Deep TMS Treatment

Deep TMS Therapy – What is dTMS and How is the treatment with Brainsway machine?

Transcranial magnetic stimulation (TMS) is a non-pharmaceutical, non-invasive treatment for depression and other mental health conditions that is especially recommended for patients for whom medications and psychotherapy have proven ineffective. As well as talk therapy, deep TMS therapy is one of the treatments available at Madison Avenue Clinic, where we use the BrainsWay™ Deep TMS Device.

What Is Deep TMS Therapy?

Deep TMS therapy, also called dTMS, is a non-invasive treatment for mental health disorders patented by the BrainsWay company based on the concept of deep brain stimulation, or activating the brain cells (i.e., neurons and neurotransmitters) that affect mental health symptoms.

During deep TMS treatment with the BrainsWay machine, the patient is comfortably seated while they wear the helmet-shaped deep TMS device, which sends tiny, barely perceptible electromagnetic pulses to the brain areas connected with their symptoms. The doctor monitors brain activity on a screen to make sure that the desired brain regions are being stimulated. A typical deep TMS session lasts around twenty minutes.

Difference Between dTMS And rTMS

There are two types of TMS therapies available to patients, with the main difference between them being the type of device used.

• Repetitive transcranial magnetic stimulation (rTMS) is the older and most common TMS method. It uses a “figure-8” coil, named for its shape, to deliver electric pulses. Most TMS devices on the market use this design, which remains largely unchanged since 1985.
• Deep transcranial magnetic stimulation (dTMS) is a newer, more advanced method that uses the H-coil structure, patented by BrainsWay, to reach deeper into the brain for greater effect without compromising on safety. To date, deep TMS treatment is only possible using the BrainsWay dTMS Device.

How dTMS Works

Both rTMS and dTMS work by regulating the abnormalities in the brain’s electro-chemical activity that can cause the symptoms of certain mental health conditions. For example, depression is associated with irregularities in the amygdala, prefrontal cortex, and hippocampus, while obsessive-compulsive disorder (OCD) is associated with abnormalities in the basal ganglia (1, 2).

All TMS therapies use a head-mounted device, similar to a skullcap or bathing cap, fitted with electromagnetic coils to deliver pulses to the brain regions associated with the patient’s symptoms. These pulses stimulate brain activity in the targeted areas, helping the patient achieve healthy connectivity between the appropriate neurons and neurotransmitters and thus be able to regulate their thoughts and emotions more easily.

dTMS Therapy Benefits

As a more modern, advanced design for transcranial magnetic stimulation, deep TMS has the following advantages over traditional rTMS.

• Deep brain stimulation – As the name suggests, deep TMS can reach deeper into the brain, achieving a 0.25” (3.2 cm) depth of penetration during treatment with the BrainsWay machine compared to 0.27” (0.7 cm) using a traditional figure-8 coil. This may explain the greater success of dTMS over rTMS in comparative tests (3).
• Greater coverage – The BrainsWay H-coil is designed to safely emit a wider and deeper magnetic field so there is no chance of missing the appropriate areas of the brain related to the patient’s symptoms.
• Consistent coil contact – The H-coil device is structured in such a way as to provide better coil contact to the targeted brain regions, with specialized variants designed to more effectively target different mental health conditions.
• Theta burst stimulation – Also known as TBS, this is a variant of dTMS that uses the BrainsWay H-coil in an alternative way. In TBS, low stimulation intensity and a shorter treatment length are deployed for extremely treatment-resistant depression and suicidal thoughts. This method has achieved success with patients whose symptoms had previously proven resistant to a normal deep TMS course and is an advantage that deep TMS equipment has over the figure-8 coil devices (4).
• Effective for more mental health conditions – Deep TMS is FDA-cleared to treat depression, anxious depression, OCD, and smoking addiction, whereas rTMS is only cleared for the treatment of depression.

Is Deep TMS Effective?

Studies have shown deep TMS to be effective in treating the following mental health conditions:

• Major depressive disorder (MDD)
• Obsessive-compulsive disorder (OCD)
• Attention-deficit hyperactivity disorder (ADHD)
• Borderline personality disorder (BPD)
• Anxiety and post-traumatic stress disorder (PTSD)
• Anxious depression
• Addiction

FAQ

How long does it take for deep TMS to work?

A typical deep TMS treatment course lasts for nine weeks, including six treatment sessions and a three-week “taper” period. Some patients may need another round of treatment before seeing satisfactory results.

Does deep TMS have side effects?

Deep TMS is a well-tolerated treatment with no major side effects, although a small minority of patients may experience slight scalp irritation or a mild headache, both short-lived and easily treatable with over-the-counter medications. Some patients may also experience a “dip”, or slight worsening of symptoms, during the middle of a treatment course before things improve toward the end.

Can dTMS cause brain damage?

There are no indications that dTMS can cause brain damage, memory loss, or other adverse effects. Research shows dTMS to be a safe and effective treatment for the abovementioned mental health disorders.

Can dTMS change your personality?

No. Due to poor public mental health education, there is some confusion as to the distinction between a mood disorder and someone’s personality. While dTMS can certainly help someone get rid of unwanted mental health symptoms and break negative thought patterns, they are always the same person, and dTMS does not change your personality.

Who should not get dTMS?

Insurance providers will usually have conditions that need to be satisfied before approval for any TMS treatment, including dTMS. Generally, patients who are under the age of 18 or over 65, who have psychotic mental health disorders (e.g., schizophrenia), or who have any existing brain implants that may be affected by electricity should not get dTMS.

Is Deep TMS Right For Me?

If you have any further questions about deep TMS, insurance coverage, or appointment availability, contact us online or call us at (212) 731-2033.

Sources:

1 – Neuroscience of depression and treatment. New Frontiers Psychiatry & TMS. Published November 8, 2021. https://www.newfrontierspsychiatry.com/neuroscience-of-depression-and-treatment/. Accessed June 22, 2022.

2 – Rapoport, J. Obsessive-compulsive disorder and basal ganglia dysfunction. Psychological Medicine. 1990;20, 465-469. https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0033291700016962. Accessed March 2, 2023.

3 – Ginou A, Roth Y, Zangen A. Comparison of superficial TMS and deep TMS for major depression. BrainsWay. https://www.brainsway.com/knowledge-center/comparison-of-superficial-tms-and-deep-tms-for-major-depression/. Accessed February 16, 2023.

4 – A Tendler, E Sisko, N Rodriguez, S Corbett-Methot, J Sutton-DeBord, J Brown, N Williams. Sequential L-PFC, DMPFC-ACC, Accelerated Intermittent Theta Burst Deep TMS for Suicidal Highly Treatment Resistant Depression Patients. Brain Stimulation. 2018;11: e1-e8. https://www.brainsway.com/knowledge-center/sequential-l-pfc-dmpfc-acc-accelerated-intermittent-theta-burst-dtms-for-suicidal-highly-treatment-resistant-depression-patients-2/. Accessed May 28, 2023.