Transcranical Magnetic Stimulation (TMS) Therapy

Transcranial Magnetic Stimulation (TMS)

TMS is a medication-free approach to treating treatment-resistant depression. In emitting targeted magnetic pulses to the prefrontal cortex of the brain, we are able to stimulate networks that regulate mood. The patient is fully conscious and able to resume their daily activities immediately following their treatment.

The treatment protocol typically consists of approximately 36 sessions, lasting 20 minutes each, spread over a period of 6-8 weeks.
The sensation of TMS is likable to that of a woodpecker tapping on your head. It is common to find the initial few sessions startling due to the unfamiliar stimulation of the scalp nerve cells in this specific manner. However, these nerve cells possess the ability to rapidly adjust to the sensation. We have observed that by the second week of treatment, issues of this nature are seldom encountered. It is important to note that this experience should not be painful, and if it causes discomfort, we will make several adjustments until you feel at ease.
First, Dr. Cao will map and measure your personal treatment cap. This cap will be worn each session, ensuring precise targeting of the treatment area consistently. Next, using a tester coil, Dr. Cao will administer targeted pulses to your motor cortex, responsible for controlling your right hand. By determining the minimum energy required to induce finger twitches, we gather the exact energy threshold necessary to activate your pathways. The treatment coil will then be placed as determined, and a single set of low-energy pulses will be administered.
TMS is an exceptionally safe and standardized treatment, to the extent that a physician is not needed to conduct subsequent treatments following the initial mapping. During your first session, we will collaboratively establish your treatment plan, and my team of skilled and knowledgeable technicians will administer your treatments according to the precise protocol we have tailored specifically for you. Dr. Cao is always on-site throughout treatment and would review your progress at least weekly.
TMS is effective, regardless of the machine. Numerous research studies have been performed to determine if certain types of TMS or specific machine manufacturers yield superior results. However, no significant variations have been discovered. TMS appears to be efficacious regardless of the specific delivery method employed.
Dr. Cao has worked extensively with both deep and focal TMS through her hospital-based work over the years. While deep TMS may simulate a larger and deeper region of the brain, Dr. Cao’s experiences suggest figure 8 coils used in focal TMS (such as the system chosen for EMK) can offer a lot more flexibility and thus personalization of treatment location and protocols, more precise targeting of the coil to the intended treatment location, and is associated with less side effects and more patient comfort during treatment.

Transcranial Magnetic Stimulation (TMS): What is it and how does it work?

TMS facilitates gradual, incremental changes within the brain, leading to a more substantial remission of depressive symptoms. Change is not immediate. Although frustrating, it promotes longevity of relief. A response is usually seen by session 20, although it varies. Certain individuals may experience the benefits of TMS as early as the first week, while others notice a gradual accumulation of small improvements such as increased energy and enhanced concentration. By treating the whole person through an integrative approach, however, our patients do tend to show sooner, higher, and more lasting response.
No, it is not advisable to discontinue any antidepressant medication. It has been demonstrated that TMS therapy yields optimal results when combined with at least one antidepressant. Additionally, the use of antidepressants appears to contribute to the maintenance of TMS benefits even after the completion of treatment. Our objective is to minimize any alterations during the course of treatment.
We work with the following insurances: Aetna/Meritain, Anthem, Beacon Health Options, Blue Cross Blue Shield/Blue Benefit, Cigna/Evernorth, Harvard Pilgrim, Humana, Medicare/Medicaid, Optum, Tufts, United Healthcare
In a large multisite naturalistic, observational study (Carpenter et al. 2012), TMS was found to improve depression significantly in 58 percent of patients and provide complete remission of symptoms in 37 percent of patients.
At EMK, we see response rate closer to 100% and remission rate closer to 80% by supplementing TMS with other personalized treatment such as focused psychotherapy, coping skill training, nutraceuticals, etc.

A patient’s perspective with TMS