Transcranial Magnetic Stimulation (TMS)

What is Transcranial Magnetic Stimulation - TMS?

Repetitive Transcranial Magnetic Stimulation, which is interchangeably called rTMS or TMS for short, is an evidence-based brain stimulation therapy that is used for the treatment of depression and many other mental illnesses. TMS uses magnetic pulses to stimulate specific areas of the brain. In depression, transcranial magnetic stimulation is typically used to target the left dorsolateral prefrontal cortex, which is approximately in the top left corner of the forehead. As the brain areas involved in the regulation of mood are interconnected, stimulation of one area of the brain, impacts all other interconnected areas positively. Through repetitive stimulation with rTMS over a typical acute course up to 35 sessions, we can achieve excellent results that are sustained well after the acute course is finished. There have been numerous studies showing excellent results in treatment resistant depression, where it is used to complement antidepressant treatment and psychological therapy. Unlike Electroconvulsive Therapy or ECT, the patient is fully alert and conscious throughout the procedure and the patient has no cognitive side effects. Also, as this involves stimulation of a specific area of the brain, the rest of the body is not exposed to the effects of the treatment unlike medications which can cause unwanted effects in other areas of the body.

Benefits of Transcranial Magnetic Stimulation - TMS

  • It is a highly effective treatment for moderate to severe and treatment resistant depression.

  • Most side effects are very mild and easily managed if they occur.

  • There are no cognitive side effects.

  • No sedation is required.

  • The treatment is non-invasive.

  • It can be used complementarily to antidepressant medications and psychological therapy.

Side Effects of TMS

  • Mild Headache

  • Mild Neckache

  • Mild twitching of underlying skin during the treatment.
    These side effects are usually a function of an awkward posture, incorrect coil placement and not yet being used to the nature of the treatment. These are usually resolved within the first few sessions if they do occur.

  • Seizures (very rare)
    The rare side effects usually occur in people who are already vulnerable to these conditions

Who is TMS for?

You may benefit from TMS if you have suffered from moderate to severe depression and have failed to recover after an adequate trial of at least two antidepressant medications from different classes and have had psychological therapy before. This includes people who have also tried and succeeded or failed with electroconvulsive therapy (ECT) and wish to try a different form of treatment. Repetitive Transcranial Magnetic Stimulation can also be used to treat people suffering from other mental illnesses such as treatment resistant auditory hallucinations in schizophrenia, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and other anxiety disorders without depressive symptoms. Whilst there are some positive studies in using rTMS with these conditions, the research is still new, and the evidence base is still developing. So, TMS for these conditions should probably be considered when all other treatments have failed. As a safety precaution, TMS is not available for people who have intracranial implants, those with epilepsy, and those with pacemakers. Presently, it is not available in our treatment centre for those under the age of 18 and those who are pregnant, but this may change in the future with further supportive evidence.  

How to access TMS?

We suggest that patients are assessed by their general practitioner or psychiatrist first in relation to their mental illness, and then referred to a TMS trained psychiatrist or facility for consideration for treatment. If the referral is accepted, the patient is then assessed in relation to their mental illness and suitability for TMS treatment. If suitable, an acute course of treatment is organised for a minimum of 20 sessions, up to 35 sessions (1 session per weekday). After completion of the acute course, there are also options for maintenance TMS treatment, which is tailored to the patients unique circumstances. Antidepressant and other medications will be continued during the TMS treatment and patients can and should continue to attend available individual and group psychological therapy.

 

How to see Dr Vijay Raj?

If you are concerned that either you or a loved one is troubled by a mental illness, please request a GP assessment. The GP can then refer to Dr Raj for further support as needed. The referral is then reviewed, and if appropriate, an appointment can be organised for the initial consult. Consults for Autism and ADHD assessments will require a few appointments for the assessments to be completed. Depending on the complexity, this may also be the case for other conditions as well. Waiting times and fees can be clarified with the practice where the consult is to occur.