Transcranial Magnetic Stimulation: A New Modality in the Treatment of Treatment-Resistant Depression
Dr. Mahmoud Okasha is a psychiatrist practicing in Norwich, CT. Dr. Okasha is a medical doctor specializing in the care of mental health patients. As a psychiatrist, Dr. Okasha diagnoses and treats mental illnesses. Dr. Okasha may treat patients through a variety of methods including medications, psychotherapy or talk therapy,... more
Transcranial magnetic stimulation is a fairly new modality to treat treatment-resistant depression. It was approved by the FDA in 2008 for the treatment of Major Depressive Disorder (MDD) that has not responded to antidepressants or for patients with MDD that cannot tolerate it.
Antidepressants consist of directing a focal magnetic field through a coil to the left Dorsolateral Prefrontal Cortex, a region in the brain that is involved with the mood (depression) the continuous stimulation of DLPFC. This will lead to stimulation of other parts of the brain namely the Limbic system which is also involved in modulating mood and consequently depression by increasing the neurotransmitters (chemicals in the brain) like Serotonin, Norepinephrine, and Dopamine, which are decreased in the depressed brain.
TMS is an efficacious treatment modality with no or very mild side effects as it is non-invasive (nothing is introduced into the brain) and nonsystemic (nothing is swallowed like medication) the rate of remission (disappearance and response (decrease in the incidence of symptoms by 50% of depressive symptoms) are higher with TMS than with any combination of medications given to treat TRD.
There are several devices currently on the market approved by the FDA and 2 types of Coils used:
1) The figure of 8 coils is the most common
2) The H coil or deep stimulation coil
They are both effective for this treatment. In 2019, the FDA approved a modified version of the H coil for the treatment of Obsessive-Compulsive Disorder (OCD).
A treatment session lasts anywhere between 11 minutes to 37.5 minutes and a course of treatment is about 36 sessions. The patient drives to the office and then sits in a very comfortable chair similar to a dentist chair and has the treatment while awake and aware with minor temporary side effects.
The main side effects are mild headaches that may last a few days and are easily controlled with Tylenol or Advil, and tingling in the scalp secondary to the magnetic stimulation. This again subsides within days as the scalp gets habituated to the stimulation.
Currently, there are numerous clinical researches studying the potential use of TMS for a variety of conditions like migraines, stokes, dementias, Fibromyalgia, chronic pain, ADHD, and substance abuse.
If you are interested in learning more about TMS, go to the website of the Clinical TMS Society.
M. Okasha MD, MRC, DPM, DLFAPA
Associate Clinical Professor, Yale School of Medicine
Medical Director Comprehensive Psychiatric Care
Norwich, CT 06360
P: 860-556-1508 F: 860-889-4606
