Transcranial magnetic stimulation (TMS) is a safe therapeutic method, which is an alternative treatment for some mental disorders. TMS has been officially approved by the United States Food and Drug Administration (FDA) for the treatment of drug-resistant depression. In many countries, this treatment is financed from the state budget, but unfortunately not yet in Poland. Nowadays, two types of TMS are most commonly used in psychiatry:
• rTMS (repetitive transcranial magnetic stimulation) – TMS in the form of repeated series of magnetic pulses with a frequency of 10 Hz (so-called high frequency) or 1 Hz (so-called low frequency);
• iTBS (intermittent theta-burst stimulation) – TMS in the form of intermittent stimulation with theta bursts at a frequency of 50 Hz. The most recent scientific research shows the same effectiveness of iTBS stimulation compared to the classic rTMS. Thanks to the higher frequency of the field used and the short duration, iTBS sessions can be performed many times during one day – the so-called accelerated iTBS. Our clinic is the first in Poland to perform iTBS sessions commercially.
MOVIE 1: What TMS is
MOVIE 2: Demonstration of the stimulation process
TMS is a method based on the use of a magnetic field and the phenomenon of electromagnetic induction for precise neuromodulation of the brain’s neuronal activity. The device produces short magnetic pulses with a power comparable to magnetic resonance imaging. They painlessly penetrate the brain tissue to a depth of approx. 3 cm, inducing the so-called depolarization current. In this way, we can stimulate the activity of the cerebral cortex at the stimulated site, and by means of transsynaptic modulation, influence the activity of adjacent brain structures.
TMS is believed to increase the secretion of neuroprotective substances and neurotransmitters in the brain, such as serotonin, and stimulates the formation of new nerve cells.
The most proven, FDA-approved for the treatment of drug-resistant depression. Sessions are performed once a day and last about 20 minutes. The therapy lasts 20 working days. Treatment efficiency – approx. 45%.
Accelerated iTBS. Four iTBS sessions a day lasting for a few minutes with 15 minute-breaks apart. The duration of therapy – 5 days. Treatment efficiency – approx. 50%.
Accelerated intensive iTBS according to a stimulation protocol developed at Stanford University (SAINT-TRD). Ten 9 minute iTBS sessions a day are performed every hour. It is probably the most effective antidepressant therapy in the world – treatment effectiveness is approx. 90%.
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The only absolute contraindication to TMS is the presence of ferromagnetic materials in the head (except for dental materials) – e.g. cochlear implants, vascular clips.
For safety reasons, TMS is not recommended for those who:
No referral is needed, however, initial qualifying consultation with a psychiatrist is necessary (in the office or via Skype or telephone). Pre-treatment consultation is provided by Piotr Sulik, MD. Please have your medical records with you (if have such), especially discharge summaries from psychiatric hospitals and results of brain imaging tests (CT, MRI, EEG)
At high frequencies (50 Hz, 10 Hz) during the session, the patient feels some teasing or nibbling in the area of the stimulation. It is especially at the beginning of the session; however, the feelings of teasing or nibbling are not intolerable. After a few minutes, the so-called habituation occurs, that is, the patient gets used to the stimulus, and the feelings of teasing or nibbling almost disappear. In our so-far practice, we have never needed to interrupt the session because of the patient’s pain. Paracetamol taken 30 minutes before the session improves the patient’s comfort.
In the case of low frequencies (1 Hz), there are no pain sensations in the treatment protocol for obsessive-compulsive disorder; patients even report exceptional pleasure and a feeling of “relief” during the session.
Most frequently, the improvement is already felt after 12-15 sessions. Some patients feel the improvement after between 20 and 30 sessions. As a matter of principle, the therapy is stopped if the patient feels no improvement after 20 sessions.
The effect of rTMS mainly depends on the protocol used, but also many other factors need to be considered. It is believed that about 50% of patients suffering from drug-resistant depression experience improvement in mood. One-third of these patients will achieve complete remission (recovery).
In 2019, a group of scientists from the world’s best medical university, Stanford University, published the results of a study (SAINT-TRD) on a specially developed, very intensive treatment protocol for iTBS. They found that as many as 90% of depressed patients achieved remission (full recovery). It is probably the most effective antidepressant therapy in the history of psychiatry. The SAINT-TRD protocol lasts 5 consecutive days and stimulation is performed 10 times a day. The SAINT-TRD protocol is performed in our clinic.
To maintain the effect of therapy, it is recommended to perform the so-called rTMS maintenance sessions at least once a month (1 session) in the first half of the year after the improvement occurred. Then, sessions are performed every two months. The therapy can be completed after one year. In some cases, the maintenance sessions may be performed more frequently.
There are no contraindications for treatment with psychotropic drugs during TMS therapy. Exceptions are high doses of antiepileptic drugs and benzodiazepines, which may weaken the effects of therapy. In the case of some patients, it is sometimes necessary to modify the dosage of psychotropic drugs that reduce the so-called seizure threshold.