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Transcranial magnetic stimulation is an exciting brain stimulation therapy that can often help people with treatment-resistant depression where nothing else has. What do you need to know?

While many people suffering from major depressive disorder will soon recover with the help of antidepressants, talk therapy, or both, not all do. An estimated 10 to 30 percent of depressed people do not get better with conventional approaches to treatment. These people have so-called treatment-resistant depression. This kind of depression poses quite the challenge for clinicians, while patients continue to live under the heavy shadow of a mental illness that just doesn't seem to be going anywhere. 

Treatment-resistant depression doesn't mean nothing further can be done, though. It does mean it's time for the "big guns"; treatment options only pulled out when necessary. Transcranial magnetic stimulation is one such option. 

What is transcranial magnetic stimulation?

Transcranial magnetic stimulation (TMS) is a fascinating, almost sci-fi sounding, approach to treating depression that falls under the "brain stimulation therapies" umbrella.

During a treatment, you sit down in a big, comfy, chair and a powerful magnet placed near your forehead delivers pulses that trigger electric activity in the regions of the brain known to be involved in making people depressed. In that sense, it sounds a little like electroconvulsive therapy. However, TMS sessions don't require general anesthesia, because they don't generally hurt — though patients may experience a bit of a tapping sensation. Transcranial magnetic stimulation exposes you to about the same amount of magnetic energy you'd receive if you had an MRI scan, and the treatment is considered very safe. 

The treatment itself is usually delivered on a tight schedule. Patients are likely to have to come in for sessions every day for a few weeks, and can expect the treatment to last somewhere between 20 and 50 minutes. The exact details vary depending on the device and protocol being used. 

Which depressed people might be a candidate for transcranial magnetic stimulation?

In accordance with guidelines laid out by the Clinical TMS Society, your doctor may recommend TMS as a treatment for you if you suffer from major depressive disorder and:

  • Haven't responded well to antidepressants or have severe side effects from taking antidepressants
  • Your depression is moderate to severe
  • You have suffered from repeated episodes of depression

You can keep taking antidepressants even if you attend transcranial magnetic stimulation sessions, and will almost certainly be advised to do so. 

Are there any side effects?

Yes, there can be, though many patients find TMS much more tolerable than electroconvulsive therapy. The most common complaints are headaches, which are temporary, and a shock-like sensation around the face and scalp as treatment is in progress. Some people feel a bit dizzy and light-headed after a session, and it is even possible to faint. The most serious potential side effect of transcranial magnetic stimulation is experiencing a seizure. 

We should also note that people who have experienced seizures in the past are not considered good candidates for transcranial magnetic stimulation. 

Is transcranial magnetic stimulation effective for depression?

Now that we have established what transcranial magnetic stimulation is, what the possible side effects are, and who might benefit from the treatment, you of course want to know how well TMS actually works in treating depression. Though different studies into the subject come up with different answers, one meta-analysis found that:

  • Transcranial magnetic stimulation is much more effective than "sham treatments" (a kind of placebo, but instead of taking a pill without active ingredients, the procedure is mimicked without actually "doing anything"). That is, 46.6 percent of the TMS group responded — meaning they experienced symptom relief — while only 22.1 percent of the sham treatment group did. 
  • Electroconvulsive treatment is actually more effective than TMS, but it has the downsides of being a feared treatment among some, and the potential to induce some tricky side effects, such as memory loss. Electroconvulsive treatment is also not available to everyone. TMS offers a very decent alternative. 
  • The effects of TMS may take a while to be noticeable, and continuing the treatment, alongside antidepressants, can yield very positive results even if you don't notice a difference right away. 
  • People who initially get better but then relapse into depression again have been shown to improve once they receive "maintenance" TMS treatments. 
All in all, somewhere between 50 and 60 percent of people with treatment-resistant depression have been found to benefit from transcranial magnetic stimulation. It is a pretty impressive option that holds the potential to finally liberate a large chunk of people from persistent depression, and as long as you are the right candidate, it may benefit you, too. 

A final word

If your doctor believes transcranial magnetic stimulation would benefit you, because you suffer from treatment-resistant depression, they will refer you by themselves if it is available in your area. People who have the feeling that TMS may be right for them do not, however, have to wait for this to happen — you can always mention that you have read about transcranial magnetic stimulation and are wondering whether it could help you. 

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