Deep Transcranial Magnetic Stimulation (Deep TMS)

Deep Transcranial Magnetic Stimulation (Deep TMS) is a non-invasive treatment that uses magnetic fields to stimulate specific areas of the brain, primarily the left dorsolateral prefrontal cortex (DLPFC), which is responsible for mood regulation[2]. The treatment coil generates highly concentrated magnetic fields that turn on and off rapidly, similar to those produced by an MRI machine. These magnetic fields produce very small electrical currents in the brain, which activate cells and are thought to release neurotransmitters like serotonin, norepinephrine, and dopamine[2]. By restoring the balance of these chemicals in the brain, Deep TMS can relieve symptoms of depression and other mental health conditions.

The advantage of noninvasive Deep TMS technology lies in its ability to reach the brain’s deeper brain structures directly, preventing a decrease in the magnetic field’s intensity and allowing for broader scope in electromagnetic field reach, covering more relevant brain regions and structures while maintaining a safe level of activation[3]. This deeper, broader field also enhances targeting of the correct brain region, eliminating the need for complex neuronavigation equipment.

Deep TMS is an FDA-approved treatment for Major Depressive Disorder (MDD) and Obsessive-Compulsive Disorder (OCD) in the US, and is CE Marked for additional psychiatric and neurological conditions in Europe[3]. It is a safe, effective, and generally well-tolerated treatment for people with these common brain disorders, including depression, anxious depression, OCD, and smoking addiction[4]. Treatment involves sitting comfortably in a chair in a healthcare provider’s office and wearing a helmet containing a patented H-Coil for approximately 20 minutes. Deep TMS does not cause systemic side effects and does not require hospitalization or anesthesia[4].

Citations:
[1] https://apn.com/resources/the-science-behind-deep-tms/
[2] https://www.med.unc.edu/psych/patient-care/interventional-psychiatry/tms/how-tms-works/
[3] https://www.brainsway.com/patients-faqs/what-is-deep-tms-and-how-does-it-work/
[4] https://www.brainsway.com/how-does-it-work/
[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2997692/

Comparison of Deep TMS v/S Conventional TMS

Deep TMS and conventional TMS differ in their coil type, magnetic stimulation depth, session length, FDA treatment indications, European CE certification mark, magnetic pulse depth, field of stimulation, targeting, and effectiveness. Deep TMS has been shown to be more effective in treating certain patients and conditions, such as OCD and moderate-to-severe depression, due to its ability to directly stimulate deeper and wider ranges of the brain. Conventional TMS, on the other hand, may suffer from targeting issues and is generally less effective in treating deeper brain structures and conditions requiring broader stimulation.

Aspect	Deep TMS	Conventional TMS
Coil type	H-shaped coil inside a helmet	Figure 8 coil
Magnetic stimulation depth	1.25 inches	0.27 inches
Session length	20 minutes per session	30-40 minutes per session
FDA treatment indications	MDD, OCD, short-term smoking cessation	MDD
European CE certification mark	MDD, OCD, AD, Autism, Bipolar Disorder, Chronic Pain, MS, Parkinson’s Disease, post-stroke rehabilitation, PTSD, the negative symptoms of Schizophrenia, and smoking cessation	MDD, certain migraine headaches
Magnetic pulse depth	1.25 inches	0.27 inches
Field of stimulation	Wider	More focal
Targeting	Direct stimulation of deeper and wider ranges of the brain	More focal
Effectiveness	Shown to be more effective in treating certain patients and conditions, such as OCD and moderate-to-severe depression	Generally less effective in treating deeper brain structures and conditions requiring broader stimulation

Citations:
[1] https://pnsoc.com/blog/deep-tms
[2] https://www.brainsway.com/professionals-faqs/how-does-deep-tms-compare-to-standard-rtms/
[3] https://www.tandfonline.com/doi/full/10.1080/17434440.2016.1233812
[4] https://www.newbraincalifornia.com/whats-difference-tms-deep-tms/
[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10523198/

Role in MDD

Deep Transcranial Magnetic Stimulation (Deep TMS) plays a significant role in the treatment of Major Depressive Disorder (MDD) by offering a safe and effective alternative for patients who have not found relief with traditional medications. Deep TMS is a non-invasive treatment that uses magnetic waves to stimulate specific areas of the brain responsible for mood regulation. This innovative technology, allows for deeper penetration into the brain, covering a wider area and providing a more accurate and effective treatment compared to traditional TMS methods. Clinical trials have shown that Deep TMS is well-tolerated and has a high success rate in treating MDD, with over half of patients with treatment-resistant depression achieving remission from their symptoms. The treatment is FDA-cleared for MDD, OCD, and short-term smoking cessation, making it a versatile and valuable option for individuals struggling with depression. Overall, Deep TMS offers a promising solution for those who have not responded to antidepressant medications, providing a novel intervention that is both efficacious and safe for managing Major Depressive Disorder.

Deep Transcranial Magnetic Stimulation (Deep TMS) has been shown to be effective in treating Major Depressive Disorder (MDD) in various studies. A 2015 multicenter pivotal RCT published in World Psychiatry found that approximately one out of three participants achieved remission after four weeks of Deep TMS treatment during the acute phase, and over 80% experienced a response during the following continuation phase[2][3]. A real-world study of over 1,300 patients in real practice settings showed that approximately 4 in 5 achieved a response and 2 in 3 achieved remission after completing at least 30 sessions[2][3]. A 2019 study published in the American Journal of Psychiatry found that a six-week course of BrainsWay’s Deep TMS treatment offered significant clinical improvement of OCD symptoms, with results similar to those of a 12-week pharmacotherapy treatment course[2][3]. Deep TMS has also been found to be significantly more effective than standard pharmacotherapy alone in reducing the symptoms of MDD in close to two-thirds of participants[3]. These studies demonstrate the high success rate of Deep TMS in treating MDD and other mental health conditions.

Citations:
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10856385/
[2] https://www.brainsway.com/professionals-faqs/what-clinical-evidence-exists-for-deep-tms-efficacy/
[3] https://www.brainsway.com/patients-faqs/what-evidence-exists-for-deep-tms-effectiveness/
[4] https://www.researchgate.net/publication/338042177_Efficacy_and_tolerability_of_deep_transcranial_magnetic_stimulation_for_treatment-resistant_depression_A_systematic_review_and_meta-analysis
[5] https://www.sciencedirect.com/science/article/pii/S0165178123004328

Role in OCD

Deep Transcranial Magnetic Stimulation (Deep TMS) has been shown to be a highly effective treatment for Obsessive-Compulsive Disorder (OCD) in real-world clinical practice and controlled studies. A multicenter clinical study found that more than 1 in 3 patients with treatment-resistant OCD achieved a reduction of more than 30% in their OCD severity after a course of Deep TMS, significantly improving their quality of life[1]. A post-marketing study of over 200 patients published in the Journal of Psychiatric Research found that nearly 60% of patients achieved a reduction in the OCD severity rating of more than 30%, and almost 90% of patients maintained their response for more than 1 year[1].

A multicenter double-blind sham-controlled study published in the Journal of Psychiatric Research found that high-frequency dTMS over the medial prefrontal cortex and anterior cingulate cortex significantly improved OCD symptoms. The study included 99 OCD patients who were randomly allocated to treatment with either high-frequency (20 Hz) or sham dTMS and received daily for 6 weeks. The results showed that the reduction in YBOCS score among patients who received active dTMS treatment was significantly greater than among patients who received sham treatment, with response rates of 38.1% and 11.1%, respectively[3].

In real-world clinical practice, the majority of OCD patients benefitted from dTMS, and the onset of improvement usually occurs within 20 sessions[2]. Deep TMS is a noninvasive treatment that does not cause any systemic or long-lasting adverse effects, and it does not require a significant recovery period. The short treatments can easily be integrated into each patient’s day-to-day schedule[1].

Citations:
[1] https://www.psychiatrictimes.com/view/achieving-ocd-relief-consideration-of-tms-earlier-in-the-treatment-continuum
[2] https://www.sciencedirect.com/science/article/pii/S0022395620310657
[3] https://pubmed.ncbi.nlm.nih.gov/31109199/
[4] https://www.sciencedirect.com/science/article/pii/S0165178120308155
[5] https://www.brainsway.com/professionals-faqs/what-clinical-evidence-exists-for-deep-tms-efficacy/

Role in Smoking Cessation

Deep transcranial magnetic stimulation (TMS) has been studied as a novel approach for smoking cessation. The efficacy of deep TMS for smoking cessation has been investigated in various studies, with promising results. A double-blind, sham-controlled, multicenter randomized controlled trial of 262 patients found that deep TMS significantly improved smoking cessation, with a continuous quit rate of 28.0% in the active treatment group compared to 11.7% in the sham treatment group[2]. Another study demonstrated that active stimulation led to a 28% quit rate compared to 12% for sham stimulation[3].

The treatment involves a brief smoking provocation to induce cravings, followed by daily deep TMS sessions for three weeks, followed by weekly sessions for three more weeks[2]. The H-Coil used in the treatment is designed to stimulate the bilateral insular and prefrontal cortices[2]. The treatment is generally well-tolerated, with the most common side effect being headache, primarily during the first treatment sessions[2].

The effectiveness of deep TMS for smoking cessation can be influenced by factors such as age, education, and smoking history. Participants younger than 40 had four times the quit rate than those older than 40, and participants with more than 12 years of education had 7 times the quit rate than participants with less education[4]. Participants who quit following treatment smoked 10 years less than non-quitters[4].

In summary, deep TMS shows promise as a non-invasive, well-tolerated treatment for smoking cessation. While more research is needed to fully establish its effectiveness, it represents an exciting avenue for innovative smoking cessation interventions.
The success rate of deep TMS for smoking cessation varies depending on various factors, including individual characteristics and treatment adherence. A pivotal study found that the continuous quit rate for patients who were treated with Deep TMS system and reached the 6-week endpoint was 28.4% compared to 11.7% for the patient group receiving sham treatment[2]. Another study demonstrated that active stimulation led to a 28% quit rate compared to 12% for sham stimulation[3]. These studies suggest that deep TMS can significantly improve the continuous quit rate and reduce cravings and the average number of cigarettes smoked per week[3].

The duration of deep TMS treatment for smoking cessation typically consists of a course of several sessions over multiple weeks, followed by follow-ups to assess progress and make any necessary adjustments. A common treatment protocol includes daily TMS for three weeks, followed by once-weekly sessions for three more weeks[2]. The total number of treatments required will depend on the patient’s response to the treatment[1].

Side effect Profile of Deep TMS

The side effect profile for Deep Transcranial Magnetic Stimulation (Deep TMS) includes common events such as headache, treatment site discomfort, muscle spasm, jaw pain, neck pain, mastication, dental pain, and general discomfort. These side effects are transient and typically resolve within days, with most being mild to moderate in severity. N Additionally, Deep TMS does not require anesthesia, and recipients are awake during the procedure, with the most common side effects being scalp discomfort at the stimulation site, tingling, lightheadedness, or headaches[1].

Citations:
[1] https://plusapn.com/resources/treatment/deep-tms-and-rtms/

Comparison of Deep TMS with ECT in treatment of Depression

Deep Transcranial Magnetic Stimulation (Deep TMS) and Electroconvulsive Therapy (ECT) are both treatments used for depression, but they differ significantly in their approach and application.

Deep TMS

Mechanism: Deep TMS uses magnetic fields to stimulate specific areas of the brain, targeting deeper and broader brain structures directly.

Side Effects: Deep TMS is associated with few side effects, allowing patients to remain awake and comfortable during treatments.

FDA Approval: Deep TMS is FDA-cleared to treat depression, OCD, and smoking cessation.

Treatment Process: Involves wearing a helmet with an H-Coil that transmits magnetic pulses to reach deeper brain structures.

Effectiveness: Shown to be effective in treating depression and other mental health conditions, with a high success rate in clinical studies.

ECT

Mechanism: ECT applies direct electric currents to the head under sedation to induce a therapeutic seizure, resetting the brain.

Side Effects: ECT can have side effects like headache, muscle aches, nausea, and memory loss, with potential cognitive effects.

FDA Approval: ECT is used for severe depression and treatment-resistant cases, but it is not FDA-approved for all conditions.

Treatment Process: Conducted in a hospital under general anesthesia, ECT is typically considered a last resort for severe cases of depression.

Effectiveness: ECT may be slightly more effective than TMS for treatment-resistant depression, but it carries a stigma and is more costly.

Comparisson

Effectiveness: ECT may be slightly more effective for treatment-resistant depression, but patients often prefer TMS due to its gentler approach and fewer side effects.

Side Effects: ECT has more potential side effects, including memory loss, cognitive effects, and stigma, while TMS is generally well-tolerated.

FDA Approval: Deep TMS is FDA-cleared for multiple conditions, while ECT is more limited in its approved uses.

Treatment Process: Deep TMS is non-invasive, allowing patients to continue daily activities, while ECT requires hospitalization and sedation.

Citations:
[1] https://www.verywellmind.com/transcranial-magnetic-stimulations-vs-ect-380646
[2] https://www.brainsway.com/knowledge-center/what-is-the-difference-between-tms-and-ect/
[3] https://www.psychiatrictimes.com/view/tms-versus-ect-question
[4] https://www.madisonavetms.com/blog/is-tms-the-same-as-ect/
[5] https://www.newbraincalifornia.com/whats-difference-tms-deep-tms/