Transcranial Magnetic Stimulation (TMS): Giving Hope to Depression Sufferers
Depression is the number one cause of non-fatal disability in Australia. The World Health Organisation (WHO) estimates depression will be the number one health concern in both the developed and developing nations by 2030.
Medication and psychotherapy are the go-to’s for treating depression, but what happens when people haven’t responded to these interventions?
For those who wish to avoid antidepressant medications or have experienced side effects from this modality, there’s a new non-invasive intervention called Transcranial Magnetic Stimulation (TMS). This treatment has been shown to be effective in shifting stubbornly persistent major depressive disorder, as well as other mental disorders like Obsessive Compulsive Disorder (OCD).
What is TMS?
TMS is delivered using a device that focuses pulses of magnetic waves on specific regions of the brain to stimulate or inhibit those brain circuits. A useful way to think about this process is resetting your mood switch.
TMS is a safe and non-invasive form of brain stimulation using a magnet, that is well tolerated by most patients and requires no anaesthesia.During a TMS treatment session, the patient sits comfortably in a chair while magnetic coils are placed on their scalp. Magnetic waves then pulsate on the area of the brain responsible for mood regulation, specifically a group of brain cells within the cerebral cortex (the thin topmost layer).
For precision targeted treatment, TMS is combined with Magnetic Resonance Imaging (MRI) to locate the exact cells within the brain that will respond to therapy. MRI (Magnetic Resonance Imaging) is a non-invasive brain scan that uses magnetic waves to map brain structure.
How effective is TMS for treating depression?
When someone is marooned in the depths of depression, the circuits in the brain have malfunctioned, making it difficult to recover from psychotherapy and antidepressants alone. Unfortunately, antidepressant medication doesn’t work for everyone - it can also take several weeks to experience any relief in symptoms and some of the side-effects are not well tolerated by some people.TMS targets malfunctioning brain circuitry by modifying and rebalancing activity and connectivity to the pathways and networks linked to the symptoms of depression.
In terms of research, TMS has been in clinical trials for over 30 years with a substantial track record of safety and absence of serious risk of harm. Studies have indicated that approximately 50-60% of people experience a positive response with TMS, with about one-third experiencing full remission and becoming symptom-free.
A large-scale 2023 UCLA study looked at the results of hundreds of patients treated with rTMS over more than a decade, and reported that more than 54%of those patients, showed improvement in mood, with symptoms improving within just one week of treatment.
Where can I get TMS treatment?
TMS is currently being used in several countries, including Australia, and is approved for depression treatment by the Therapeutic Goods Administration (TGA), supported by the Royal Australian and New Zealand College of Psychiatrists (RANZCP).
TMS has been Medicare approved in Australia since 2021, with rebates available for patients who are diagnosed with medication-resistant major depressive disorder.
An average course of TMS is 20-35 treatments (each taking around 20 minutes), over four-six weeks. TMS is typically first given as one session each weekday, equalling 20 treatments over four weeks. A further 15 treatments may be required, and are spaced out to prevent relapse. Some patients relapse on an average of four months after the initial course, and require a re-treatment course or ongoing maintenance treatments.
Until recently, TMS was only offered in a psychiatrist’s practice. Now, a GP or psychiatrist can refer you for TMS treatment and it is available in various TMS treatment clinics throughout Australia.
VisionTMS offers a decentralised TMS service for patients in different city locations. There is also a regional protocol to support patients not living in Sydney. VisionTMS also offers its MRI-guided TMS treatment at Uspace, the young adult mental health service at St Vincent’s Private Hospital, Sydney.