Deep TMS for Depression

Deep transcranial magnetic stimulation (Deep TMS) is an advanced form of transcranial magnetic stimulation (TMS) that is used as a treatment for depression. It is a non-invasive treatment that uses magnetic fields to stimulate nerve cells in the brain involved in mood regulation and emotion. The magnetic fields are generated by an electromagnetic coil placed on the scalp. Unlike standard TMS, which targets superficial regions of the brain, Deep TMS can penetrate deeper brain structures. This is achieved through specialized coils, such as the H-coil, which is designed to reach broader and deeper areas of the brain, targeting areas such as the prefrontal cortex, which is associated with mood regulation.

Indications 

Deep TMS is typically reserved for treatment-resistant depression. Depression is a mental health disorder or mood disorder, characterized by symptoms such as a constant feeling of sadness, a loss of interest in hobbies or daily activities of life, and feelings of worthlessness, that may include ideation of self-harm or even suicide. Standard treatments for depression include antidepressant medications and psychotherapy. However, many patients do not find relief from these standard treatments. This is referred to as treatment-resistant depression (TRD).

Preparation

In general, preparation for deep TMS for depression may include the following:

• A thorough assessment by a psychiatrist or neurologist is performed to determine if the patient is a good candidate for deep TMS. This includes evaluating the severity of the depression, any contraindications (such as metal implants in the head), and previous treatment responses.
• The clinician may take baseline measurements of the patient’s depression symptoms using standardized scales, for example, the Hamilton Depression Rating Scale, to track progress over time.
• Brain mapping may be performed, using MRI or other imaging techniques, to identify the specific areas of the brain to be targeted.
• You should inform your doctor of all medications, supplements, and herbal remedies you are currently taking. Your doctor may need to adjust or put on hold certain medications before starting Deep TMS.

Procedure

In general, deep TMS for depression may include the following steps:

• The patient is seated comfortably in a chair.  A healthcare provider will position the Deep TMS helmet or cap on your head. This device contains electromagnetic coils designed to deliver magnetic pulses to specific brain areas.
• The Deep TMS machine delivers magnetic pulses through the coil. The specific coil used, often an H-coil, is designed to reach deeper brain structures than standard TMS coils.
• Each session typically lasts about 20-30 minutes. The patient might feel a tapping sensation on the scalp and hear a clicking sound as the machine operates.
• Treatment usually involves daily sessions (Monday to Friday) for 4-6 weeks. The total number of sessions can vary based on the patient’s response and the treatment protocol.
• Throughout the treatment, the clinician monitors the patient for any side effects or discomfort and adjusts the coil positioning or stimulation parameters accordingly.

Post-procedure care

There is no need for recovery time after a deep TMS session. You can immediately return to your normal activities, including driving. Periodic assessments are conducted to monitor the patient's progress. Adjustments to the treatment plan may be made based on the patient’s response and any side effects experienced.

Risks and Complications

Deep TMS for depression generally is considered a safe procedure. However, some patients may experience mild headaches, scalp discomfort at the stimulation site, or a tingling sensation in the face - all of which generally subside quickly.

Summary

Deep TMS offers a promising non-invasive option for treating depression, particularly for those who have not responded to traditional therapies. Regular follow-up and monitoring ensure the treatment's effectiveness and the patient's safety.