The idea of placing a special device against your head, flicking a switch and resetting your mood or zapping away unpleasant symptoms may sound like the stuff of science fiction. But with the growing use of repetitive transcranial magnetic stimulation, a noninvasive technique that uses magnetic pulses to stimulate targeted areas of the brain, this scenario is becoming a reality. Approved by the Food and Drug Administration a decade ago to treat major depression that hasn’t responded to antidepressants, TMS is now being used or studied for a host of other ills, from anxiety and obsessive-compulsive disorder to autism, dementia and chronic pain.
“Before I had the treatment, the pain was severe and walking was difficult,” recalls a Los Angeles physician who was getting TMS therapy for depression in 2014 when she experienced a debilitating flare-up of nerve pain in her groin, a complication from an earlier surgery. Her doctor suggested TMS to treat her pain, aiming the pulses in such a way that they would inhibit pain signaling in her sensory cortex. “Scientifically, it made sense to me,” the physician-patient says. “I felt remarkably better after each session — 80 percent of my pain was gone, just like that.”
[See: Am I Just Sad — or Actually Depressed?]
The common denominator behind the seemingly disparate disorders that may be treatable with TMS — which also include post-traumatic stress disorder, Parkinson’s disease, stroke, attention deficit hyperactivity disorder, chronic migraines, traumatic brain injury, tinnitus (aka ringing in the ears) and multiple sclerosis — is that they’re disorders of brain network function. “The brain is an electric organ,” explains Dr. Joan Camprodon-Gimenez, director of the division of neuropsychiatry and neuromodulation at Massachusetts General Hospital and an assistant professor of psychiatry at Harvard Medical School. “With TMS, we are using electromagnetic pulses to change brain activities — to excite or inhibit activity in a particular brain region — in ways that will reverse or modulate the symptoms of a particular disorder.”
During treatment, an electromagnetic coil is placed against the patient’s skull near the forehead while pulses are delivered, stimulating neurons to fire and excite other neurons. “Every part of the brain is interconnected,” notes Dr. Mehmet Dokucu, director of the neuromodulation program in psychiatry at Northwestern Memorial Hospital in Chicago. “So even if we target a particular part of the brain, other deeper areas get stimulated, too.”
How this translates into specific gains isn’t completely understood. But the theory is that the treatment is enhancing the brain’s ability to change and “run circuits more efficiently, make new neural connections, and restore neural rhythms,” says Dr. Linda Carpenter, a psychiatrist and research professor of psychiatry and human behavior at Brown University and director of the Butler Hospital TMS Clinic and Neuromodulation Research Facility in Providence, Rhode Island. There may be some other effects, too, she says, such as improving blood flow and the functioning of the cells’ mitochondria — their energy producers.
Data on how effective TMS is for various conditions and how long the effects last is limited. The evidence that TMS makes a substantial difference for many cases of chronic pain “is not super compelling,” Camprodon-Gimenez says, and it’s only just beginning to be studied for autism, ADHD, OCD and other conditions. In Parkinson’s and stroke patients, some research has shown that TMS appears to ease problems with movement. On the other hand, there’s strong research regarding depression. A 2012 study found that nearly 60 percent of people with treatment-resistant depression who underwent TMS were in remission at the three-month follow-up.
The severity of symptoms may influence the results. A 2015 study at the Walter Reed National Military Medical Center found that patients with mild to moderate depression had significantly better responses than those with severe depression did. Meanwhile, a 2016 study in the journal Neurology examined the effects of 10 daily sessions of repetitive TMS on the motor and mood symptoms of patients with Parkinson’s: In people with both Parkinson’s and depression, TMS led to improvements in motor function but not mood.
[See: How to Find the Best Mental Health Professional for You.]
In other cases, motor skills and frame of mind improve in tandem, whether because of a neurological or a psychological ripple effect. Debbie Hall, of New Albany, Ohio, underwent TMS to stimulate the areas that control mobility and fine motor control in her left arm and hand after having a stroke in 2013. After six sessions, “I could pick up BBs — I was so excited!” says Hall, 52. Her mood also improved dramatically — as a result of the treatment, the physical improvement, or both. Since then, Hall has retained much of the functionality she gained.
To treat depression, magnetic pulses are directed at a brain region that is underactive in people with the condition, explains Jonathan Becker, an assistant professor of clinical psychiatry and director of the Neuromodulation Service at Vanderbilt University Medical Center. For chronic pain, the sensory motor cortex, which receives physical sensations from the body, is being studied as the target. Generally, fast pulses at a high frequency enliven the targeted areas, while pulses at a low frequency can suppress activity, says Dr. Andrew Leuchter, a professor of psychiatry and director of the TMS Clinical and Research Service at the David Geffen School of Medicine at UCLA. While patients with depression typically benefit from having certain parts of their brain revved up, people with chronic pain, anxiety or PTSD often require a dialing down of activity in key areas of the brain. Patients often describe the sensation as feeling like a woodpecker is tapping on their head — not quite painful but not exactly comfortable, either. The magnetic pulses are similar to those generated by magnetic resonance imaging machines.
Compared with electroconvulsive therapy, which uses electrical stimulation in a more generalized fashion to treat severe treatment-resistant depression and other mental disorders, targeted TMS treatments involve a lower risk of side effects such as seizures, and there is no memory loss. While some people experience a mild headache or slight fatigue after sessions in the first week, most don’t have any lingering side effects. The protocol typically involves five days a week for four to eight weeks. Each session generally lasts 20 to 40 or 60 minutes and is done on an outpatient basis. Many people begin to notice changes after about two weeks, though some people are early responders, some are late responders and others don’t benefit at all.
TMS is not a cure, which means that supportive interventions such as medication, psychotherapy and exercise for depression may be needed to maintain improvements. “Just because a medication didn’t get you well, that doesn’t mean it can’t keep you well,” Becker says. Over the following year, depression symptoms typically return for about one-third of people who’ve had successful TMS. Those who have a relapse of depression can receive additional sessions of TMS. “There’s no limit to the number of booster or maintenance sessions a person can have,” Carpenter says.
[See: The Many Ways Exercise Fights Depression.]
The bad news: Most insurance plans cover TMS for major depression only. Leonore Gordon, 61, who had Parkinson’s-induced challenges with mobility and motor skills, saw significant improvement when she participated in a study of TMS for Parkinson’s at New York University. “I got married in 2014, and I was able to dance at my wedding,” says Gordon, a retired therapist in Brooklyn. Some of the improvements have since faded, and Gordon would like to have TMS again. Since it would be outside of a clinical trial this time, though, she’ll need to wait until TMS is approved for Parkinson’s — and insurance coverage kicks in.
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Rebooting the Brain With Transcranial Magnetic Stimulation originally appeared on usnews.com
