TMS & Other Therapies

Childhood Trauma and Its Impact of TMS Therapy Outcomes

May 28, 2021

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Transcranial Magnetic Stimulation therapy, often referred to as TMS therapy, is a noninvasive brain stimulation therapy mainly used to treat patients with Major Depressive Disorder. The treatment, which uses electromagnetic pulses to stimulate nerve cells, is often used to by those with depression who didn’t have success with medication or therapy. 

Using magnets to impact brain activity is not a new concept—scientists have toyed around with the idea for over 100 years—but it wasn’t until 1985 when the first device used for TMS therapy, a coil placed over the patient’s head, was created. 

Over the next several decades, scientists did significant research to understand how TMS therapy could be used to stimulate different areas of the brain, thereby affecting different mood disorders. In 2008, the FDA approved TMS therapy as an acceptable form of intervention for depression.

While TMS therapy is considered a standard method to treat depression today, there are still areas that researchers are looking into, specifically how it can be used to potentially treat other mental disorders. What impacts the effectiveness of TMS therapy, who might benefit most from it, etc.,—these are all questions scientists are exploring.

A woman sitting in a doctor's office receives TMS therapy.
Transcranial Magnetic Stimulation Therapy, more commonly referred to as TMS therapy, is a noninvasive method used to treat Major Depressive Disorder that uses electromagnetic pulses to stimulate regions of the brain impacted by the disorder. Image courtesy of HelpGuide.

One of these questions includes how childhood trauma could potentially impact the effectiveness of TMS therapy. New information about the topic was presented on March 18th at the Anxiety and Depression Association of America 2021 Virtual Conference

According to a presentation from researchers at the Butler Hospital Research Facility and Brown University’s Department of Psychiatry and Human Behavior, individuals who have experienced trauma during childhood may have less effective results with TMS therapy as a means of treating depression.

In this article, we will discuss the benefits of TMS therapy in addition to why recent research suggests it could potentially be less effective when used to treat patients who have experienced childhood trauma. 

The benefits of TMS therapy

Advantages when compared to alternative treatments

While several known and successful treatments for depression exist, like psychotherapy and medication, not all of them are beneficial to everyone who suffers from the disorder. In fact, it’s estimated that roughly two-thirds of people diagnosed with depression don’t have significant success with the first antidepressant they take. 

TMS Therapy provides a noninvasive alternative to psychotherapy and antidepressants by stimulating areas of the brain known to be involved in depression with strong magnetic fields. What’s particularly appealing, is that, unlike antidepressants, side effects from TMS therapy are uncommon, with the exception of mild headaches. 

Success rates

The success rate of TMS therapy varies depending on each patient. However, it’s estimated that 50-60% of individuals diagnosed with depression who have not experienced relief from antidepressants see results with TMS therapy. Furthermore, about one-third of these patients’ symptoms go away completely after undergoing treatment.  


A doctor performs TMS therapy on a patient.
TMS therapy is often used to treat those who didn’t have success taking antidepressants, since its noninvasive approach as well as mild symptoms make it an appealing alternative to other forms of treatment. It’s estimated that 50-60% of individuals with depression who were unable to experience significant relief from antidepressants find success in using TMS therapy. Image courtesy of South Tampa Psychiatry.

While symptoms of Major Depressive Disorder usually don’t go away altogether, TMS therapy often has patients feeling better for several months. On average, the effects of the treatment last for a little over a year, at which point patients may decide to return for another round of TMS therapy.

New insight about the impact of childhood trauma on the effectiveness of TMS therapy

How the significant benefits of TMS therapy are influenced by a myriad of outside factors is still being looked into. One of these factors, childhood trauma, was addressed in a poster presentation titled “Impact of Early Life Adverse Events on Clinical Outcome of Transcranial Magnetic Stimulation for Depression,” at the Anxiety and Depression Association of American Virtual Conference this year. 

Studies have shown that those who experience childhood trauma are more likely to suffer from Major Depressive Disorder and other psychiatric disorders as adults. In fact, childhood trauma is associated with changes in subregions of the amygdala and hippocampus in adults who have depression.

Researchers say that understanding the specific structural and neurochemical changes in the brain that result from mental health disorders is the first step in developing new treatments aimed at minimizing their effects. Successful methods to combat mental health disorders have become especially crucial in the present day, since the number of people affected by them has increased dramatically since the start of the COVID-19 pandemic.

For individuals diagnosed with depression who experienced childhood trauma, is TMS therapy still an effective tool? According to the researchers behind the poster presentation, it doesn’t seem like this is the case.


A person comforts a distressed woman sitting on a couch.
Studies show that individuals who suffer from Major Depressive Disorder and who have experienced childhood trauma have altered subregions in the amygdala and hippocampus. According to researchers, understanding which areas of the brain are affected by depression is the first step to developing new treatments aimed at minimizing their effects. Image courtesy of MidValley Healthcare.

Methods used to gather data

Researchers who conducted the study had 117 subjects receiving TMS therapy for the first time to treat resistant depression fill out the Childhood Trauma Questionnaire (CTQ), which assesses the type and severity of childhood trauma experienced. Specifically, five types of trauma were addressed: physical abuse, emotional abuse, phsysical neglect, emotional neglect, and sexual abuse.

The Inventory of Depressive Symptomatology Self-Report (IDS-SR) was used to determine the severity of subjects’ depression symptoms, as well as clinical response and remission.

Results

The study showed statistically significant results that individuals who experienced more severe trauma during childhood showed less improvement after TMS therapy than those in the study who faced less severe trauma. Specifically, this was the case with those who experienced higher rates of physical neglect and physical abuse than other subjects in the study.

In addition, subjects who didn’t respond to TMS therapy experienced higher rates of physical abuse, physical neglect, and sexual abuse as children. However, according to researchers, having a history of moderate to severe childhood trauma did not predict the non-response or non-remission.

A doctor's stethoscope rests on a lab report.
A new study presented at the Anxiety and Depression Association of America 2021 Virtual conference suggests that TMS therapy is less effective for individuals with Major Depressive Disorder who experienced childhood trauma. Furthermore, the type of relief patients experience from it may correlate to the type of trauma they experienced. 

Not only does the study support the theory that TMS therapy is less effective for those who experienced childhood trauma, it also shows that the effectiveness of TMS therapy as a treatment for depression can be dependent on the type of childhood trauma experienced. 

Moving forward

The results of the study provide the first steps necessary to treat diagnosed Major Depressive Disorder patients who have faced trauma as a child with specific and individualized approaches. Further research exploring the potential biological pathways and mechanisms that may account for differences between severely depressed individuals with or without certain types of childhood trauma can add new insight to the conversation. 

TMS therapy has proven to be an effective way to treat individuals with depression, specifically those who have not witnessed any results from more common forms of treatment like medication. 

However, while TMS therapy is an effective strategy for some individuals, this is not the case for everyone, particularly the case for those who suffer from depression and have endured childhood trauma. 

Knowing the specifics of how TMS therapy affects a variety of people who suffer from Major Depressive Disorder, including those who have not only suffered from childhood trauma, but different types and severity of childhood trauma, is crucial to provide the insight and motivation necessary in order to develop more individualized and successful treatments. This is ultimately the end goal—to do as much as we can to help those who have depression suffer less. While more time and research is necessary to develop more successful ways to treat depression, the work done to date is a promising start.

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