The time needed for a patient to start seeing positive results differs from one patient to the other and is quite difficult to predict. Patients typically undergo daily TMS sessions, scheduled five days a week for 6 weeks. Most individuals who respond to this treatment begin to notice positive changes within a few weeks of starting their sessions. Some patients experience positive results earlier, while others may notice improvements towards the end of the sixth week of TMS treatment.

Both TMS and ECT use a machine to affect the brain as a means to treat severe depression. Electro-convulsive therapy (ECT) involves passing an electric current through the brain. This causes a generalized (grand mal) seizure. It requires a general anesthetic. While having ECT, patients may require inpatient care, and patients require someone to drive them to and from ECT treatments. ECT can cause short term memory loss for the period before and after each treatment session. Patients usually have 6-12 treatment sessions over three to six weeks.

TMS uses an electromagnetic coil to create an alternating magnetic field over the scalp. This magnetic field causes neurons to repeatedly fire. The repeated firing of these neurons is responsible for the anti-depressant and anti-anxiety effects of TMS.

TMS is an outpatient procedure that does not require an anesthetic, and patients can resume their normal life activity after the session.

Both TMS and ECT can lead to a rapid improvement in symptoms. Up to 70% of depressed patients who fail to respond to antidepressants respond to ECT and more then 60% of patients who fail to respond to antidepressants respond to TMS.

Some patients who fail to respond to ECT will respond to TMS and some patients who fail to respond to TMS will respond to ECT. ECT is still considered the best treatment for some patients with very severe depression, psychotic depression or catatonia.

TMS can be very effective in the treatment of depression. For over 20 years it has demonstrated the ability to improve depression symptoms in patients in research studies as well as under more real-world conditions. In one of the largest studies of patients treated with TMS for depression, around 60% of participants reduced their symptoms by at least 50% (responded) and around 30% of participants no longer met criteria for depression (remitted). This study did include some participants who had been treated with ECT to manage their symptoms, and they had equal chances to achieve improvement compared to people who had not had ECT in the past. TMS is effective in the treatment of obsessive-compulsive disorder (OCD) as well. Around 40% of participants in the landmark study for FDA (Food and Drug Administration) clearance achieved remission and around 60% of participants responded to treatment. This is just a sample of some of the illnesses that TMS has been demonstrated to effectively treat but there are other illnesses that are under investigation or approved in countries outside of the United States including PTSD, stroke rehabilitation, and chronic pain.

Dr. Fohrman will discuss with you the best way to administer TMS. The session lasts between 21 and 24 minutes depending on the protocol used. The standard number of TMS sessions is 36 - 5/week x 6 weeks followed by three-week taper - 3 per week, 2 per week and one more.

TMS delivers magnetic pulses to certain brain regions, producing changes in the activity of the brain cells. The frequency of pulse delivery influences whether brain activity is increased or decreased in the affected cells. This means that the effects of TMS treatment can be long lasting because it changes the patterns by which nerve cells and brain networks connect and communicate with each other.

Antidepressants work by modifying the actions of neurotransmitters (brain chemicals) or modifying neurotransmitter receptors. TMS induces small electrical currents in the brain which improve the connections between brain cells and increase the growth of brain cells. Treatment with antidepressants involves taking medications which are absorbed through the mouth, stomach and small intestine with possible side effects throughout the body. They can cause adverse effects such as gastrointestinal side effects, weight gain and can have an effect on sexual function (reduced sex drive and delayed ejaculation). Patients can also be allergic to antidepressants or other chemicals contained in the medication.

TMS does not involve the ingestion of chemicals, therefore, there are no systemic adverse effects. There is no impact on the digestive system, on sexual function, cognition and there are no allergic responses. The only side effect with TMS that is greater than 5% is transient site pain, headache which abates typically within the first week as patients desensitize to the treatment.

Antidepressants modify brain chemicals and receptors via an effect on protein synthesis, they can take between three to six weeks to work, while TMS has a faster onset of action. Studies show that in patients who have not responded to two or three antidepressants the response rate to the next antidepressant is 10-15%. If such patients are given TMS, the response rate is about 60%.

TMS is a well-tolerated treatment, the vast majority of patients can have TMS. People with non-removable metallic, ferromagnetic objects which is less than 30 cm from the treatment coil might not be suitable for TMS and should consult with their TMS prescriber if they have any of these items:

implanted electrodes

stimulators

aneurysm clips or coils

cochlear implants

stents in the head

metal fragments

TMS can still be given to people with certain types of stents and implants. People with implanted cardiac defibrillators cannot have TMS. Dental work including fillings/implants and piercings are not a contraindication for TMS.

It is advisable that you have regular follow-ups with your treating clinician after you respond to TMS. This should help to consolidate your recovery and in order to agree on a treatment plan if you start having depressive symptoms again. A lot of patients who respond to TMS maintain their improvement without having additional treatments for at least a year. However, there is a group of patients who might re-experience depressive symptoms after responding to TMS. For this group of patients, the treating clinician might decide to reintroduce TMS. These are sometimes called booster or rescue TMS and if you responded to your initial course of TMS it is highly likely you will respond to TMS again. In addition, if TMS is reintroduced sooner in the onset of depression, typically patients require fewer TMS booster sessions to stabilize their mood. Some patients might need to have what we call maintenance TMS sessions. This involves the patient having regularly scheduled TMS sessions once every few weeks in order to maintain mood stability. The frequency of these maintenance TMS sessions is usually decided after a discussion between the patient and their treating clinician while taking different factors into account. Your treating clinician might also suggest prescribing you medication (such as an antidepressant) to consolidate your recovery, deal with recurrence of symptoms or to protect you against relapsing.

In summary, a good proportion of patients who respond to TMS maintain their improvement without further interventions and for patients who re-experience depressive symptoms TMS can still help them to overcome these symptoms.

The time needed for a patient to start seeing positive results differs from one patient to the other and it is quite difficult to predict. Assuming that patients have daily sessions for five days every week the majority of patients who respond to TMS start seeing positive results after a few weeks of receiving the treatment. However, some patients report positive results sooner than this and other patients can have a delayed response that at times happens towards the end of the 6th week of TMS treatment.