By Dr. David Woo - July 12, 2018

Transcranial magnetic stimulation (TMS) is one of the newest forms of treatment for depression. TMS is an especially exciting discovery because it has been shown to be effective in relieving depression even for patients with treatment-resistant depression. Yet if TMS is new, how was depression treated before TMS? And how did TMS surface as a treatment for depression?

A History of Treatment for Depression

Sadly, people with mental illness have not always been treated humanely by society, nor by the medical profession. Isolation, torture, and institutionalization of people with mental illness dates back to ancient times and continued up through the 19th and early 20th centuries. However, with advances in science and medical understanding, after the early 1900s the treatment approach for mental illness began to change for the better.

In the 1930s, psychotherapy and electroconvulsive shock therapy (ECT), which uses electric currents to induce a seizure in the patient, became commonly used treatments for depression. However, initially ECT was was  done without anesthesia, making it a feared experience. Fortunately, the treatment gradually evolved to be a more humane treatment—done under anesthesia, with patient education and consent—that truly is effective in changing the brains of depressed patients. Once used widely, ECT is now used only in cases of very severe depression.¹

Medications to treat mental illnesses became more common in the 1950s. The first antidepressant medication was discovered by accident, when a drug used in the treatment of tuberculosis had the unintended effect of improving patient mood.² After that, other forms of antidepressant medication were discovered and studied. One innovative antidepressant medication, the selective serotonin reuptake inhibitor or SSRI, was developed in the 1970s and approved under the name of Prozac by the US Food and Drug Administration (FDA) in 1988. Since then, even more antidepressant medications have been studied and used to effectively treat depression.

The Discovery of Transcranial Magnetic Stimulation (TMS)

Since the 1830s, scientists have been interested in the effects of magnetic waves on the brain. However, for many years, researchers did not have the resources to target specific areas of the brain with high intensity magnetic waves. By 1985, a century and a half later, technology that allowed magnetic stimulation of the brain had advanced to the point where doctors and researchers were able to study it as a form of treatment for brain disorders.³ The treatment was named transcranial magnetic stimulation (TMS).

Researchers began to use medical imaging studies, such as PET scans, to look at blood flow and other processes in the brains of people with depression. They discovered that the front left portion of the brain (the dorsolateral prefrontal cortex) showed lower levels of activity in people with symptoms of depression.⁴ After this discovery, researchers tested the effects of TMS when it was concentrated on that specific area of the brain. They found that using TMS treatment on patients with depression increased activity in that area of the brain and improved patient mood.⁵ Over the years, more and more research was done to see just how effective TMS could be for patients with depression.

TMS Gained FDA Approval in 2008

In 2007, an important study was done on the effectiveness of TMS for people with treatment-resistant depression. The study compared patients who received active TMS treatment with patients who received placebo TMS treatment. After 6 weeks of TMS treatment, the study found that the active TMS group was more than twice as likely to achieve remission than the placebo group.⁶ In 2008, the US FDA approved TMS as a treatment for treatment-resistant depression. The mental health treatment community was especially excited about TMS because it had few to no side effects.⁷ Currently, TMS treatment for depression is being offered by hundreds of providers across the United States.⁸

Want to find out more about how the difference between TMS and antidepressants? Read our blog post How Does TMS Compared to Medication Treatment?

References

1. Taylor R. A Short History of Mental Illness Treatment. Owlcation.com. Link. Updated January 22, 2018. Accessed June 21, 2018.
2. Hillhouse TM, Porter JH. A brief history of the development of antidepressant drugs: From monoamines to glutamate. Exp Clin Psychopharmacol. 2015; 23(1): 1–21. Link. Accessed June 21, 2018.
3. Barker AT, Jalinous R, Freeston IL. Non-invasive magnetic stimulation of human motor cortex. Lancet. 1985;1(8437):1106–7. Link. Accessed June 21, 2018.
4. Bench CJ, Friston KJ, Brown RG, Scott LC, Frackowiak RS, Dolan RJ. The anatomy of melancholia–focal abnormalities of cerebral blood flow in major depression. Psychol Med. 1992;22(3):607-15. Link. Accessed June 21, 2018.
5. George MS, Wassermann EM, Williams WA, Callahan A, Ketter TA, Basser P, Hallett M, Post RM. Daily repetitive transcranial magnetic stimulation (rTMS) improves mood in depression. Neuroreport. 1995;6(14):1853-6. Link. Accessed June 21, 2018.
6. O’Reardon JP, Solvason HB, Janicak PG, et al. Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: A multisite randomized controlled trial. Biol Psychiatry. 2007 ;62(11):1208-16.  Link. Accessed March 15, 2018.
7. Grohol JM. TMS Treatment for Depression Gains FDA Approval. Psychcentral.com. Updated October 9, 2008. Accessed June 21, 2018.
8. NeuroStar® Providers. Link. Accessed July 2, 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.