Transcranial Magnetic Stimulation (TMS) is a new, effective, and well-tolerated treatment method for depression. It can be used as an adjunct to or in place of traditional psychotherapy and medication when these treatments do not yield sufficient improvement. TMS is a novel technique that uses magnetic pulses to stimulate neurons in targeted areas of the brain. These pulses are delivered to the prefrontal cortex (the brain region associated with mood regulation) via a magnetic coil placed on the front of the head. Patients undergo a preliminary process to determine the appropriate level of magnetic stimulation and the exact location of the brain region to be targeted. The entire procedure takes approximately 45 minutes. TMS is non-invasive, requiring no anesthesia or sedation. The patient remains comfortably seated and awake during the procedure. Since no additional medication is administered during the procedure, TMS has no cognitive or systemic side effects that would prevent patients from returning to their daily activities immediately afterward. TMS treatment generally consists of 15 to 30 sessions administered over a period of three to six weeks. However, treatment protocols may vary depending on the individual patient. Throughout the treatment period, patients are closely monitored through clinical consultations and standardized scales to assess the treatment's effectiveness and symptoms on a weekly basis. This approach allows for the treatment duration to be optimized for each patient. Maintenance therapy may be recommended for patients who experience significant improvement (complete remission).
Is TMS Effective for Depression?
TMS is a safe, effective, and non-invasive treatment approved by the FDA (U.S. Food and Drug Administration) for treating treatment-resistant depression. Numerous studies have demonstrated that TMS is effective in treating depression in patients who have had an inadequate response to one or more antidepressants. Meta-analyses and evidence-based guidelines summarizing the results of current clinical studies have concluded that TMS's effectiveness for depression is supported by high-level evidence (Lefaucheur et al. 2014, 2020). While response and remission rates vary from patient to patient, TMS can keep some patients symptom-free for extended periods, while others may require maintenance therapy (Demirtas-Tatlidede et al. 2008).
Can TMS Be Applied to Other Conditions Besides Depression?
Research on the use of TMS for other psychiatric and neurological disorders is ongoing. The European TMS Committee's evidence-based guidelines classify the clinical use of TMS into three levels based on the current evidence (Lefaucheur et al. 2020):
In our center, the use of TMS for conditions other than depression is evaluated on an individual basis, according to the guidelines' recommendations and evidence levels. Since the activity changes in the brain differ for each condition, the TMS treatment applied may vary depending on the disease and the individual's characteristics. It is important to remember that these guidelines are based on the currently available scientific data and that recommendations may change over time. Finally, it is important to emphasize that rTMS is not a miraculous method that can cure all brain disorders. Therefore, it is ethically crucial to apply this method to appropriate patients in light of the available scientific evidence.
TMS procedures are painless, so there is no need for anesthesia or to sedate the patient. Some patients may experience mild headaches or scalp discomfort after the first treatment, but these minor discomforts usually diminish after a few sessions. Since TMS is a non-invasive technique, the only sensation you may feel is a slight tap on your head.
