TMS Therapy

TMS for the treatment of depression

What is TMS Therapy?

TMS Therapy or Transcranial Magnetic Stimulation treatment is for depressions that don’t respond to medications. Brain stimulation therapies are some of the most active areas of research in psychiatry. TMS treatment consists of non-invasive stimulation of one of the areas of the brain associated with a specific disease. The left Dorsolateral Prefrontal Cortex (DLPFC) is stimulated in depression and this causes the depression to improve.

Electromagnetic fields

If you recall middle school, you might remember experiments where you wrapped copper wire around a metal bar. And this turned the bar into an electromagnet. TMS Therapy uses a very sophisticated and powerful electromagnetic coil. A specialized computer controls the intensity and parameters of the treatments.

Electromagnetic pulse

The coil is operated at a given frequency where it is activated then turned off many times a second. This pulsating electromagnetic field goes through the skin and skull easily and interacts directly with the neurons in the brain. This pulse can either stimulate or inhibit the neurons, depending on the frequency of the pulse. 

How does TMS work?

Contrary to popular belief, the brain is able to change and adapt. After years of research, it is now very clear that the brain is capable of changing, something we call neuromodulation. Electromagnetic stimulation of the brain, with a pulsing electromagnetic field, is one of the many ways to effect neuromodulation.

How does TMS cause neuromodulation?

In TMS Therapy, the pulsing electromagnetic field causes the release of neurotransmitters and nerve growth factors. TMS also causes an increase in blood flow to that area. The connections between neurons, called synapses, increase in density after a series of treatments. The area stimulated reconnects to other areas nearby and even at a distance.

TMS Treatment of Depression

In depression, a PET Scan of the brain shows that the dorsolateral prefrontal cortex (DLPFC) is underactive. The limbic system is responsible for our moods. The DLPFC connects and influences the limbic system and therefore, indirectly controls our mood. The underactive DLPFC connection to the limbic system is not as strong in depressed people. The DLPFC becomes active again after TMS Therapy, as shown by a repeat PET Scan. And this correlates with improvements in depression.

TMS Therapy for other ailments

Other conditions such as anxiety, Obsessive-Compulsive Disorder, Post-Traumatic Stress Disorder and Traumatic Brain Injury can also be treated.

Who can benefit from TMS?

Health Canada and the FDA approve TMS Therapy in the treatment of treatment-resistant Major Depressive episodes. TMS Therapy is a first-line treatment for treatment-resistant depression as per the 2016 CANMAT guidelines.

Not everyone benefits

Every person is different and as such, results will differ from person to person. TMS therapy may be able to alleviate your symptoms of depression or help them disappear entirely. Typically, relieving depressive disorder symptoms may take several weeks of treatment.

Is TMS therapy safe?

Long term effects of exposure to TMS Therapy are not known. There are no significant short-term or long-term safety concerns associated with exposure to other devices such as MRI scanners, and therefore, it is unlikely that there are any long-term effects to getting TMS Therapy.

Side-effects

TMS Therapy does not have the side-effects of antidepressants. Some patients report fatigue in the hours after a treatment. TMS Therapy can cause headaches and scalp discomfort. TMS Therapy is well-tolerated and the risks of adverse events are minimal.

COMMON

  • Headache
  • Scalp discomfort at the site of stimulation
  • Tingling, spasms or twitching of facial muscles
  • Lightheadedness
  • Discomfort from noise during treatment
  • Changes in energy levels (increase or decrease)
  • Teary eye(s)

VERY RARE

  • Seizures (about a 4/50,000 chance)
  • Hearing problems
  • Hypomania/mania
  • Exacerbation of depressive symptoms
  • Nightmares/Vivid Dreams

What do I do if I’m interested?

If you or your healthcare provider has determined that TMS Therapy may be right for you, book a Free Assessment with our Registered Nurse.

Free assessment

During this assessment, we will screen for contraindications to TMS Therapy, as well as discuss your medical and psychiatric history and medications. The initial assessment acts to ensure that you are a suitable candidate for TMS Therapy. Any of your remaining questions or concerns can be raised at this time. Intake forms and a new patient informational packet will be provided.

What happens during the treatment?

Treatment is administered by a trained technician and overseen by a medical doctor. You will get a chance to familiarize yourself with the equipment and treatment procedure prior to starting the first session. During treatment, patients are fully conscious and able to read, listen to music, or talk with the provider. TMS therapy is an outpatient procedure which means that no hospitalization is required. The TMS therapy procedure itself is non-invasive and requires no anaesthesia.

First Day of Treatment

The intensity of the stimulus that will be delivered is determined by inducing a motor-evoked potential (i.e. causing movement or a twitch to occur) in the thumb muscle. You may feel a tingling or tapping sensation on the head. Scalp muscles may feel a little tense, during and a bit after the procedure. This is normal and may result in a minor headache. There may be some pain in the first 3 sessions so we stimulate at a slightly lower intensity so you can get used to it. Then we continue at the determined intensity.

Duration of Treatment

TMS treatment of depression is divided into 3 phases:

Phase 1 – The Acute Phase

In the Acute Phase, we aim to give you the maximum improvement of your depression. On average, patients require between 30 and 50 daily treatments, 5 days a week, for this phase. The actual number of treatments depends on the severity and duration of your illness and any complication. Factors that can complicate your illness are such things as having other diagnoses.

Phase 2 – The Stabilization Phase

The Stabilization Phase immediately follows and its goal is to maintain the gains you have achieved in the Acute Phase. The stabilization phase prevents the reappearance of the symptoms of the current episode. This phase consists of 1-3 treatments a week for 8-12 weeks.

Phase 3 – The Maintenance Phase

The third phase is the Maintenance Phase and will follow the second phase for some people. Not everyone needs the maintenance phase. The Maintenance Phase can be with medication alone or can include both TMS treatments and medication. This phase’s goal is to prevent a recurrence or a new episode over time. Many things factor into the decision to do maintenance. Some people will need maintenance for 3-5 years and others will need it for life. If you choose to have Maintenance TMS Therapy, you should get 1-2 treatments every 3-6 weeks.

Communication with Staff

It is important that you feel comfortable at HeadWay Clinic. Please feel free to discuss any concerns that you have, and to ask questions as they may arise. HeadWay Clinic staff members appreciate learning how we can help make your treatment experience as pleasant as possible.

Your last day of treatment

We use clinical scales and verbal report from the patient to determine the response to the treatment. At the end of the treatment, our medical staff will review with you your treatment and discuss ongoing needs and answer any outstanding questions.

Follow-Up

Our team wants to keep in touch with you after your treatments are finished.

  • We encourage regular follow-ups by phone or email.
  • We encourage you to call with your questions.

FAQ

Is TMS Therapy covered by OHIP?

No, it’s not yet covered by OHIP. In 2016 Health Quality Ontario (HQO) submitted a report to the Ministry of Health and Long Term Care and it recommended that TMS Therapy be a covered benefit of OHIP but the ministry never did anything with it. Recently, MOHLTC requested an updated report from HQO and Dr Gagnon was part of the expert panel advising them. We are hopeful that TMS will be covered in the next couple of years but we don’t know for sure.

Does insurance cover TMS Therapy?

Please contact your benefit or insurance provider to see if you qualify for full or partial coverage of TMS therapy. If you were involved in a motor vehicle accident, your insurance will likely cover it if it is necessary and reasonable. Blue Cross for Veterans Affairs and active Canadian Forces personnel will usually cover it for PTSD and Depression.

Is TMS Therapy available at all HeadWay Clinic locations?

Yes, it is!

Who should get TMS Therapy?

For it to be covered by most insurers who do cover it, a person has to have failed to get better on at least one antidepressant or could not tolerate the side-effects of antidepressants. If you pay out of pocket then it can also just be a personal choice to do TMS Therapy instead of medications.

Who is not a good candidate for TMS Therapy?

You can’t have any ferrous metal in your head or your eyes to be eligible for TMS. A titanium aneurysm clip is fine as it isn’t subject to magnetic forces. You can’t have a cochlear implant or pacemaker. In other words, if you can have an MRI, you can get TMS. If you suffer from a seizure disorder, you should not get TMS. For further information contact any one of our sites to get screened or if you have any questions.

Should I continue to take my antidepressants if I get TMS Therapy?

Most patients can continue their current antidepressant during TMS Therapy. Studies have shown that TMS treatments can “revive” an antidepressant that had lost most, if not all, it’s beneficial effects on a patient. That antidepressant can also be used to do the Maintenance Therapy if continuing with periodic TMS treatments is not possible.

Is TMS Therapy like electroshock treatments or ECT?

TMS therapy is not at all like Electro Convulsive Therapy (ECT). ECT is a treatment based on using electricity to induce seizures. It is very effective and in many cases, it is a life-saver. ECT requires anaesthesia and can have serious side-effects, including memory loss. It is only done in a hospital.

On the other hand, Transcranial Magnetic Stimulation uses magnetic pulses to non-invasively stimulate specific brain regions associated with major depressive disorder.
No seizures are required for the treatment to be effective, and they are a very rare adverse event (< 4/50000) that we avoid at all cost. TMS therapy is performed in our office, requires no anaesthesia, and has no systemic side effects.