TMS: What is it and what does it treat?
Generally speaking, when we think of treatment for psychiatric conditions, it falls into three main categories:
While there are many options in the pharmacology arm and psychotherapy arm to treat various psychiatric conditions, there are fewer options in the neuro-modulation arm. Electro-convulsive therapy is one of the original forms of neuro-modulation. There is a lot of controversy related to ECT because of the need for anesthesia and possible side effects. Newer treatments using neuro-modulation are being developed using newer technology and better understanding of the neurobiological etiology of different psychiatric disorders.
Transcranial Magnetic Stimulation (TMS) is a new technology utilizing neuro-modulation that is being used in psychiatry to treat a variety of mental health concerns. It is currently FDA approved for treatment resistant depression in adults. Treatment resistant depression is defined as not responding to at least 3 adequate antidepressant trials. As more research is conducted and TMS is utilized more in practice, it will be important for primary care providers to have a basic understanding of this new treatment method to know when a patient should be referred for a consultation to consider TMS.
TMS and other newer forms of neuro-modulation are non-invasive and do not require anesthesia or sedation. TMS can be done in an outpatient setting. A typical treatment session lasts 20-40 minutes with sessions repeated over a course of 4-6 weeks. It is a method for neuro-modulation without generating a seizure (as in ECT) as a way to improve mood. TMS uses magnetic pulses to stimulate nerve cells in the brain to improve symptoms of depression. It uses magnetic coils to run energy across the cortex of the brain. The most commonly used protocol is to send a magnetic current across the left dorsolateral prefrontal cortex. It is described as a top-down approach to improve cortical control.
TMS is considered a relatively risk free intervention. Possible side effects include: temporary discomfort or pain, transient hearing loss, and lightheadedness or fainting. In rare cases, it can induce a seizure. It is being covered more and more by insurance companies as a treatment for major depression, particularly in cases where the depression is not responding to medication. Providers who are advocates for TMS are recommending it as a first line intervention for patients who want to avoid medication, although this has not been well studied and is not typically covered by medical insurance.
Research is being done to see if TMS can be an effective treatment for other psychiatric conditions, including the negative symptoms of schizophrenia, PTSD, Autism, and Bipolar Disorder. It is being studied as a treatment for neuropathic pain and migraines. Treatment approaches using neuro-modulation, especially as researchers better understand the specific brain areas and pathways involved in specific psychiatric disorders could be a large part of how mental health conditions are treated in the future.