Does Transcranial Magnetic Stimulation (TMS) Really Work?
March 6, 2019
If you’re reading this article, you probably have some interest in human psychology, and if you have some interest in human psychology, odds are you’ve at least heard of TMS treatment. Having been featured as a miracle cure for depression in publications like Men’s Health and programs like Dr. Oz TMS treatment has become a widely known and talked about clinical treatment for depression. But what exactly is it?
To start, TMS stands for Transcranial Magnetic Stimulation. Typically, when you hear the term TMS -- and its miraculous results -- you’re hearing someone talk more specifically about Left Prefrontal Repetitive Transcranial Magnetic Stimulation, also called rTMS. But TMS is easier. What this basically boils down to is a clinical psychologist presses a small, ironically brain-sized device to the left side of your head and flips a switch. This device then emits magnetic waves through your skull and into your brain causing stimulation and heightened neurological activity. You do this a few times and voila! say goodbye to depression.
Well, not exactly voila. There are still a lot of questions clinicians can’t answer about TMS treatments, and after all, this is basically the same logic that saw us pressing charged paddles to people’s temples and shocking the sick out of them a few decades ago, but more on that later. For now it’s enough to know that, according to several studies released in reputable psychological journals and several anecdotal testimonials, TMS seems to be doing what we thought it would, and rather painlessly too! Let’s take a deeper look at the science and evidence behind the treatment in our introduction to TMS.
- The Carpenter Study
- The Dunner Study
- Benjamin Testimonial
- Sharon Gray Testimonial
- Lingering Questions
The Carpenter Study
In 2012, a study was released in Depression and Anxiety that found that TMS was “an effective treatment for those unable to benefit from initial antidepressant medication.” Before Dr. Carpenter and her team, there hadn’t been an observational study of TMS like this. What the research team set out to do was observe the effects of TMS in real clinical environments.
The study included 42 TMS clinical practice sites and over 300 patients. The results were impressive: of the patients observed 58% saw marked relief from symptoms of Major Depressive Disorder (MDD). What was more impressive was, of those patients in the study, over ⅓ of them saw complete remission from their symptoms.
In layman’s terms: it worked. It is worth noting, however, that the study took place at 2 weeks (baseline) and 6 weeks (when treatment ran its course), this will be relevant later.
The Dunner Study
2 years later, Dr. Dunner and his team of researchers with the Center for Anxiety and Depression set out to see if these results researchers and clinicians were finding with TMS treatments were sustainable. His team observed 257 patients across 42 TMS clinical practices who agreed to follow ups over a 1 year period.
The team returned to the patients at 3, 6, 9 and 12 months to follow up post treatment and what they found was encouraging. First of all, at the end of acute treatment a whopping 120 patients were found to meet IDS-SR remission criteria. 75 of those (62.5%) continued to adhere to remission criteria after the 12 month follow up meeting.
These numbers were found to be statistically significant and were taken to prove that rTMS treatments could both have significantly positive effect on patients with treatment resistant MDD, and that those effects would last (at least past the one year mark).
Earlier last year, Men’s Health released an interview with a man who had formerly undergone TMS treatments for treatment resistant MDD. Credited only as “Benjamin” the interviewee wished to remain partially anonymous to allow for freedom of expression.
In our introduction to TMS treatments we want to give you the most authentic information possible to allow you to come to your own conclusions about TMS’ effectiveness. With that being said the Men’s Health article seems to corroborate everything the Carpenter and Dunner studies have told us. Benjamin had major depression and then he didn’t anymore.
After these treatments, I feel like I'm more connected with myself and the world around me, and I can truly say that I'm happy with myself. I like me. It took a long time to get to that point, because throughout depression, I kind of hated myself. I hated life, and I hated who I was. Now I have a lot more clarity — I'm even thinking about my future. -Benjamin, Men’s Health 2018
Again, it’s worth noting that Benjamin mentions in his interview that he’s still in the midst of his treatment. In fact, he says he still has 4 more treatments to go before the end of his initial acute treatment period. For what it’s worth, however, the initial results of TMS treatments seem to be dramatic and positive in treating MDD.
Sharon Gray Testimonial
In an article written in the American Psychological Association, an older woman gives us her take on TMS treatments from her perspective. Credited as Sharon Gray, though that’s not her real name, this 60 year old woman tells a tale of decades of treatment resistant depression that she couldn’t shake until receiving TMS treatments. It’s worth noting here that, at 60 years old, Sharon is older than the average test group for both the Carpenter and Dunner studies.
With neurology changing significantly in older age it’s possible that the effects of TMS can be different for people who are reaching old age. It’s a salient point to make because, according to Sharon, her TMS treatments wore off. Despite the evidence of long lasting effects in the Dunner study, Sharon reports that she’s had to undergo TMS treatments at least 3 times to maintain her resistance to MDD.
And what’s more interesting is her response to subsequent treatments past her initial time at a TMS clinic were not as dramatic. As we saw with the Carpenter study and Benjamin’s testimonial, the effects of the initial acute round of TMS treatments can be almost miraculous. Sharon even reports this in the APA article.
"I went to sleep on a Tuesday night depressed, and woke up Wednesday morning not depressed."
But she also describes her reaction to later treatments as “modest” and her mood as “pretty good”. Far from the shock and awe of her initial reaction and Benjamin’s take on the treatments. Whether this seeming discrepancy in the data is due to Sharon’s advanced age, or simply an underreported reality of TMS treatments is unclear. In fact, much of the treatment’s effects remain unclear.
The biggest question surrounding TMS treatments is really how to administer it. What frequency is most effective? What patients are most receptive? What magnetic intensity will help the most? It’s really just a sea of questions because the fact of the matter is, psychologists really aren’t sure why the treatments work at all.
We think it has something to do with exercising your neurons. The idea is that activating neurological pathways that otherwise go unworked in the depressive brain allows these pathways to grow stronger and can alleviate some of the symptoms associated with the disorder.
The same reasoning was being electroshock therapy (ETC) which also saw marked success in its prime, though it also depended on the patient seizing and required anaesthesia which comes with its own list of complications. TMS seems to be doing everything ETC could without any of the side effects, which is promising.
However, not enough is known about just what is happening in there when the magnetic pulse rattles around your skull, all we really know is it seems to work.
More research is needed to test the viability and truly long term implications of TMS treatments for major depression, but science is on its way. Recent French studies have attempted to test the appropriate protocol for recurring maintenance treatments, but they’ve been small. Research has been slow, but as of right now: the FDA has approved of treatment; and many insurance providers in the US have started to cover the treatments.
TMS has become a last resort for many people who haven’t seen a way out of their major depression and is seemingly a ray of hope in what can otherwise become a hopeless endeavor. As of now, potential side effects include headaches and application site soreness, which -- for anyone who’s seen a pharmacological commercial -- doesn’t really seem that dramatic.
Science will continue to answer the questions, but at least as a final line of defense, TMS seems to be doing the job for hundreds of people seeking help and relief.