What is Transcranial Magnetic Stimulation (TMS) therapy?
Transcranial magnetic stimulation (TMS) a comprehensively researched, internationally endorsed treatment for difficult to treat depression.
TMS is a non-invasive, mild brain stimulation technique that uses a treatment coil placed over the patients’ head to administer brief magnetic pulses to a specific location in the brain. When these pulses are administered in rapid succession, it is referred to as “repetitive TMS” or “rTMS”. TMS has been used to treat depression since the 1980s. It is an approved treatment in countries including New Zealand, Australia, United States, Canada, and the United Kingdom
When is it used?
Transcranial Magnetic Stimulation (TMS) is used to treat depression and can be offered when patients have not responded to trials of anti-depressant medications, prefer to try an alternative to medication, or cannot tolerate anti-depressant medication side effects. However, like pharmacotherapy, not all patients will respond to TMS treatment. TMS is not offered to all patients and it is important that a full psychiatric evaluation is undertaken for each patient to determine if TMS is a suitable treatment.
How does TMS work?
TMS produces changes in the activity of neurons in regions of the brain thought to be associated with mood regulation, such as the dorsolateral prefrontal cortex. The treatment coil produces a magnetic field that passes through the skull, into the brain and induces the brief activity of nerve cells. It is understood that TMS works by modifying and correcting activity levels in the depressed brain, either by increasing the activity in the areas that are underactive when people are depressed or reducing activity in areas that are overactive.
See the informative YouTube video below
Is TMS an approved treatment?
Yes, TMS is currently approved by the FDA (Food and Drug Administration), The Royal Australian and New Zealand College of Psychiatrists, and the Australian Therapeutic Goods Administration for the treatment of depression. Ongoing studies are currently researching the use of TMS as a treatment for pain, fibromyalgia, anxiety, tinnitus, obsessive-compulsive disorder, PTSD, and more.
What can I expect during a course of TMS?
At the completion of the psychiatric assessment, a TMS treatment protocol will be discussed and prescribed.
A typical course of TMS is 20 to 30 sessions over a course of several weeks. A single treatment takes 30 to 40minutes and is typically given over consecutive weekdays on an outpatient basis i.e. 5 treatments Monday to Friday. There are several TMS treatment protocols that the prescribing psychiatrist can consider. Theta burst (iTBS) protocol is an FDA-approved treatment for depression. Theta burst TMS can be considered when a patient needs to travel and wants to have more than one treatment a day (accelerated TMS treatment). The patient is alert and fully awake whilst receiving TMS, an anaesthetic is not required. TMS does not involve seizure induction or loss of consciousness, memory is not affected.
The treatment does not affect your ability to drive, and patients can return to work after treatment. TMS is usually well tolerated with minimal risk and any side-effects are usually mild and can be managed easily. The most common side effect is headache and discomfort from the coil. These are mild and usually, significantly reduce over the course of the treatment.
Who administers TMS?
TMS is always administered by a trained TMS technician. A nurse will always be present to monitor the patient during the treatment.
How long will it take to work?
This depends on the TMS treatment protocol prescribed. The most commonly prescribed protocol is “a course of at least 20 to 30 sessions over consecutive weekdays is recommended for therapeutic results although patients may notice changes occurring early. The doctor will review the progress of treatment throughout the TMS course.
What does TMS cost?
Each TMS session costs between $200 and $250 (depending on the TMS protocol prescribed).
In Australia, Medicare help to cover the cost of TMS treatment and in the United Kingdom it can be offered as a publicly funded treatment through the NHS (National Health Service). In New Zealand, private health insurance companies are reviewing TMS as a health treatment but currently do not cover the costs of treatment.
Do I need a referral to start TMS?
Yes, a referral from a psychiatrist or GP is required. An initial assessment with a Consultant Psychiatrist is required for a full psychiatric evaluation, assess the patient’s suitability for treatment and prescribe TMS. The cost of the initial psychiatric assessment may be covered by your Health Insurance company. Otherwise, the cost of the initial psychiatric assessment is $600 (including GST) which includes a comprehensive treatment plan and report. If TMS is recommended, the psychiatrist will organise an appointment to consent to treatment, carry a safety questionnaire and measure motor threshold.
Click on the links below for further articles on TMS.
- Professional Practice Guideline
- Clinical TMS Society Consensus Review
- Repetitive transcranial magnetic stimulation for treatment resistant depression
TMS Referral Form