The Quick Highlights

What is TMS?

Deep TMS is FDA-cleared and clinically proven to alleviate symptoms of depression without causing significant adverse or long-lasting side effects.

What does it treat?

Major depressive disorder (MDD)

Obsessive Compulsive Disorder (OCD)

What does it entail?

Treatment consists of 36 sessions across 6-weeks followed by periodic maintenance sessions. Each session takes approximately 20 minutes. You will need to be available to attend treatments Monday-Friday for approximately 30 minute periods for a total of 6 weeks to complete all 36 treatments.

Clinically Proven to Improve Symptoms

Clinical data demonstrates that nearly 3 in 4 patients achieve a clinical response, with 1 out of 2 achieving remission. You may also experience significant reduction in anxiety symptoms.

No Systemic Side Effects Commonly Associated with Medication

Years of safety data support noninvasive Deep TMS treatment. Patients can resume daily activities immediately after each treatment session.


The Nitty Gritty

What is TMS?

Transcranial magnetic stimulation (TMS) is a medical device treatment used to treat a number of different mental health and neurological disorders. Its technological apparatus sends out an electromagnetic field with the ability to safely reach brain structures found to take part in the appearance of the targeted condition. By influencing these structures, TMS is able to safely regulate their neural activity, creating a more stable cadence to their activation, thereby facilitating symptom alleviation and contributing to the patient’s well-being.

TMS treatment typically involves a series of 10-to-20-minute sessions over a period of several weeks. As it is noninvasive, TMS does not necessitate the use of anesthesia, nor does it require a lengthy recovery period. Patients are normally able to drive themselves to and from treatment sessions, allowing them to incorporate TMS into their daily schedules.

TMS does not cause any significant, long-lasting, or adverse side effects. Its most common side effect being a localized headache at the site of activation, which typically passes on its own after the first few sessions.

Here at Neurology, Psychiatry and Balance Therapy Center, all staff has been extensively trained and certified in TMS.

Common Misconception: TMS is NOT ECT!

Electroconvulsive therapy, or ECT, is a medical device treatment that preceded TMS by several centuries. It sets off a series of brief seizures that stimulate the brain and affect its neural functioning.

Despite its proven efficacy, though, ECT does entail a number of drawbacks that prevent it from being considered a first-line mental health treatment for depression. Firstly, ECT can cause severe side effects, specifically short-term memory loss. It also requires the use of anesthesia, as well as a comparatively long recovery period, making it harder to work into one’s regular routine. Finally, due to widespread misinformation about the treatment, ECT is perceived as being a painful, traumatic form of therapy whose sessions leave patients incapacitated.

Due to its combination of high efficacy and often intolerable side effects, over the last few decades ECT has mainly been used in treatment-resistant cases of depression.

Unlike ECT, TMS is very well tolerated and noninvasive. Since it does not necessitate the use of anesthesia or a lengthy recovery period, TMS can be incorporated into the patient’s daily schedule, and allows for them to drive themselves to and from each treatment session.

The TMS Therapy Procedure

A noninvasive medical device treatment, TMS utilizes electromagnetic fields to safely regulate the neural activity of brain structures found to be associated with the targeted mental health condition. Two such conditions are depression, which has been associated with erratic activity in the bilateral prefrontal cortex and dorsolateral prefrontal cortex; and OCD, which has been associated with erratic activity in the anterior cingulate cortex.

An average TMS treatment session lasts between 20-40 minutes. During each session, the patient is seated in a comfortable chair, as the TMS operator focuses the machine’s electromagnetic fields on the targeted area of the brain. A full TMS treatment plan usually includes daily sessions over a four-to-five weeks, followed by periodic maintenance sessions.

By sending out pulses of electromagnetic fields, TMS therapy has been shown to create a more stable rhythm of activation within the targeted neural structures, thereby alleviating the frequency and severity of the patient’s presenting symptoms, facilitating relief, and improving their well-being.

In addition to TMS’s proven effectiveness as a standalone treatment, its noninvasive nature allows TMS therapy to be combined with other forms of treatment, such as psychopharmacology, which can improve the treatment regimen’s overall efficacy.

Types of TMS therapy: Traditional and Deep TMS

Traditional TMS.

Traditional transcranial magnetic stimulation (traditional TMS), also known as repetitive transcranial magnetic stimulation (or rTMS), was the first type of TMS to be introduced on the market, in 1985. It has been recognized by the FDA to be a safe and effective treatment for the following mental health conditions:

  • Depression.
  • Migraine headaches.
  • OCD, though not yet with clinically proven outcome data.

Traditional TMS uses a figure-8-shaped, handheld device to send out its electromagnetic pulses, which manage to reach a brain depth of 0.27” (0.7cm), which has been shown to stimulate approximately 3cm3 of brain matter.

During a traditional TMS treatment session, the TMS operator holds the figure-8 over the targeted area, releasing the pulses to where the relevant neural structure is believed to be. Each traditional TMS therapy session takes about 40 minutes.

Though it has been found to be effective, traditional TMS treatments can run into targeting issues, with the use of a handheld device causing practitioners to miss the targeted brain structure. To avoid this, practitioners sometimes incorporate an additional, neuroimaging device that helps pinpoint the structure’s location.

Deep TMS- This is what we offer at NPBTC

Deep transcranial magnetic stimulation (Deep TMS) was made publicly available in 2013, as a development of standard TMS. It has been FDA-cleared to be a safe and effective treatment for the following mental health and neurological conditions:

  • Depression. Deep TMS is indicated to treat depressive episodes in adult patients suffering from major depressive disorder, who have already failed to achieve satisfactory improvement from previous antidepressant medication in the current episode.
  • Theta Burst for Depression. Deep TMS has also been indicated to treat major depressive disorder through a shorter, three-minute treatment session, defined as a “theta burst” protocol.
  • Depression with Anxiety Symptoms. Deep TMS is indicated for the treatment of depressive episodes, as well as for decreasing anxiety symptoms in adult patients contending with major depressive disorder, who may exhibit comorbid anxiety symptoms, and who failed to achieve satisfactory improvement from previous antidepressant medication treatment in the current episode.
  • OCD. Deep TMS has been indicated to be used as an adjunct for the treatment of adult patients contending with obsessive-compulsive disorder. Deep TMS is currently the only noninvasive medical device treatment with clinically proven outcome data to receive FDA clearance status for treating this condition.
  • Smoking addiction. Deep TMS is indicated to be used as an aid in short-term smoking cessation for adults.

Deep TMS uses its own, patented H-Coil technology to deliver electromagnetic fields deeper into the brain, reaching a significant sub-threshold of 1.25” (3.2cm), which has been shown to stimulate approximately 17cm3 of brain matter.

The H-Coil itself is held inside a cushioned helmet that is fitted onto the patient’s head. This allows Deep TMS’s H-Coil to reach wider swatches of the brain, while also directly reaching deeper neural structures. As a result, Deep TMS is able to avoid the targeting issues that sometimes arise with traditional TMS from occurring, resulting in increased efficacy. An independent study published in 2019 in the Journal of Psychiatric Research seemed to confirm this, finding that patients with moderate-to-severe baseline depression experienced a significantly greater response level to a combined course of Deep TMS and medication, compared to either traditional TMS and medication, or medication alone.

A full-length Deep TMS treatment session lasts about 20 minutes, while the more recently developed, theta burst Deep TMS treatment for depression, lasts for three minutes. The treatment is divided into an acute phase that includes four weeks of daily sessions, and a continuation phase that includes two sessions a week over 8-12 weeks. Patients undergoing Deep TMS treatment often report experiencing a marked improvement of their well-being within three weeks of the initial session.

Here at Neurology, Psychiatry and Balance Therapy Center, we pride ourselves on offering the most efficient and effective treatments available for our patients. We utilized Deep TMS for Depression and OCD.

TMS Efficacy

As with other forms of mental health therapy, the main criteria by which TMS is evaluated are its efficacy and safety. It is by these standards that the probability of its success among patients seeking treatment is evaluated.

The efficacy of TMS has been repeatedly proven, with studies finding TMS to offer patients significant symptom relief. One such study, published in 2015 in World Psychiatry, examined Deep TMS’s efficacy with treatment-resistant patients of depression. The study relied on double-blind, randomized control trials, receiving data from 20 different research centers.

The study concluded that about one of three participants achieved remission after four weeks of Deep TMS therapy that is included in the treatment’s acute phase. The treatment was found to be successful even in cases where patients had found three or more types of antidepressants to be inefficient.

Additionally, over 80% of participants experienced an improvement during the treatment’s continuation phase.

Deep TMS was reported to have even higher efficacy rates within a real-life clinical setting with patients receiving the treatment in the field. Of the recorded data of more than 1000 patients undergoing Deep TMS therapy for depression, approximately 75% achieved a beneficial clinical response, and one of two patients achieved remission.

A different study on Deep TMS, published in 2019 in the American Journal of Psychiatry, focused on its efficacy in treating OCD. The study found that a six-week treatment course of Deep TMS provided patients with OCD significant relief that was similar to the results of a 12-week pharmacotherapy treatment. Over one in three patients experienced a significant decrease in OCD symptoms, including those previously determined to be unresponsive to medication treatment and/or psychotherapy. All in all, Deep TMS was concluded to be well-tolerated by participants, offering them the same level of symptom relief as medication, in half the time.

Deep TMS was also found to offer symptom relief when part of a treatment that combined it with medication. A study from 2019, published by the Journal of Psychiatric Research, concluded that undergoing Deep TMS together with standard antidepressant medication is significantly more effective than standard pharmacotherapy alone, as it reduced the symptoms of close to two-thirds of participants battling depression. Additional research similarly suggests that when treated with Deep and psychotherapy, the overall efficacy of the patient’s treatment plan will increase.

TMS Therapy Safety

TMS therapy has repeatedly been shown to be a safe form of mental health treatment, beyond the relevant condition being treated. In a randomized, controlled study published in Clinical Neurophysiology, the safety of both traditional TMS and Deep TMS was found to be comparable to that of a sham group. Both types of TMS were shown to be well-tolerated, without causing participants any or long-lasting significant side effects.

Possible Deep TMS Side Effects During and Immediately After Treatment

Patients undergoing Deep TMS may experience some mild discomfort during the treatment session, in addition to a tapping sensation in the targeted area. In general, TMS side effects are usually quite mild.

Possible TMS for Depression Side Effects following Treatment

The most common side effects observed following Deep TMS for depression are:

  • Mild pain at the site of the treatment (25%).
  • Discomfort at the site of the treatment (19%).
  • Jaw pain (10.2%).

Possible TMS for OCD Side Effects following Treatment

A double-blind, randomized, controlled, multi-center study on Deep TMS for OCD found no significant differences between the treatment and sham groups, suggesting these side effects may not be caused by the treatment itself. That said, the following, non-significant side effects were observed:

  • Headaches (32% in the treatment group, 35% in the sham group).
  • Anxiety (12% in the treatment group, 3% in the sham group).
  • Jaw pain (8% in the treatment group, 1% in the sham group).
  • GI symptoms (8% in the treatment group, 0% in the sham group).
  • Common cold (8% in the treatment group, 9% in the sham group).
  • Diarrhea (6% in the treatment group, 1% in the sham group).
  • Neck pain, (4% in the treatment group, 5% in the sham group).
  • Fatigue (2% in the treatment group, 9% in the sham group).

Deep TMS Contraindications and Safety Concerns

Patients with the following contraindications should refrain from Deep TMS treatment:

  • Patients with suicidal ideation.
  • Patients with psychotic symptoms.
  • Patients with a metal embedded in their cranium.
  • Patients with an electronic device implanted in their body.
  • Patients with a pre-existing neurological condition, such as past seizures.
  • Patients who are pregnant or nursing.
  • Patients with a history of substance abuse.
  • Patients with a neurological condition such as epilepsy, dementia, cerebrovascular disease, increased intracranial pressure, a history of repetitive or severe head trauma, or a history of primary or secondary tumors in the CNS.
  •  Patients who do not meet the DSM criteria for the mental health condition for which they wish to be treated.
  • Patients who are less than 18 years of age, or older than 68 years of age.