Effective Transcranial Magnetic Stimulation for Depression

#1. Time Commitment.

#2. Risk Of Seizure (low risk).

#3. Mild Scalp Discomfort.

#4. Insurance Coverage Criteria Must Be Met.

#5. Availability in your area

#6. Lack of Public Awareness.

#7. Cost (without insurance)

#1 Non-invasive.

#2. No Systemic Side Effects.

#3. Covered By Insurance.

#4. TMS Fits In Your Daily Routine.

#5. TMS Is Fairly Effective.

#6. None Addictive.

#7. No Memory Issues With TMS

A few insurance companies  require four antidepressants failure before approving a patient to receive TMS therapy. They do it primarily for financial reasons.  Aetna, Cigna, and United require two antidepressant failures. Tricare and Medicare require one failure of treatment before approving TMS. ​

The main absolute contraindication for TMS therapy is the presence of a movable ferromagnetic intracranially (inside the head). In other words, if someone has a brain stent, clip, or stimulator then this person should not be receiving TMS therapy. There are other relative contraindications for TMS that will require further evaluation with the doctor before TMS therapy.

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The list of relative contraindications includes a history of seizure, head injury, brain surgery, any metal in the head (outside of the skull) such as shrapnel, surgical clips, or fragments. Implanted devices such as pacemakers. The presence of any of the above warrants further investigation and discussion with the doctor to evaluate the benefits vs the risks of  TMS therapy.

Before having rTMS, it is often necessary to come in for a pre-treatment diagnostic evaluation. If there are any questions about your health or safety, you should talk with your doctor or mental health provider before the procedure can be scheduled.

TMS Therapy is not recommended for people with the following devices:

• Aneurysm clips or coils.

• Stents.

• Implanted stimulators.

• Implanted vagus nerve or deep brain stimulators.

• Implanted electrical devices, such as pacemakers or medication pumps.

• Electrodes for monitoring brain activity.

• Cochlear implants for hearing.

• Any magnetic implants.

• Bullet fragments.

• Any other metal device or object implanted in your body.

Talk to your doctor if:

• Any medications you are taking, including prescription and over-the-counter medicines, herbal supplements, vitamins or other supplements, and the recommended dosages.

• You have a history of seizures or a family history of epilepsy.

• You have other mental health disorders, for example, bipolar disorder or psychosis.

• You have a brain tumor, a stroke, or a traumatic brain injury.

• You struggle with frequent and severe headaches.

• You have any other medical conditions.

• You've had previous treatment with rTMS, and it was effective in treating your depression.

During treatment, the doctor will measure your head to determine the best place for the magnets and how much magnetic energy to use. The first appointment typically lasts about 45 minutes.

Most likely, during your first appointment:

• You will be taken to a special room where you will sit in a reclining chair and given ear-protecting foam plugs.

• Your doctor will determine the amount of magnetic energy needed by increasing the dose until your fingers or hands twitch. The level of stimulation can be changed, depending on your symptoms and side effects during therapy.

• A device will be placed against your head that is switched on and off rapidly. This results in a tapping or clicking sound that usually lasts for a few seconds, followed by a pause. You'll also feel a tapping sensation on your forehead. This part of the process is called mapping.

• Once you've been given the go-ahead to begin TMS Therapy, we typically start with a series of two or three treatments at a time. Here's what to expect during each treatment:

• First, you'll be asked to sit in an armchair and put on earplugs before placing the magnetic coil against your temple. This will cause clicking sounds.

• The TMS Therapy process takes about 19 minutes and includes the stimulation of scalp nerves with a magnetic field. 

• You can return to your daily routine activities after treatment

The number of TMS sessions depends on the patient, condition, contraindications, and system protocols.

On average Thirty to Thirty-six sessions ensure optimum efficacy.

The typical schedule of TMS therapy for depression is 30 sessions followed by 6 sessions of taper off.

The schedule is usually as follows:

• One session a day, 5 days a week for 6 weeks.

• Then one session a day 3 days a week in week #7.

• Then one session a day 2 days a week in week #8. 

• Then one session in week #9.

The typical schedule of accelerated TMS therapy for depression is 10 sessions a day for 5 days for a total of 50 sessions.

MagVenture TMS Therapy Magpro R30 system with liquid cooling  uses  D-70 coil for depression and D-B80 coil for the treatment of OCD. for adjunctive treatment of OCD. The MagVenture TMS Therapy System is intended to be used as an adjunct for the treatment of adult patients suffering from Obsessive-Compulsive Disorder (OCD). This is a 510(k) FDA-clearance granted in 2020. ​

And recently FDA cleared MagVenture for chronic pain disorder.

All TMS therapy studies had shown a good success rate. The main pivotal randomized controlled trial that was submitted for FDA approval in 2007 showed that 58% of patients showed a response and 37% of patients had a remission after 30 treatment sessions of TMS. An NIH spNIH- sponsored trial in 2010 showed a similar outcome. Many other randomized controlled trials replicated the same outcome. Nowadays, it is a given that TMS is effective for depression