is also used for other disorders, such as anxiety and OCD. It has been approved by the FDA for these purposes since 2008 and 2009, respectively. FDA approval for TMS for ADHD is still ongoing, but current studies do show promising results (15).
In contrast to TMS, DBS is still not approved by the FDA for the treatment of depression. However, it is a well-established therapy for people with movement conditions and is FDA-approved for Parkinson’s disease, essential tremor, and dystonia. It is also used for psychiatric conditions such as OCD and epilepsy.
TMS vs. DBS Comparison Table
|Method||TMS is noninvasive and uses a helmet with electromagnetic coils to induce focused brain stimulation through the scalp, modulating neural activity.||DBS involves surgically implanting electrodes into specific brain regions and delivering continuous electrical pulses to regulate neural circuits.|
|Indications||Primarily used for treatment-resistant depression, anxiety disorders, OCD, and some neurological conditions like migraines.||A broad range of disorders, including Parkinson’s disease, essential tremor, OCD, and epilepsy.|
|Duration of Treatment||TMS typically involves daily sessions lasting 20-40 minutes over several weeks.||DBS is a long-term therapy, with continuous stimulation, often lasting years, if not indefinitely.|
|Side Effects||Generally mild, including scalp discomfort and headaches, and well tolerated by patientsSeizures are rare (less than 1% of patients).||May cause surgical complications, infections, mood changes, cognitive issues, and hardware-related problems.|
|Cost||TMS is less expensive than DBS, with lower upfront costs of around $7,000-$8,000 for a complete course, but some patients may need to pay for repeated sessions.||DBS is more costly initially due to surgery and device implantation but may have lower long-term costs as maintenance is less frequent. Average costs, including surgery and maintenance, can range from $100,000-$150,000.|
|Efficacy||Effective in treating depression OCD, anxiety, PTSD, and other conditions.||Can provide significant and long-lasting symptom relief for many neurological disorders|
|Contraindications||Metallic implants in the head, a history of seizures, or certain neurological conditions.||Any active infections, head implants, or significant cognitive impairment.|
TMS and DBS are both effective and well-tolerated brain stimulation therapies with a solid foundation in evidence-based medicine. Both can help people with mental health struggles who do not respond well to conventional treatments. However, they have some important differences that should be considered before choosing one over the other.
As a noninvasive treatment, TMS has fewer risks and complications than DBS while still having its efficacy backed up by scientific studies and FDA approval. It is generally recommended for patients whose primary issue is with treatment-resistant depression, OCD, or anxiety and who want to have minimal disruption in their daily life, without the risks and recovery period associated with surgery. DBS, on the other hand, would be the better option for long-lasting neurological conditions such as Parkinson’s disease. Neither TMS nor DBS should be confused with electroconvulsive therapy (ETC), which is usually a second-line treatment for severely acute mental health conditions.
If you are interested in learning more about TMS or DBS therapy for depression or other mood disorders, you should consult with your doctor or a mental health professional who can provide you with more information and guidance on whether these treatments are suitable for you.
Madison Avenue TMS & Psychiatry offers psychotherapy and TMS for treating depression, anxiety, and other mental health disorders. Contact us online or call (212) 731-2033 if you have any questions or to make an appointment.
- Major depression. National Institute of Mental Health. Updated January 2022. Link. Accessed May 06, 2022.
- Delaloye S and Holtzheimer PE. Deep brain stimulation in the treatment of depression. Dialogues in Clinical Neuroscience. March 2014; 16(1): 83–91. Link. Accessed May 06, 2022.
- Deep brain stimulation. American Association of Neurological Surgeons. Link. Accessed May 06, 2022.
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- FDA approval: medtronic deep brain stimulation for medically refractory epilepsy. Epilepsy Foundation. Published May 01, 2018. Link. Accessed May 6, 2022.
- Vercise deep brain stimulation (DBS) system – P150031. U.S. Food and Drug Administration. Publicaton Date Unknown. Updated January 27, 2021. Link. Accessed May 6, 2022.
- Deep brain stimulation: A way to rebalance neural circuits. International Neuromodulation Society. Published July 06, 2018. Updated December 13, 2019. Link. Accessed May 6, 2022.
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- 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. Link. Accessed May 6, 2022.
- How long does Deep TMS treatment take? Brainsway. Link. Accessed May 6, 2022.
- Carpenter LL, Janicak PG, Aaronson ST, et al. Transcranial magnetic stimulation (TMS) for major depression: A multisite, naturalistic, observational study of acute treatment outcomes in clinical practice. Depression and Anxiety. July 2012;29(7):587-96. Link. Accessed September 17, 2023.
- Dunner, DL, Aaronson ST, Sackeim, HA, et al. A multisite, naturalistic, observational study of transcranial magnetic stimulation for patients with pharmacoresistant major depressive disorder: Durability of benefit over a 1-year follow-up period. J Clin Psychiatry. 2014;75(12):1394-401. Link. Accessed September 17, 2023.
- Weaver L, Rostain AL, Mace W, Akhtar U, Moss E, O’Reardon JP. Transcranial magnetic stimulation (TMS) in the treatment of attention-deficit/hyperactivity disorder in adolescents and young adults: a pilot study.2012;28(2):98-103. Link. Accessed September 17, 2023.