By Dr. David Woo - August 29, 2018

Transcranial magnetic stimulation (TMS) is a six-week, one-course treatment therapy that gained FDA approval in 2008. TMS has been approved for the treatment of depression that does not respond to standard therapies like medications and talk therapy, often referred to as treatment-resistant depression. (1)

TMS has shown positive results for individuals with treatment-resistant depression. (2) But one important question is: Does TMS provide positive outcomes in the long term even though it’s just a single course of treatment? Before answering this question, let’s take a quick look at how TMS reduces and/or eliminates symptoms of depression. Then, we’ll explore how scientists measure the effects of TMS to determine its long-term qualities. Finally, we’ll discuss the long-term effects of TMS compared to systemic antidepressant medications.  

How Does TMS Interact With the Brain to Relieve Symptoms of Depression?

TMS uses magnetic pulses to interact with nerve cells, called neurons, in the regions of the brain associated with mood and depression. Magnetic pulses are delivered painlessly through a coil that is placed close to the head. These pulses communicate with neurons to stimulate the release of neurotransmitters (chemical signals), activating and increasing depleted neurotransmitters. This improves communication between different regions of the brain involved in mood regulation. (3)

How Do Scientists Understand the Long-Term Effects of TMS?

During research studies observing the effects of TMS, scientists have used different research instruments to measure the effects of the treatment. These tools include:

• Clinician-Reported Clinical Global Impressions-Severity of Illness Scale: A scale completed by the observing healthcare team. This tool helps researchers understand the effect that the patient’s symptoms have on their ability to function in daily life. (4)
• Inventory of Depressive Symptoms Self-Report: A questionnaire filled out by the patient about the frequency and severity of his/her symptoms of depression. (5)
• 9-Item Patient Health Questionnaire: A questionnaire filled out by the patient used to measure the severity of symptoms of depression. (6)

These tools help physicians understand the severity of the diagnosis from the patients’ point of view, as well as from a clinical point of view as a healthcare professional. They are used both before and after treatment to track the patient’s progress.

TMS Provides Long-Term Results Without the Side Effects Associated With Systemic Medications

A study published in 2014 in the Journal of Clinical Psychiatry revealed results that showed TMS to be effective for relieving symptoms of depression in the long term for many patients — even as a single course of treatment. Two hundred fifty-seven patients diagnosed with major depressive disorder participated in this study, across 42 different clinics. All participants received a six-week course of TMS treatment with their providers. Each patient completed an assessment before TMS treatment, and a follow-up assessment every three months for the next 12 months after treatment. The results of this study showed that 62.5 percent of patients showed remission, or no symptoms of depression, even one year after initial treatment.(7) 

TMS (neither rTMS nor dTMS) is also not associated with any long-term side effects. Short-term side effects that have been reported include scalp discomfort and headache that often go away within the first week of treatment.(1,8) This differs from systemic antidepressant medications that are associated with undesirable side effects like trouble sleeping, weight gain, fatigue, and sexual dysfunction, which can continue to affect an individual’s health and quality of life long-term.(9) To learn more about how TMS works, its efficacy rate, and the benefits of this therapy, click here.

Resources:

1. Grohol JM. TMS Treatment for Depression Gains FDA Approval. Psychcentral.com. Updated October 9, 2008. Accessed August 17, 2018.
2. Carpenter LL, Janicak PG, Aaronson ST, et al. Transcranial magnetic stimulation (TMS) for major depression: A multisite, naturalistic, observational study of acute treatment outcomes in clinical practice. Depress Anxiety. 2012;29(7):587-96. Link. Accessed August 17, 2018.
3. Neurostar mechanism of action. YouTube: Neurostar Advanced Therapy. Link. Published on June 07, 2021. Accessed on March 30, 2022.
4. Busner J, Targum S. The Clinical Global Impressions Scale, Applying a Research Tool in Clinical Practice. Psychiatry (Edgmont). 2007;4(7):28–37. Link. Accessed August 20, 2018.
5. Administration. Inventory of Depressive Symptomatology (IDS) and Quick Inventory of Depressive Symptomatology (QIDS). Link. Publication date unavailable. Accessed August 20, 2018.
6. The Patient Health Questionnaire (PHQ-9) – Overview. Center for Quality Assessment and Improvement in Mental Health. Link. Publication date unavailable. Accessed August 20, 2018.
7. Dunner DL, Aaronson ST, Sackeim HA, et al. A multisite, naturalistic, observational study of transcranial magnetic stimulation for patients with pharmacoresistant major depressive disorder: Durability of benefit over a 1-year follow-up period. J Clin Psychiatry. 2014;75(12):1394-401. Link. Accessed August 17, 2018.
8. Levkovitz Y, Isserles M, Padberg F, et al. Efficacy and safety of deep transcranial magnetic stimulation for major depression: a prospective multicenter randomized controlled trial. World Psychiatry. 2015;14(1):64-73.
9. Ferguson J. SSRI Antidepressant Medications: Adverse Effects and Tolerability. Prim Care Companion J Clin Psychiatry. 2001 Feb; 3(1): 22–27. Link. Accessed August 20, 2018.

Dr. David Woo

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.