TMS For Depression - Basic Info: How Well TMS Works, Protocols, Side Effects

This video is a basic guide to Transcranial magnetic stimulation, or TMS, which is a therapeutic method for the treatment of depression.

During TMS therapy magnetic impulses are given to the brain to modulate activity. For the first time FDA approved in 2008, TMS has been used since almost 15 years to treat depression. How well does it work? Which protocols are there? What are the side effects? And what are current developments.

Research suggests that TMS is effective in approximately 50-60%. There are three FDA approved protocol. First, there is high frequency repetitive TMS (rTMS) over the left prefrontal cortex. Second there is deep TMS. Third there theta burst stimulation over the left prefrontal cortex. Machines from various companies are FDA approved to run these protocols.

The safety profile of TMS is very good compared to other methods. It is non-invasive and there is no evidence in research for long term structural damage. However, side effects may occur such as head aches, aggitation, fatigue or ringing in the ears. We provide tips how these side effects can be minimized.

Currently research focuses on individualizing TMS to a person's unique brain activity profile. This will hopefully increase response rates of TMS in the future. If you have any question, don't hesitate to leave them in the comments.

Time stamps
0:00 Introduction
0:48 TMS effectiveness and protocols
3:44 Side effects of TMS
5:15 Accelerated TMS and individualized TMS using brain scans

References/resources:
Overview of FDA approved TMS protocols:
Cohen, S. L., Bikson, M., Badran, B. W., & George, M. S. (2021). A visual and narrative timeline of US FDA milestones for Transcranial Magnetic Stimulation (TMS) devices. Brain stimulation, 15(1), 73–75. Advance online publication. doi.org/10.1016/j.brs.2021.11.010

Clinical trial on rTMS:
O'Reardon, J. P., Solvason, H. B., Janicak, P. G., Sampson, S., Isenberg, K. E., Nahas, Z., et al. (2007). Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biological psychiatry, 62(11), 1208–1216. doi.org/10.1016/j.biopsych.2007.01.018

Clinical trial on deep TMS:
Levkovitz, Y., Isserles, M., Padberg, F., Lisanby, S. H., Bystritsky, A., Xia, G., Tendler, A., et al. (2015). Efficacy and safety of deep transcranial magnetic stimulation for major depression: a prospective multicenter randomized controlled trial. World psychiatry 14(1), 64–73. doi.org/10.1002/wps.20199

Clinical trial on theta burst stimulation:
Blumberger, D. M., Vila-Rodriguez, F., Thorpe, K. E., Feffer, K., Noda, Y., Giacobbe, P., et al. (2018). Effectiveness of theta burst versus high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D): a randomised non-inferiority trial. Lancet, 391(10131), 1683–1692. doi.org/10.1016/S0140-6736(18)30295-2

SNT protocol:
Cole, E. J., Phillips, A. L., Bentzley, B. S., Stimpson, K. H., Nejad, R., Barmak, F., et al. (2022). Stanford Neuromodulation Therapy (SNT): A Double-Blind Randomized Controlled Trial. The American journal of psychiatry, 179(2), 132–141. doi.org/10.1176/appi.ajp.2021.20101429

Risk of seizure:
Taylor, J. J., Newberger, N. G., Stern, A. P., Phillips, A., Feifel, D., Betensky, R. A., & Press, D. Z. (2021). Seizure risk with repetitive TMS: Survey results from over a half-million treatment sessions. Brain stimulation, 14(4), 965–973. doi.org/10.1016/j.brs.2021.05.012

See also:
Cotovio, G., Boes, A. D., Press, D. Z., Oliveira-Maia, A. J., & Pascual-Leone, A. (2022). In Older Adults the Antidepressant Effect of Repetitive Transcranial Magnetic Stimulation Is Similar but Occurs Later Than in Younger Adults. Frontiers in aging neuroscience, 14, 919734. doi.org/10.3389/fnagi.2022.919734

Harvey, S. A., Tendler, A., DeLuca, M., Stehberg, J., Naimark, R., Schmidt, D., et al. (2020). Deep TMS for major depression, interim post-marketing analysis of 1040 patients. Brain Stimulation, 13(6), P1858. doi.org/10.1016/j.brs.2020.06.068

TMS video material: The Brainclinics Foundation (Youtube)

Narrated by: Miles Wischnewski

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