Transcranial magnetic stimulation (TMS) is a procedure that uses magnetic pulses to stimulate nerve cells in the brain. The Food and Drug Administration (FDA) approved the use of TMS as a treatment for major depression in 2008. This use of TMS is limited to those who have tried as least one antidepressant medication that has proven unsuccessful. Trials have shown that TMS can be an effective treatment option for people with major depression, though researchers still have much to learn about maximizing its effect.

Transcranial Magnetic Stimulation (TMS) Procedure

During a TMS procedure, a clinician applies an electromagnetic coil to the patient’s forehead. The coil administers electromagnetic pulses that stimulate nerve cells in the brain. The coil is applied near an area of the brain that controls mood regulation. The magnetic field produced by the procedure is roughly the same strength as an MRI scan. 

A TMS session is usually administered by a doctor or nurse but does not require anesthesia. It lasts anywhere from 30 to 60 minutes. You will feel a slight tapping on their forehead from the pulses during the procedure. Then a tapping sound for a few seconds followed by a pause. In order to determine the right magnetic dosage, the clinician increases the energy level until the patient’s hands or fingers begin to twitch. If side effects are detected, adjustments to the amount of stimulation can be made during the procedure. When the pulses are given rapidly and in succession, the treatment is called repetitive transcranial magnetic stimulation or rTMS. rTMS therapy involves a series of treatment sessions; a typical course of rTMS is 4 to 6 weeks. There is also a type of TMS called deep transcranial magnetic stimulation (dTMS), which can stimulate deeper into the brain and cover a larger area.

Treatment sessions vary in length depending on the TMS coil used and the number of pulses delivered but typically last around 30 to 40 minutes. Patients receive TMS 5 days a week.  However, this can vary depending on an individual’s response to treatment.

Scientists still debate about the best position to place the electromagnetic coil on the head, the best frequency and intensity for the pulses, and whether the procedure is more effective when delivered as a single treatment or with booster sessions. There is also an ongoing debate about whether patients benefit most when they receive TMS alone or in conjunction with medication and psychotherapy.

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Effectiveness of Transcranial Magnetic Stimulation

Clinical trials have proven the effectiveness of TMS in treating major depression. One review of 42 TMS clinics in the United States reported that 58% of people receiving treatment reported improvement and 37% reported full remission. Researchers are studying whether booster sessions can be helpful in reducing the risk of depression relapse, but clinicians have had to decide the best way to administer such sessions. They are also studying whether engaging in an activity such as cognitive behavioral therapy while receiving TMS treatment can provide the biggest benefit to brain cells.

If you are receiving multiple TMS sessions, it may take several weeks for your depressive symptoms to decrease. Talk to your doctor about whether they recommend ongoing maintenance sessions. It is possible if you have another depressive episode in the future to return for further TMS treatments.

In addition to treating major depression, researchers are studying the effectiveness of TMS in treating schizophrenia, attention deficit-hyperactivity disorder, post-traumatic stress disorder, and vascular depression following a stroke. They are also beginning to study the effectiveness of transcranial magnetic stimulation in treating the symptoms of autism. The results for these conditions are varied, but research has indicated that the treatment could be useful in treating acute pain and chronic pain conditions including fibromyalgia.

Transcranial Magnetic Stimulation Side Effects and Risks

The risks of TMS are relatively low because the procedure is noninvasive—it does not require anesthesia or the implantation of electrodes. The treatment can take place in a doctor’s office, and patients are allowed to drive themselves home after the procedure. Side effects from the treatment can include facial spasms or tingling, lightheadedness, headaches, and scalp discomfort where the stimulation is applied. There is a very small risk of seizure. The treatment may also induce mania among those with bipolar disorder or hearing loss, but these effects are also rare.

Other Types of Brain Stimulation

TMS is not the only kind of brain stimulation therapists that are used to treat mental illness. Electroconvulsive therapy (ECT) has been studied the most and has been used the longest in the United States. One drawback of ECT is that it can cause memory loss and concussion. People who receive ECT must also undergo anesthesia to receive the treatment. Other types of brain stimulation therapists include vagus nerve stimulation (VNS), magnetic seizure therapy (MST), and deep brain stimulation (DBS). Scientists are also continuing to explore other ways of stimulating brain cells to improve mood.

Being Evaluated for Transcranial Magnetic Stimulation

A patient must complete multiple steps before they are eligible and prepared to receive transcranial magnetic stimulation. If you are a candidate for TMS, you must first receive a physical and psychiatric examination to determine whether the procedure is a safe and potentially useful option. It’s important to tell your doctor if you are pregnant or planning to become pregnant, or whether you have any metal or implanted devices in your body. TMS may also be ruled out based on other medical conditions, a history of seizures, brain damage, or other mental illnesses.

If you are interested in TMS, it’s important to check with your insurance provider to see whether your insurance covers the cost of the procedure. Without insurance, the cost of transcranial magnetic stimulation can be thousands of dollars. You may also have to provide documentation proving that other treatment options like medication and psychotherapy have not proven effective in reducing the symptoms of depression.

Researchers still have a lot to learn about transcranial magnetic stimulation. They are still refining the procedure itself and determining how many treatments are necessary for the most effective outcomes. But trials so far suggest that TMS can be a hopeful alternative option for those who don’t respond as well to medication for treating their depression. If you’re interested in learning more about transcranial magnetic stimulation, talk to your doctor or psychiatrist about your options and a potential evaluation.

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Last Updated: Aug 7, 2018