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TMS Therapy in Denver, CO

Up to 75% of TMS patients report a significant improvement in their symptoms within the first few weeks of treatment.

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Mental illness is the leading cause of disability in the U.S. and Canada among ages 15 to 44.1 Approximately 1 in 4 U.S. adults lives with a diagnosable mental disorder. In 2020, an estimated 14.8 million U.S. adults (8.4%) ages 18 or older and 4.1 million (17%) adolescents ages 12 to 17 had at least one major depressive episode with severe impairment in the past year.2 Mental illness can be debilitating, especially for those who show no signs of improvement after medication and psychotherapy.

What can be done for these common but serious conditions? Scientific discoveries have revealed new hope for chronic mental illness. Lack of activity in parts of the brain associated with mental illness, such as the prefrontal cortex, can be treated with electromagnetic stimulation. This treatment has been shown to especially help those with treatment-resistant depression. Clinical trials are also in various stages to treat bipolar disorder, obsessive-compulsive disorder, post-traumatic stress disorder, smoking cessation, and schizophrenia.3

What is TMS?

The treatment is called Transcranial Magnetic Stimulation (TMS). It uses electromagnetic fields to normalize brain activity by stimulating neurons associated with mental illness. During TMS, an electromagnetic coil is placed on the patient’s head. A small electric current runs through the coil and generates a magnetic field, which stimulates a small area of brain cells that are commonly associated with mood and emotion. As the magnetic current passes through the skull and into the brain, this induces brief activity of brain cells underlying the treatment coil.

This process improves how the mood center neurons function over time.3,4,5,6
Approximately 50% to 60% of patients with treatment-resistant depression experience an improvement with TMS treatment. About one-third of these individuals experience a full recovery, meaning that their symptoms go away completely. Some symptoms recur with time; however, most maintain recovery after treatment for more than a year. Further treatment is available for those with recurring symptoms.4 TMS is done in an office setting while the patient is awake and does not require needles, surgery, or anesthesia. The treatment does not cause significant discomfort and can work alongside current medications. Since nothing except pure energy enters the body, TMS treatment is free of the side effects of antidepressant medications.

Psychiatric Consultation Picture

How Does It Work?

The first Transcranial Magnetic Stimulator machine was created in 1985 by Dr. Anthony Barker and colleagues to research healthy neuro pathways in the brain. A few years later, scientists discovered from brain scans that certain underactive parts of the brain were associated with depression. In 1995, researchers placed the transcranial magnetic stimulator on the underactive parts of the brain, hoping to increase neural activity and improve mood. It worked! After thirteen years of clinical trials and research, TMS treatment was approved in 2008 by the U.S. Federal Drug Administration. Since then, further studies are still needed to understand the exact mechanisms behind TMS, since the ideal intensity and frequency varies with each patient.8,9

The technical function of a TMS machine starts with an electrical current (about 5000 amps), which rapidly flows through a circuit and a copper-wire coil. This causes a magnetic field perpendicular to the electric current, which is similar to the magnetic field created by a magnetic resonance imaging machine (MRI). When the copper coil is held near the patient’s head, the magnetic fields reach about two to three centimeters into the brain directly beneath the coil to produce very small electrical currents. These electrical currents activate cells in the brain which are thought to release neurotransmitters that affect mood, including serotonin, norepinephrine, and dopamine. Since depression is thought to be caused by an imbalance of these neurotransmitters, TMS can restore balance after several treatment sessions, alleviating depressive symptoms.

Types of TMS

Various types of TMS treatments have been developed based on the magnetic frequency, depth, coil type, and session length. All have been shown to be safe methods of treating depression. Three main types are used in current treatment. Consult with your mental health professional about which type is best for you. The three main types of TMS treatments include:

Repetitive Transcranial Magnetic Stimulation (rTMS)

rTMS delivers repeated magnetic pulses to one brain area, usually 3000 pulses at 10 Hz strength over 37.5 minutes. The pulses reach a depth of about 0.7 to 1.5 centimeters into the brain near the forehead in the dorsolateral prefrontal cortex. This area of the brain is responsible for executive and cognitive functions, like abstract reasoning, working memory, intention formation, goal-directed action, attention control, and negative affectivity. A figure-8 coil is used inside a wand to apply the repeated magnetic field vertically onto a narrow area of the forehead.

Theta Burst Stimulation (TBS)

TBS is a type of rTMS that uses short magnetic bursts in higher frequencies that more closely resemble natural patterns of neural activity in the brain. A 3-pulse burst at 50Hz frequency is repeated at 5 Hz intervals, or intermittently with a 2-pulse burst every 10 seconds for about 190 seconds, resulting in 600 total pulses. TBS can also be delivered over 40 seconds for a total of 600 total pulses. Because of the high frequency, each treatment usually lasts only 40 to 190 seconds. Multiple treatments can be administered in one day and repeated over several days.

Deep Transcranial Magnetic Stimulation (dTMS)

dTMS delivers a single magnetic field in a continuous stream, not in pulses like rTMS, over a 20-minute period. It reaches a depth of up to 3.5 centimeters in the brain near the forehead called the subgenual anterior cingulate cortex, which is responsible for the reward and motivation function. An H1-coil is used inside a helmet worn by the patient to apply the magnetic field radially across the forehead surface in order to reach deeper into the brain.

What Happens During Treatment?

TMS treatments are done in an office setting by a mental health professional. Before beginning treatment, the patient is asked to remove any magnetic-sensitive objects, like jewelry or credit cards, then sit comfortably in a treatment chair. Ear plugs are worn by the patient for comfort and hearing protection since the TMS machine produces a loud clicking sound with each pulse, much like an MRI machine. Several measurements are calibrated to ensure the correct location and power threshold are reached for each patient.

For rTMS, the wand with the coil inside is brought to rest above the patient’s forehead. For dTMS, a cushioned helmet with the coil inside is placed onto the patient’s head. During rTMS treatment, the patient hears a series of clicking sounds and may feel a tapping sensation on the head while the machine delivers the magnetic pulses. Some patients may feel a tingle in the muscles of the scalp, jaw, or face during the procedure. Each rTMS session usually lasts 30-60 minutes, while dTMS sessions usually last 20 minutes. Treatments are usually required every weekday for 4 to 6 weeks, depending on the patient’s reaction to treatment. The patient remains awake through the whole process and can resume regular daily activities immediately after treatment. Changes are anticipated within 2 to 4 weeks.6,7,12

Does TMS Really Help?

Study after study confirms the TMS improves depression symptoms. After just six weeks of treatment, many people with treatment-resistant depression have found long lasting relief. Up to 82% of patients find significant relief from depression symptoms after TMS treatment. Up to 63% of patients have no further depressive symptoms after one course of treatment. Related mental illnesses have also been improved by TMS treatments. Anxiety decreased by 33%, OCD by 30%, and 39% for PTSD. Relief from depression after TMS treatment has proven effective for up to a year, but more studies are needed to measure long-term benefits.13,14

When compared to commonly prescribed medications for depression (SSRIs), TMS is clearly superior. These medications have an average 27.5% success rate, or lower for those with treatment-resistant depression, and an average 4-to-8-month trial period to find the right medication. In addition, medications have more significantly more side effects than TMS treatment. An average of 20%-40% of all depressed patients remain chronically depressed with antidepressants and psychotherapeutic interventions 13,14 One study indicated that rTMS is twice as effective at improving symptoms of major depression than antidepressant medications and talk therapy.15

Is TMS Right for Me?

TMS is a unique treatment for people with mild to moderate treatment resistance and medication intolerance. TMS was originally approved by the FDA in 2008 to help people with Major Depressive Disorder (MDD) who have not responded to previous treatments; however, TMS is also being studied to help relieve other mental illnesses. Before beginning any treatment, consult with your mental health professional about what might work for you. Each person is different, and what works for one may not work for another. TMS patients usually have the following conditions:4,7,12

  • Current diagnosis of depression
  • Some history in current or former trials of psychotherapy
  • Inability to respond to traditional therapy and medications

TMS treatments are not recommended for patients with the following conditions:7,12

  • A history of seizures
  • Non-removable metal plates or implants in their head (except braces and tooth fillings)

What are the Possible Side Effects of TMS?

TMS has proven to be a safe, well-tolerated treatment; however, it can cause some mild side effects, including:7,16

  • Headache
  • Scalp discomfort at the site of stimulation
  • Tingling, spasms, or twitching of facial muscles
  • Lightheadedness

Seizures are described as a possible side effect but are extremely rare. In the most recent clinical trial involving over 10,000 treatments, no seizures were reported. 7 Only 12 cases were reported from 1985 to 2003.9 Other rare but serious side effects include:

  • Mania, particularly in people with bipolar disorder
  • Hearing loss if there is inadequate ear protection during treatment

Get TMS Therapy in Colorado at Mind Spa Denver

TMS treatment for depression is offered at Mind Spa. Our licensed therapists and medical professionals are dedicated to providing patients with safe and effective mental health treatment that teaches them how to properly heal their symptoms. Contact Mind Spa today or call (720) 822-3838 to learn more about your personalized treatment options.

References

1 World Health Organization (2020). Depression. https://www.who.int/news-room/fact-sheets/detail/depression 

2 National Institute of Mental Health. (n.d.). 2020 NAMHC workgroup on drug development. https://www.nimh.nih.gov/about/advisory-boards-and-groups/namhc/reports/2020-namhc-workgroup-on-drug-development 

3 Stern, A. P. (2020, October 27). Transcranial magnetic stimulation (TMS): Hope for stubborn depression. https://www.health.harvard.edu/blog/transcranial-magnetic-stimulation-for-depression-2018022313335 

4 Retreat Behavioral Health. dTMS vs rTMS: Deep TMS vs repetitive TMS. https://www.retreatbehavioralhealth.com/blog/dtms-vs-rtms/ 

5 Active Recovery TMS. (n.d.). The differences between deep TMS and repetitive TMS: A guide.

 https://activerecoverytms.com/the-differences-between-deep-tms-and-repetitive-tms-a-laymans-guide/ 

6 Johns Hopkins Medicine Psychiatry and Behavioral Sciences. (n.d.). Frequently asked questions about TMS. https://www.hopkinsmedicine.org/psychiatry/specialty_areas/brain_stimulation/tms/faq_tms.html 

7 University of Michigan Department of Psychiatry. (n.d.). Repetitive transcranial magnetic stimulation. https://medicine.umich.edu/dept/psychiatry/programs/neuromodulation/repetitive-transcranial-magnetic-stimulation 

8 Spielberg, B. (2020, August 18). TMS and Brain Health. https://www.tmsbrainhealth.com/which-type-of-tms-is-best-comparing-deep-rtms-vs-rtms-vs-neurostar/ 

9 Brain Center TMS. (n.d.). Transcranial magnetic stimulation: An effective noninvasive therapy. https://braincentertms.com/what-is-transcranial-magnetic-stimulation/ 

10 Mishra, B. R., Sarkar, S., Praharaj, S. K., Mehta, V. S., Diwedi, S., & Nizamie, S. H. (2011). Repetitive transcranial magnetic stimulation in psychiatry. Annals of Indian Academy of Neurology, 14(4), 245–251. https://doi.org/10.4103/0972-2327.91935

11 UNC School of Medicine Psychiatry. (n.d.). How does TMS Work? https://www.med.unc.edu/psych/patient-care/interventional-psychiatry/tms/how-tms-works/ 

12 Cleveland Clinic. (2018, June 28). Transcranial magnetic stimulation (TMS). https://my.clevelandclinic.org/health/treatments/17827-transcranial-magnetic-stimulation-tms 

13 Spielberg, B. (2020, August 18). What is the success rate of TMS therapy? TMS & Brain Health. https://www.tmsbrainhealth.com/tms-therapy/ 

14 Success TMS. (2021, November 16). Does TMS work? The latest TMS success rates. https://successtms.com/blog/is-tms-effective 

15 UC San Diego Health Behavioral and Mental Health Care. (n.d.). Transcranial magnetic stimulation (TMS) for depression. https://health.ucsd.edu/specialties/behavioral-mental-health/depression-treatment/Pages/tms.aspx

16 Mayo Clinic. (2018, November 27). Transcranial magnetic stimulation. https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625

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