Transforming Depression Care with Transcranial Magnetic Stimulation (TMS)

Dr. Ruchita Agrawal is the Associate Chief Medical Officer for Adult Services at Seven Counties Services. Her role is pivotal in enhancing the quality and accessibility of mental health and addiction care. Dr. Agrawal is an Assistant Professor at the U of L Department of Psychiatry, involved in clinical as well as research work.  She is the current president of the Kentucky Psychiatric Medical Association.

As a board-certified adult psychiatrist with 15 years of experience, I have seen firsthand the transformative impact of various treatments for Major Depressive Disorder (MDD). However, one treatment stands out for its effectiveness, safety, and ability to improve lives in a remarkably short timeframe: Transcranial Magnetic Stimulation (TMS). At Seven Counties Services, where I’ve been practicing for over 12 years, TMS is changing the landscape of care for patients with treatment-resistant depression. This article aims to introduce TMS as a life-changing tool for managing MDD to healthcare professionals.

What is TMS and How Does It Work?

TMS is a non-invasive treatment that uses magnetic pulses to stimulate underactive regions of the brain, particularly the left prefrontal cortex, an area linked to depression. These pulses activate nerve cells, promote neurogenesis (the formation of new nerve cells), enhance neuroplasticity, and modulate neurotransmitters such as serotonin and norepinephrine.

Unlike antidepressant medications, which can take six to eight weeks to show significant effects, TMS directly targets brain activity and often leads to remission within six weeks of treatment. The remission rates with TMS are significantly higher than with medications. Many patients report improvements as early as their second or third session, experiencing reduced depressive symptoms and improved functionality. This rapid and direct stimulation sets TMS apart as an innovative alternative to traditional therapies.

The Treatment Process

TMS involves 36 sessions over six to eight weeks, typically administered Monday through Friday. The process begins with a mapping session using neuro-navigation technology to identify the exact area of the brain requiring stimulation. Once mapped, subsequent sessions involve placing a treatment coil on the targeted region for 18-20 minutes of magnetic stimulation. During this time, patients remain awake and can engage in activities such as reading, listening to music, or simply relaxing.        

The treatment is non-invasive and does not require anesthesia, which makes it vastly different from electroconvulsive therapy (ECT). Patients can drive themselves home after each session and resume their daily routines with minimal disruption.

Side Effects and Safety

TMS is well-tolerated by most patients, with the most common side effect being mild headaches due to scalp tapping. Some patients may also hear a clicking sound from the magnetic pulses, which can be managed with earplugs. Unlike ECT, TMS does not require sedation, and its non-invasive nature ensures a lower risk profile. However, TMS is contraindicated for individuals with metallic implants in the head or a history of seizure disorders.

Identifying Suitable Candidates

TMS is FDA-approved for individuals with treatment-resistant MDD—patients who have not achieved remission after trying at least two antidepressants. It offers a vital option for those who have experienced partial responses or intolerable side effects from medications. For healthcare professionals, evaluating a patient’s medication history and ruling out contraindications is essential when considering TMS as a treatment option.

The Transformative Impact of TMS

From my experience, TMS is not merely a treatment—it is a path to reclaiming lives. Patients often describe feeling as though they are emerging from a dark cloud, regaining energy, improving relationships, and performing better at work. The feedback has been overwhelmingly positive, with patients consistently praising the simplicity and effectiveness of the process.

As mental health professionals, it is our responsibility to explore and adopt evidence-based treatments that can offer our patients the highest chances of recovery. TMS has revolutionized my approach to treating depression, and I encourage my colleagues to consider it as a primary option for suitable patients. This non-invasive, life-changing treatment represents the future of mental health care.