Dr. Tourjee on ABC News discussing Transcranial Magnetic Stimulation (TMS)
Transcranial Magnetic Stimulation (TMS)
How It Works
Listen to Dr Tourjee on 101.7 The Bull
1. What is Neurostar TMS?
NeuroStar TMS Therapy is the first non-systemic and non-invasive outpatient depression treatment cleared by the US Food and Drug Administration (FDA) for patients who have not benefited from prior antidepressant treatment. NeuroStar TMS Therapy uses highly focused, pulsed magnetic fields to stimulate function in targeted brain regions.
NeuroStar TMS Therapy is:
- Non-invasive, meaning that it does not involve surgery. It does not require any anesthesia or sedation, as the patient remains awake and alert during the treatment.
- Non-systemic, meaning that it is not taken by mouth and does not circulate in the bloodstream throughout the body.
2. How does TMS work?
TMS uses pulsed magnetic fields similar in strength to a magnetic resonance imaging (MRI) machine to stimulate the part of the brain thought to be involved with mood regulation. TMS Therapy is a short outpatient procedure.
These magnetic pulses may have a positive effect on the brain’s neurotransmitter levels, making long-term remission possible
3. Is it safe?
NeuroStar TMS Therapy has been shown to be well tolerated and the system has been demonstrated to be safe in clinical trials. Throughout over 10,000 active treatments performed in clinical trials, the most commonly reported side effect was scalp discomfort during treatment sessions. This side effect was generally mild to moderate, and occurred less frequently after the first week of treatment. Less than 5% of patients treated with NeuroStar TMS Therapy discontinued treatment due to side effects.
In NeuroStar clinical trials, over 10,000 TMS treatments demonstrated its safety, with no occurrence of seizures. However, there is a small risk of a seizure occurring during treatment. This risk is no greater than what has been observed with oral antidepressant medications.
4. How effective is it?
Based on outcome registry data for Major Depressive Disorder, 83% responded acutely to the treatment and 62% were in remission! Only the NeuroStar® Advanced Therapy Outcomes Registry has data on over 12,485 patients since being initiated in September 2016, making it the largest data set in major depressive disorder. This data is from 118 NeuroStar practice sites (2,6,22). In these real-world outcomes**, by clinician rating (CGI-S) 83% of patients responded to an acute course of NeuroStar, and 62% achieved remission.(5,22). While NeuroStar TMS Therapy has been demonstrated to be effective, not all patients will benefit from it. Patients should be carefully monitored for worsening symptoms, signs or symptoms of suicidal behavior, and/or unusual behavior. Families and caregivers should also be aware of the need to observe patients and notify their treatment provider if symptoms worsen.
5. How difficult is it to do the treatments and where are they conducted?
Treatments with NeuroStar TMS are easy:
- Therapy sessions are conducted in your doctor’s office
- You can return to normal activities right away
- You are awake during treatment
- There are no negative effects on memory or sleep
6. How long is treatment?
A usual course of TMS treatment for depression involves 36 sessions, 5 days a week for 6 weeks (Monday through Friday), followed by 6 sessions divided over the next three weeks. Each session lasts between 19-37 minutes depending on the particular protocol your physician assigns you.
7. What should I expect?
If TMS is the right treatment for you, treatment sessions can be scheduled to begin soon
At the first TMS appointment your TMS physician will determine the optimal placement and strength of the magnetic field. Once determined, these settings are saved to ensure proper placement with every treatment.
Each subsequent treatment will be conducted by one of our TMS technicians. Treatments typically last about 19-37 minutes during which you will be awake and alert.
The magnetic pulses make a clicking sound and feel like a tapping on the scalp. TMS is non-invasive, meaning it does not involve surgery, and has no systemic effects. Typical TMS side effects are transient and mild irritation or discomfort at the treatment site and headache.
How NeuroStar TMS Therapy Works
Here’s what you can expect from a NeuroStar Advanced Therapy (TMS) session:
You’ll recline comfortably in the treatment chair. A small, curved magnetic coil will be positioned lightly on your head
TMS delivers focused magnetic stimulation directly to the target areas of the brain. You’ll hear a clicking sound and feel a tapping sensation on your head
Depending on your doctor’s recommendation, each treatment takes between 19 and 37 minutes
You can resume normal activities immediately.
Because there are no effects on alertness or memory, you can drive yourself to and from treatment sessions
8. Can TMS cause brain tumors?
No, NeuroStar TMS Therapy uses the same type and strength of magnetic fields as MRIs (magnetic resonance imaging), which have been used in tens of millions of patients around the world and have not been shown to cause tumors. The magnetic energy used in a full course of TMS Therapy is a small fraction of just one brain scan with an MRI.
9. How long do the antidepressant effects last?
NeuroStar TMS is the only TMS system with the durability of its effects established over 12 months. In a clinical trial, 2 out of 3 patients who had either responded to treatment or completely remitted their depression symptoms reported 12 months later that they remained at the level they were at the end of the trial. Additionally, after the trial, only 1 in 3 patients needed to return for ‘maintenance’ TMS sessions.
10. Is this like shock/electroconvulsive therapy (ECT)?
No, TMS and ECT are very different. While both are effective in the treatment of depression, there are many differences in safety and tolerability.
During TMS Therapy, patients sit in a chair and are awake and alert throughout the entire 19-37 minute procedure – no sedation is used with TMS Therapy. Patients can transport themselves to and from treatment.
In over 10,000 active treatments with the NeuroStar TMS Therapy system in clinical trials, no seizures were observed. TMS Therapy was also shown to have no negative effects on memory function in these studies.
In contrast, “shock therapy,” or electroconvulsive therapy (ECT), intentionally causes a seizure. Patients receiving ECT must be sedated with general anesthesia and paralyzed with muscle relaxants. Recovery from an ECT treatment session occurs slowly, and patients are usually closely monitored for minutes or a even few hours after a treatment.
Short-term confusion and memory loss are common with ECT, and long-term disruptions in memory have been shown to occur and may persist indefinitely in some people. Because of the side effects associated with ECT, a significant amount of caregiver support is required.
11. What are some of the benefits of TMS?
- Reduction in the emotional effects of depression
- Greater control of anxiety issues
- No big changes in appetite
- Fewer body aches and pains
- Prevention of lethargy
12. Is TMS covered by my insurance?
At Northshore Minds, we do not accept any insurance plans. Therefore, our TMS is private pay only. However, you may be eligible for some out-of-network benefits depending on your carrier.
13. How soon are benefits noticed?
It is widely observed that patients need 30 to 40 TMS sessions to derive the most benefit in the treatment of their depression symptoms. In clinical trials, 1 in 2 patients achieved significant relief of symptoms after four weeks of treatment and 1 in 3 experienced complete remission after six weeks of treatment. Some patients may experience results in less time, while others may take longer.
During the course of TMS Therapy, your TMS prescribing psychiatrist or doctor should consult with you to evaluate your progress, thus ensuring you receive the most benefits from TMS as soon as possible