People with depression can live with symptoms for a long time before finding effective treatment. Failure to treat depression may be due to the drug-resistant nature of the depression itself, adverse drug side effects, or poor drug use. There is still hope for patients who cannot find relief from pharmacology. Transcranial Magnetic Stimulation (TMS) 1 is a viable option to either replace or combine medication, and is a non-invasive treatment that uses repeated magnetic pulses to safely and effectively increase neural activity related to various mental illnesses regulate. This specific treatment has been shown to help people with treatment-resistant depression
There are currently 2 types of TMS available as therapy: 1) traditional transcranial magnetic stimulation and 2) deep transcranial magnetic stimulation, also known as deep TMS. While they share certain similarities, each has its own unique properties.
Behind the technology: how does TMS work?
TMS works on the basis of Faraday’s law of induction3, which describes the fundamental interaction between magnetic fields and electrical currents. The human body communicates through the central nervous system, which uses electrical currents that run through neurons in the body to trigger muscle contractions and other activities. When properly aligned and with the appropriate force, magnetic fields can influence neural activity in the brain by inducing an inverted electrical current, similar to how an actual current flows on the surface of the brain. The result is a change in the polarization of neurons in the affected area of the brain, making nerve cells either more excitable or less excitable.
With the same strength as an (MRI) machine, a magnetic coil is held over the scalp and directs a magnetic energy field over the scalp and into the brain. By targeting specific parts of the prefrontal cortex, TMS aims to reduce and even eliminate depressive symptoms. However, some TMS technologies are limited in their reach and effectiveness. This is where different forms of TMS come into play.
Traditional TMS vs. Deep TMS: What’s the Difference?
Both traditional TMS and deep TMS have been shown to be safe, well tolerated, and effective methods of treating depression. The differences between the two include the depth of stimulation, the type of coil, and the length of the session.
Depth and focus
Traditional TMS uses a figure-of-eight coil, while deep TMS uses a patented H-coil held in a padded helmet. While the magnetic pulses activated by traditional TMS only reach a depth of 0.27 “(0.7 cm), Deep TMS technology reaches a significant sub-threshold of 1.25” (3.2 cm) .4 Deep TMS also uses a significantly wider stimulation field compared to conventional TMS.
Recent studies5 have shown that deep TMS has been clinically shown to stimulate deeper and wider areas of the brain, particularly treatment-resistant depression and treatment-resistant obsessive-compulsive disorder (OCD).
Traditional TMS received FDA approval for the treatment of depression in 2008. Deep TMS has received 3 indications of FDA approval. Its first FDA approval was for the treatment of depression in 20136, followed by FDA approval for OCD in 2018.7 Deep TMS was also the first TMS system to receive FDA approval in the addiction area8 for smoking addiction in 2020 .
In addition to FDA approval, deep TMS also received the European Conformité Européenne (CE) certification mark for several other conditions, 9 which indicates that deep TMS complies with the safety, health and environmental standards of the products sold within the European Economic Area (EEA) . Deep TMS has received European CE Marking for a wide variety of mental and neurological disorders including Depression, Obsessive Compulsive Disorder, Alzheimer’s Disease, Autism Spectrum Disorder, Bipolar Disorder, Chronic Pain, Multiple Sclerosis, Parkinson’s Disease, Stroke Rehabilitation, post traumatic stress disorder, negative symptoms of schizophrenia, and smoking addiction.
Because each treatment uses different devices and achieves different depths and widths of direct stimulation, traditional TMS and deep TMS have shown different degrees of effectiveness in treating a variety of patients and their symptoms. A study published in the Journal of Psychiatric Research showed that baseline patients with moderate to severe depression had significantly higher response rates10 when treated with deep TMS and medication compared to traditional TMS and medication or medication alone.
The Importance of Identifying Differences in TMS
At a time when mental illness is rampant, 11 it is important to fully understand alternative solutions such as TMS and how each treatment can affect patient outcomes and experiences. In addition to offering patients a non-invasive treatment such as TMS, it is our responsibility to promote education by all possible means so that patients know that if they find themselves on an unsuccessful cycle of treatment, they will not lose hope. Health is personal, and your treatment, even if it is TMS treatment, must also be personal.
Dr. Rodriguez is the founder and medical director of the Delray Center for Healing in Delray Beach, Florida. The Delray Center uses an integrative wellness approach that includes individual and group psychotherapy, transcranial magnetic stimulation, psychiatric drug management, and holistic elements such as exercise therapy, acupuncture, massage, and nutritional counseling. Dr. Rodriguez completed a psychiatric training at the University of Miami, where he worked as a senior physician.
- Transcranial magnetic stimulation. Mayo Clinic. Reviewed May 10, 2021. https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625
- Can You Overcome Treatment Resistant Depression? BrainsWay. Reviewed May 10, 2021. https://www.brainsway.com/knowledge-center/overcome-treatment-resistent-depression/
- Magnetic flux, induction and Faraday’s law. Physics Libre texts. Updated November 5, 2020. Reviewed May 10, 2021. https://phys.libretexts.org/Bookshelves/University_Physics/Book%3A_Physics_(Boundless)/22%3A_Induction_AC_Circuits_and_Electrical_Technologies/22.1%3A_Magnetic_Flux
- Ginou A, Roth Y, Zangen A. Comparison of superficial TMS and deep TMS in major depression. BrainsWay. Reviewed May 10, 2021. https://www.brainsway.com/knowledge-center/comparison-of-superficial-tms-and-deep-tms-for-major-depression/
- Cocchi L, Zalesky A, Nott Z, Whybird G, Fitzgerald PB, Breakspear M. Transcranial magnetic stimulation in obsessive-compulsive disorder: a focus on network mechanisms and state dependence. Neuroimage Clin. 2018; 19: 661-674. doi: 10.1016 / j.nicl.2018.05.029
- BrainsWay receives FDA approval. BrainsWay. Published online in 2013. Reviewed May 10, 2021. https://www.brainsway.com/news_events/brainsway-receives-fda-clearance/
- BrainsWay receives first FDA approval for a non-invasive device for the treatment of obsessive-compulsive disorder. BrainsWay. Published online on August 19, 2018. Checked on May 10, 2021. https://www.brainsway.com/news_events/brainsway-receives-first-ever-fda-clearance-of-a-non-invasive-device-for -treatment -of-obsessive-compulsive disorder /
- BrainsWay Receives FDA Approval for Adult Smoking Addiction BrainsWay. Published online August 24, 2020. Reviewed May 10, 2021. https://www.brainsway.com/news_events/brainsway-receives-fda-clearance-for-Smoking-addiction-in-adults/
- A platform for mental health treatment. BrainsWay. Reviewed May 10, 2021. https://www.brainsway.com/our-treatments/
- Filipčić I, Filipčić IS, Milovac Z, et al. Effectiveness of Repetitive Transcranial Magnetic Stimulation Using a Coil of 8 or Coil H1 in the Treatment of Major Depression; A randomized clinical trial. J Psychiatrist Res. 2019 July; 114: 113-119. doi: 10.1016 / j.jpsychires.2019.04.020
- Reinert M, Nguyen T, Fritze D. The state of mental health in America. Mental Health America. Published online October 20, 2020. Reviewed May 10, 2021. https://mhanational.org/issues/mental-health-america-printed-reports
This article originally appeared on Psychiatry Advisor