People with depression can live with symptoms for long periods of time before finding a treatment that works. Failure around depression treatments can be a result of the drug-resistant nature of the depression itself, adverse side effects to medication or poor medication adherence. For patients who are unable to find relief through pharmacology, there is still hope. Transcranial magnetic stimulation (TMS)1 is a viable option to either replace or couple with medication and is a noninvasive treatment that utilizes repeated magnetic pulses to safely and effectively regulate neural activity related to various mental health conditions. This specific treatment has been shown to help people with treatment-resistant depression.2

There are currently 2 kinds of TMS available as a form of therapy: 1) Traditional transcranial magnetic stimulation and 2) Deep transcranial magnetic stimulation, also known as deep TMS. While they share certain similarities, each holds its own unique attributes.

Behind the Technology: How Does TMS Work?


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TMS functions because of Faraday’s law of induction,3 which describes the basic interaction between magnetic fields and electric currents. The human body communicates through the central nervous system, which utilizes electrical currents running through neurons in the body to trigger muscle contractions and other activity. Magnetic fields can, if properly directed and with appropriate force, affect neural activity in the brain by inducing an inverted electric current, much like running an actual current on the surface of the brain. The result is a change in the polarization of neurons in the affected area of the brain, causing nerve cells to either become more excitable, or less excitable.

Utilizing the same strength as an (MRI) machine, a magnetic coil is held over the scalp, running a field of magnetic energy over the scalp and into the brain. By targeting specific portions of the prefrontal cortex, TMS aims to reduce and even eliminate depressive symptoms. However, some TMS technology is limited in its reach and efficacy. That is where different forms of TMS come into play.

Traditional TMS vs Deep TMS: What’s the Difference?

Both traditional TMS and deep TMS have been shown to be safe, well-tolerated, and effective methods of treating depression. The differences between the two include stimulation depth, coil type, and the length of the session.

Depth and Targeting

Traditional TMS uses a figure-8 coil, while deep TMS uses a patented H-coil held inside a padded helmet. While the magnetic pulses activated by traditional TMS only reach a depth of 0.27” (0.7 cm), deep TMS technology manages to reach a significant sub-threshold of 1.25” (3.2 cm).4 Deep TMS also utilizes a significantly wider field of stimulation compared with that of traditional TMS.

According to recent studies,5 deep TMS is clinically proven to safely stimulate deeper and wider ranges of the brain, especially treatment-resistant depression and treatment-resistant obsessive compulsive disorder (OCD).

FDA Clearance

Traditional TMS received FDA clearance to treat depression in 2008. Deep TMS has received 3 FDA clearance indications. Its first FDA clearance was for the treatment of depression in 2013,6 followed by FDA clearance for OCD in 2018.7 Deep TMS also became the first TMS system to receive FDA clearance in the addiction space,8 for smoking addiction in 2020.

In addition to receiving a clearance status from the FDA, deep TMS also received the European Conformité Européenne (CE) certification mark for several other conditions,9 indicating that deep TMS was found to conform to the safety, health, and environmental standards of products sold within the European Economic Area (EEA). Deep TMS has received the European CE mark for a wide range of mental health and neurological conditions including depression, OCD, Alzheimer disease, autism spectrum disorder, bipolar disorder, chronic pain, multiple sclerosis, Parkinson disease, post-stroke rehabilitation, post-traumatic stress disorder, negative symptoms of schizophrenia, and smoking addiction.

Effectiveness

As each treatment uses different equipment and reaches different depths and widths of direct stimulation, traditional TMS and deep TMS have been shown to produce different levels of effectiveness in treating a variety of patients and their symptoms. A study published in the Journal of Psychiatric Research showed that patients with moderate to severe baseline depression achieved significantly higher response rates10 when treated with deep TMS and medication, when compared with traditional TMS and medication, or medication alone.

The Importance of Identifying Differences in TMS

During a time when there are heightened cases of mental illness,11 it is essential to acutely understand alternative solutions such as TMS, and how each treatment can influence patient outcomes and experiences. In addition to offering patients the option for a noninvasive treatment like TMS, it is also our responsibility to elevate education through every means possible so patients know not to lose hope when they find themselves in an unsuccessful treatment cycle. Health is personal, and their treatment — even if it is TMS treatment — must be made personal as well.

Dr Rodriguez is the founder and medical director of the Delray Center for Healing in Delray Beach, Florida. The Delray Center uses an integrative wellness approach, including individual and group psychotherapy, transcranial magnetic stimulation, psychiatric medication management, as well as holistic elements, such as exercise therapy, acupuncture, massage, and nutritionist counseling. Dr Rodriguez completed psychiatric training at the University of Miami, where he served as chief resident.

References

  1. Transcranial Magnetic Stimulation. Mayo Clinic. Assessed May 10, 2021. https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625
  2. Can You Overcome Treatment-Resistant Depression? BrainsWay. Assessed May 10, 2021. https://www.brainsway.com/knowledge-center/overcome-treatment-resistant-depression/
  3. Magnetic Flux, Induction, and Faraday’s Law. Physics Libre Texts. Updated November 5, 2020. Assessed May 10, 2021. https://phys.libretexts.org/Bookshelves/University_Physics/Book%3A_Physics_(Boundless)/22%3A_Induction_AC_Circuits_and_Electrical_Technologies/22.1%3A_Magnetic_Flux_Induction_and_Faradays_Law
  4. Ginou A, Roth Y, Zangen A. Comparison of superficial TMS and deep TMS for major depression. BrainsWay. Assessed May 10, 2021. https://www.brainsway.com/knowledge-center/comparison-of-superficial-tms-and-deep-tms-for-major-depression/
  5. Cocchi L, Zalesky A, Nott Z, Whybird G, Fitzgerald PB, Breakspear M. Transcranial magnetic stimulation in obsessive-compulsive disorder: a focus on network mechanisms and state dependence. Neuroimage Clin. 2018; 19: 661–674. doi:10.1016/j.nicl.2018.05.029
  6. BrainsWay Receives FDA Clearance. BrainsWay. Published online in 2013. Assessed May 10, 2021. https://www.brainsway.com/news_events/brainsway-receives-fda-clearance/
  7. BrainsWay Receives First Ever FDA Clearance of a Non-Invasive Device for Treatment of Obsessive Compulsive Disorder. BrainsWay. Published online August 19, 2018. Assessed May 10, 2021. https://www.brainsway.com/news_events/brainsway-receives-first-ever-fda-clearance-of-a-non-invasive-device-for-treatment-of-obsessive-compulsive-disorder/
  8. BrainsWay Receives FDA Clearance for Smoking Addiction in Adults. BrainsWay. Published online August 24, 2020. Assessed May 10, 2021. https://www.brainsway.com/news_events/brainsway-receives-fda-clearance-for-smoking-addiction-in-adults/
  9. A Platform for Mental Health Treatment. BrainsWay. Assessed May 10, 2021.  https://www.brainsway.com/our-treatments/
  10.  Filipčić I, Filipčić IS, Milovac Z, et al. Efficacy of repetitive transcranial magnetic stimulation using a figure-8-coil or an H1-Coil in treatment of major depressive disorder; A randomized clinical trial. J Psychiatr Res. 2019 Jul;114:113-119. doi:10.1016/j.jpsychires.2019.04.020
  11. Reinert M, Nguyen T, Fritze D. The State of Mental Health In America. Mental Health America. Published online October 20, 2020. Assessed May 10, 2021. https://mhanational.org/issues/mental-health-america-printed-reports

This article originally appeared on Psychiatry Advisor



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