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What Is Deep TMS Therapy (dTMS)?


Deep TMS therapy, also called dTMS, is a type of transcranial magnetic stimulation (TMS) therapy that is FDA-approved to treat patients diagnosed with major depressive disorder (MDD) and obsessive-compulsive disorder (OCD). 

During dTMS treatments, a doctor or nurse fits a helmet that contains a metal coil over the patient’s head. The coil emits magnetic pulses that noninvasively stimulate brain cells located in specific regions of the brain associated with mood. (1)

Is dTMS Depression Treatment Effective?

Yes. Deep TMS has been clinically proven to relieve depressive symptoms, even in patients diagnosed with treatment-resistant depression. A randomized clinical study found that patients who receive dTMS are twice as likely to achieve remission compared to patients who were given sham or placebo treatment. (2) 

Deep TMS is only one of two types of TMS methods used in clinics today to successfully treat depressive symptoms—the other is called repetitive TMS, or rTMS. You can learn more about TMS therapy success rates here.

How Does dTMS Therapy Compare to rTMS Therapy?

Both dTMS and rTMS are FDA approved to relieve depressive symptoms in patients diagnosed with treatment-resistant MDD. So, what’s different between the two?

  • The device used: Deep TMS is administered using the BrainsWay device, while rTMS is administered using the Neurostar® device.
  • The shape of the magnetic coil: Deep TMS uses an H-coil, while rTMS uses a figure-8 coil.
  • Stimulation depth: Deep TMS can stimulate the brain four to six centimeters below the surface of the brain, while rTMS can stimulate one to two centimeters below the surface of the brain. (3,4)
  • FDA-approved indications: Deep TMS was approved by the FDA for depression treatment in 2013, while rTMS was approved much earlier, in 2008. However, only dTMS has been FDA approved to treat OCD. (3,5,6)  This doesn’t mean that rTMS can’t successfully be used to treat conditions other than depression – there are a number of studies that suggest that rTMS can be used successfully to treat other conditions off-label.

dTMS OCD Treatment

Both dTMS and rTMS can be used to safely treat symptoms of OCD, though only dTMS is FDA-approved for OCD treatment (and neither is approved yet for other non-depression conditions). FDA approval benefits patients because insurance companies will cover more of the cost of TMS therapy, but it is not the only indicator of a safe and effective treatment option. A study published in The New England Journal of Medicine shows that repetitive TMS is safe and effective in reducing symptoms of OCD. (8) 

Though we do not use the BrainsWay device (keep reading to learn why), its 2018 FDA approval for the treatment of OCD is a big step in the right direction toward making TMS more accessible to patients with conditions like PTSD, anxiety, or traumatic brain injury.

At Madison Avenue TMS & Psychiatry, We Use Neurostar® ’s rTMS Device. Here’s Why. 

At Madison Avenue TMS & Psychiatry, our patients’ safety is our number one priority. This is why I use Neurostar®’s figure-8 coil for repetitive TMS. It was the first TMS device to be approved by the FDA and therefore has been studied far more than BrainsWay’s deep TMS device. 

The main reason that I choose to use Neurostar®s repetitive TMS device is that the risk of seizure is much lower than with the BrainsWay deep TMS device. The risk of seizure for the rTMS figure-8 coil is estimated to be three out of 1000 patients per treatment, or less than one percent overall risk. (9) In the pivotal sham-controlled trial for BrainsWay’s H-coil, one out of 101 patients had a seizure per treatment. (10) 

At the Clinical TMS Society Conference held in February 2019, seizure rates for both rTMS and dTMS were discussed. The seizure rate with Neurostar®s figure-8 coil was estimated to be one seizure in 268,000 treatments, while the seizure rate with BrainsWay’s H-coil was estimated to be one out of 4,800 treatments. Assuming that patients receive 36 treatments, this means that one out of 7,444 patients receiving Neurostar®s TMS would have a seizure, while one out of 133 patients receiving BrainsWay’s TMS would have a seizure.

To learn more about Neurostar® and how it can help relieve depressive symptoms, contact our office


Resources:

1. What is Deep TMS and How Does It Work? Brainsway. https://www.brainsway.com/patients-faqs/what-is-deep-tms-and-how-does-it-work. Publication Date Unavailable. Accessed December 05, 2019. 

2. 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 Y, George MS, and Zangen A. Efficacy and safety of deep transcranial magnetic stimulation for major depression: a prospective multicenter randomized controlled trial. World Psychiatry. February 2015;14(1):64–73. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4329899/. Accessed December 05, 2019.

3. Baeken C, Brem AK, Arns M, Brunoni AR, Filipčić I, Ganho-Ávila A, Langguth B, Padberg F, Poulet E, Rachid F, Sack AT, Vanderhasselt MA, and Bennabir D. Repetitive transcranial magnetic stimulation treatment for depressive disorders: current knowledge and future directions. Current Opinion in Psychiatry. September 2019;32(5):409–415. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688778/. Accessed December 05, 2019.

4. McClintock SM, Reti IM, Carpenter LL, McDonald WM, Dubin M, Taylor SF, Cook IA, O’Reardon J, Husain MM, Wall C, Krystal AD, Sampson SM, Morales O, Nelson BG, Latoussakis V, George MS, MD, and Lisanby SH. Consensus Recommendations for the Clinical Application of Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Depression. Journal of Clinical Psychiatry. Jan-Feb 2018;79(1):16cs10905. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846193/. Accessed December 05, 2019. 

5. Horvath JC, Mathews J, Demitrack MA, and Pascual-Leone A. The NeuroStar TMS device: conducting the FDA approved protocol for treatment of depression. Journal of Visualized Experiments. November 12, 2010;(45). https://www.ncbi.nlm.nih.gov/pubmed/21189465. Accessed December 05, 2019. 

6. FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder. US Food and Drug Administration. Published August 17, 2018. https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-transcranial-magnetic-stimulation-treatment-obsessive-compulsive-disorder. Accessed December 05, 2019. 

7. Deep TMS Reduces Symptoms of Treatment-Refractory OCD. Psychiatry and Behavioral Health Learning Network. Published June 12, 2019.  https://www.psychcongress.com/article/deep-tms-reduces-symptoms-treatment-refractory-ocd. Accessed December 05, 2019. 

8. Zhou DD, Wang W, Wang GM, Li DQ, and Kuang L. An updated meta-analysis: Short-term therapeutic effects of repeated transcranial magnetic stimulation in treating obsessive-compulsive disorder. Journal of Affective Disorders. June 2017;215:187-196. https://www.ncbi.nlm.nih.gov/pubmed/28340445. Accessed December 05, 2019. 

9. Carpenter LL, Janicak PG, Aaronson ST, Boyadjis T, Brock DG, Cook IA, Dunner DL, Lanocha K, Solvason HB, and Demitrack MA. 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. https://www.ncbi.nlm.nih.gov/pubmed/22689344. Accessed December 05, 2019. 

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 Y, George MS, and Zangen A. Efficacy and safety of deep transcranial magnetic stimulation for major depression: a prospective multicenter randomized controlled trial. World Psychiatry. February 2015;14(1):64-73. https://www.ncbi.nlm.nih.gov/pubmed/25655160. Accessed December 05, 2019. 

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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