TMS Info For Patients
What is repetitive Transcranial Magnetic Stimulation (rTMS)?
rTMS was approved as a medical procedure by Health Canada in 2002 for treatment of major depressive disorder. It is also used in treatment of several other mental and physical conditions. rTMS is a non-medication treatment that uses a magnet applied to the scalp to stimulate specific parts of the brain implicated in these conditions. With repetitive stimulation of these areas, rTMS can alter the strength of connections between neurons in the brain, leading to changes in brain function, and improving abnormal patterns that can be associated with depression.
How does a course of rTMS treatments work?
If you are a suitable candidate for rTMS and agree to undergo treatment, you will be asked to complete a series of questionnaires on the level of your symptoms. At your first treatment session, the specific brain region that will be stimulated given your condition and the strength of electromagnetic pulse required will be determined. The first treatment will begin by applying the electromagnetic coil to your scalp. When the coil is activated, it will send magnetic pulses several centimeters under the scalp’s surface to either stimulate or inhibit parts of the brain. A full treatment course usually involves 20-30 treatment sessions. Treatment sessions are typically once daily, five days per week, with each treatment lasting 10-20 minutes. In some cases — for example, in individuals who are travelling at a considerable distance for treatment — accelerated protocols can be considered which can reduce the length of a treatment course.
What are the benefits of rTMS treatment?
rTMS has been shown in hundreds of studies to be beneficial in the treatment of major depression with relatively fewer side effects than medications or electroconvulsive therapy (ECT). Generally speaking, rTMS trials have shown that 60% of people have a significant improvement in their symptoms and 30-40% have remission of their depression. This is not as strong a response rate as ECT. However, rTMS has relatively fewer side effects in comparison to ECT and other standard treatments.
rTMS has also been shown to be beneficial in treating other conditions. A growing body of literature has shown benefit in treatment of pain conditions such as fibromyalgia, migraine and neuropathic pain conditions. There is increasing evidence for its use in post-traumatic stress disorder and some neurological conditions.
rTMS may be particularly suited for: (1) people who have not had good results with other standard treatments; (2) people who have had problems with side effects from other standard treatments; (3) people who have a preference to avoid medications or more invasive treatments.
What are the risks of rTMS treatment?
Most people tolerate rTMS without any significant side effects. The most common side effect is discomfort on or near the scalp. This is because the magnetic pulse that stimulates the brain will also stimulate the scalp near the magnet, and can create an unpleasant feeling. This discomfort, however, typically improves over the course of treatment. A smaller proportion of people have headaches after the session itself. A small percentage of people have feelings of being faint. Rare side effects include the potential risk of developing hypomania (feelings of increased energy, euphoria or irritability, reduced need for sleep) or thoughts of self harm in less than 1% of cases. There is a small risk of seizure being induced by the treatment, estimated to be about 1 in 10,000 cases. Those seizures that have occurred in treatment have not led to seizures outside of treatment sessions. In some cases, rTMS has been used as a treatment for epilepsy.
Is rTMS better than other treatments for major depressive disorder?
rTMS is not necessarily a “better” treatment than other treatments for major depression. rTMS has a good response rate compared to other treatments (though less than ECT) and can help many people. It also has a relatively favorable side effect profile and does not require any specific preparation for treatment (people can walk in and walk out after treatment sessions). It is best to think of rTMS as another option for treatment of major depression (and other conditions) that is generally well tolerated (see below for an outline of risks/side effects).
How do I know if rTMS will work for me?
You don’t. Like much of treatment in psychiatry, it is not known if treatment will be effective until the treatment has been tried. Overall, 60% of people with depression will have improvement. Those with recurrent episodes of depression with improvement to a normal baseline between treatments tend to have better results from treatment. People who have had poor prior response to rTMS or ECT are less likely to respond to rTMS. During treatment you will be monitored by one of the physicians in the clinic to determine whether you are getting benefit from treatment.
What happens after the rTMS course of treatment is complete?
After the course of treatment is complete you will continue to follow-up with the provider who referred you to the clinic. In some cases, ongoing “maintenance” rTMS may be recommended. In other cases, treatment with medication or psychotherapy may be recommended.
How do I get a consultation?
A physician involved in your care will make a referral if they believe that rTMS may be beneficial for your condition. You will then be booked to see one of the clinic physicians to determine whether rTMS may be of benefit to you and whether you are suitable to receive the treatment. Conditions that may benefit from rTMS treatment include: major depressive disorder, bipolar disorder when the individual is depressed, posttraumatic stress disorder. Pain conditions that may benefit from rTMS include: fibromyalgia, certain neuropathic pain conditions. As there is evidence for rTMS in other conditions, other indications are assessed on a case by case basis. In our clinic, we treat adults over the age of 18. Individuals need to be able to sit comfortably in a chair for thirty minutes, and be able to commit to the treatment (which is 5 days per week, for up to 6 weeks), and have a form of payment. rTMS is NOT currently covered by the Nova Scotia public health plan (MSI). As a result, third party or out-of-pocket payment is required. The clinic has financing options available. There is no charge for the initial consultation.