By Dr. David Woo - July 24, 2019
Transcranial magnetic stimulation (TMS) is a noninvasive treatment option for mental health disorders, such as depression. Although TMS is only FDA-approved for the treatment of treatment-resistant depression (2008) and OCD (2018), many doctors including myself support the off-label use of TMS to treat other mental health and behavioral conditions. (1, 2) This is because scientists all over the world are conducting clinical trials that have provided convincing evidence that TMS may be helpful to patients with conditions other than depression and OCD.
I use TMS in my practice to treat patients with depression, and I do believe that people with mental health and behavioral disorders outside of depression and OCD can benefit greatly from TMS. In this article, I’ll be outlining the evidence for the usefulness of TMS for the treatment of certain mental health conditions.
TMS for OCD
Treating obsessive-compulsive disorder with TMS looks promising. (7) dTMS with the Brainsway device was FDA-approved for the treatment of OCD in 2018. Studies have shown that using TMS to target certain hyperactive brain centers in people with OCD can lead to a general reduction in symptoms, depression, and anxiety. (8)
TMS for Anxiety
Much like depression, scientists believe that anxiety disorders stem from an abnormality in the regulation of brain activity in certain regions of the brain associated with mood. A study published in Psychological Medicine in 2010 observed brain activity in healthy participants and participants diagnosed with general anxiety disorder. During the study, researchers would try to evoke a worry response in participants by showing them certain images and speaking certain phrases. This helped researchers see which part of the brain is activated when the worry emotion is felt. They observed that participants with general anxiety disorder were not able to return to a normal state after experiencing worry, whereas healthy participants were able to. (3)
As TMS can stimulate activity in particular regions of the brain, studies like this suggest that it may be beneficial for people with an anxiety disorder.
TMS for PTSD and Traumatic Brain Injury
Patients with trauma-related conditions, such as post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI), may undergo changes in the normal function of certain regions of the brain. For example, people affected by PTSD have been shown to have increased activity in the amygdala, decreased activity in the prefrontal/anterior cingulate, and loss of volume of the hippocampus. (4) This discovery has led scientists to believe that patients with trauma-related conditions may benefit from TMS, and therefore to lead research initiatives to see if this may be true.
A review published in Neuropsychiatric Disease and Treatment in 2019 looked at the results of multiple research studies and analyzed how TMS affected people with PTSD and TBI (which often occur together). This review found that TMS, administered over the frontal regions of the brain, showed a trend of relieving symptoms of PTSD and TBI. (5) Moreover, the US Department of Veterans Affairs Center for Compassionate Care Innovation (CCI) supports the expanded use of TMS for veterans with PTSD. (6)
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1. Horvath JC, Mathews J, Demitrack MA, Pascual-Leone A. The NeuroStar TMS device: conducting the FDA approved protocol for treatment of depression. The Journal of Visualized Experiments. 2010;12(45):2345. Click Here. Accessed July 16, 2019.
2. Rebecca Voelker, MSJ. Brain Stimulation Approved for Obsessive-Compulsive Disorder. The Journal of the American Medical Association. 2018;18;320(11):1098. Click Here. Accessed July 16, 2019.
3. Paulesu E, Sambugaro E, Torti T, Danelli L, Ferri F, Scialfa G, Sberna M, Ruggiero GM, Bottini G, Sassaroli S. Neural correlates of worry in generalized anxiety disorder and in normal controls: a functional MRI study. Psychological Medicine. 2010;40(1):117-124. Click Here. Accessed July 16, 2019.
4. Bremner, JD. Traumatic stress: effects on the brain. Dialogues in Clinical Neuroscience. 2006;8(4):445–461. Click Here. Accessed July 16, 2019.
5. Namgung E, Kim M, and Yoon S. Repetitive transcranial magnetic stimulation in trauma-related conditions. Neuropsychiatric Disease and Treatment. 2019;15:701–712. Click Here. Accessed July 16, 2019.
6. Weistreich T. Veterans with PTSD treated with Transcranial Magnetic Stimulation. US Department of Veterans Affairs. Published June 1, 2018. Click Here. Accessed July 16, 2019.
7. L.Carmi et al. Deep Transcranial Magnetic Stimulation (Tms) in Obsessive Compulsive Disorder (Ocd) Patients. European Psychiatry. Published March 2015. https://www.sciencedirect.com/science/article/pii/S0924933815306180 Accessed October 4, 2019.
8. Joan A. Camprodon-Gimenez. Transcranial Magnetic Stimulation (TMS) for Obsessive Compulsive Disorder (OCD). Fall 2015 edition of the OCD Newsletter, International OCD Foundation. https://iocdf.org/expert-opinions/transcranial-magnetic-stimulation-tms-for-obsessive-compulsive-disorder-ocd/ Accessed October 4, 2019.