By Dr. David Woo - September 5, 2022

Transcranial magnetic stimulation (TMS) is a medication-free, non-invasive therapy that has been proven safe and effective for the treatment of mental health conditions such as depression, anxious depression, and OCD.(1)

TMS is an important treatment option for patients because it is proven to help treat symptoms of depression, anxious depression, and OCD when traditional treatments, such as medication, don’t provide enough help.

How Does TMS Work?

TMS uses magnetic pulses to electrically stimulate brain cells (neurons) and regulate activity in previously determined regions of the brain to treat symptoms of mental health disorders. The electrical current stimulated by the TMS magnetic pulses essentially “resets” communication pathways between neurons, and allows for new pathways to form.

What Are the Side Effects of TMS Therapy?

TMS is generally very well tolerated by patients, but mild to moderate side effects may occur, such as:

• Scalp discomfort at the stimulation site
• Tingling or spasms of the facial muscles
• Mild headaches or brief lightheadedness

Side effects such as headache and scalp discomfort can be treated with over-the-counter pain medications, are usually short-lived, and tend to decrease over time.  

How Safe Is TMS Therapy?

Years of research, clinical trials, and meta-analysis of clinical trials support that TMS is both a safe and well-tolerated treatment option for adult patients.(2,3,4,5) To learn more about TMS success rates, click here.

Certain patients may not qualify for TMS due to safety concerns, including those who:

• Have a metal/electronic implant
• History of seizures or a seizure disorder
• Are taking a tricyclic antidepressant, such as Elavil (amitriptyline) and Pamelor (nortriptyline)(6) 

Unlike invasive brain stimulation techniques, such as vagus nerve stimulation, used for difficult-to-treat mental health conditions, TMS doesn’t require an incision or a procedure. When compared to electroconvulsive therapy (ECT), a treatment generally used as a “last resort” for patients with severe depression, TMS doesn’t require anesthesia.

Who Is A Good Candidate for TMS Therapy?

Those who are good candidates for TMS include people who:

• Have been diagnosed with a condition that TMS is clinically proven to treat (TMS is FDA-approved for the treatment of treatment-resistant depression, anxious depression, OCD, and more)
• Have not found relief (or enough relief) from traditional, standard treatments
• Have experienced unpleasant side effects from standard medication treatment
• Do not have a history of seizures or a seizure disorder
• Do not have any metal or electronic implants, such as a pacemaker or an aneurysm clip

In addition to being FDA-approved to treat depression and OCD, rTMS has been shown to reduce symptoms and improve the quality of life for people with generalized anxiety disorder and post-traumatic stress disorder (PTSD). (1,7,8)

What Happens During a TMS Therapy Session?

When you arrive for your TMS sessions, you’ll be asked to sit comfortably in a chair, where you’ll sit for the remainder of the session. A magnetic coil will then be placed above your scalp. You’ll be awake for the entirety of the session, which generally lasts about 20 minutes. 

The TMS machine will produce clicking noises (similar to those produced by an MRI machine), so you’ll be asked to wear earplugs to protect your hearing during treatment. You may also feel a light tapping sensation on your head. These clicking noises and tapping sensations are generated from the magnetic pulses.

Resources:

1. Cohen SL, Bikson M, Badran BW, and George MS. A visual and narrative timeline of US FDA milestones for Transcranial Magnetic Stimulation (TMS) devices. Brain Stimul. 2022;15(1):73-75. Link. Accessed August 9, 2022.

2. Machii K, Cohen D, Ramos-Estebanez C, Pascual-Leone A. Safety of rTMS to non-motor cortical areas in healthy participants and patients. Clin Neurophysiol. 2006;117:455–71. Link. Accessed August 12, 2022.

3. Loo CK, McFarquhar TF, Mitchell PB. A review of the safety of repetitive transcranial magnetic stimulation as a clinical treatment for depression. Int J Neuropsychopharmacol. 2008;11:131–47. Link. Accessed August 12, 2022. 

4. Janicak PG, O’Reardon JP, Sampson SM, Husain MM, Lisanby SH, Rado JT, et al. Transcranial magnetic stimulation in the treatment of major depressive disorder: a comprehensive summary of safety experience from acute exposure, extended exposure, and during reintroduction treatment. J Clin Psychiat. 2008;69:222–32. Link. Accessed August 12, 2022.

5. Taylor R, Galvez V, Loo C. Transcranial magnetic stimulation (TMS) safety: a practical guide for psychiatrists. Australas Psychiatry. 2018;26(2):189-192. Link. Accessed August 12, 2022.

6. Transcranial magnetic stimulation for major depressive disorder: What a pharmacist should know. Mental Health Clinician. 2012;2(6):152–155. Link. Accessed August 12, 2022.

7. Rodrigues PA, Zaninotto AL, Neville IS, Hayashi CY, Brunoni AR, Teixeira MJ, Paiva WS. Transcranial magnetic stimulation for the treatment of anxiety disorder. Neuropsychiatr Dis Treat. 2019;15:2743-2761. Link. Accessed August 12, 2022. 

8. Namgung E, Kim M, and Yoon S. Repetitive transcranial magnetic stimulation in trauma-related conditions. Neuropsychiatric Disease and Treatment. 2019;15:701–712. Link. Accessed August 12, 2022. 

Dr. David Woo

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.