rTMS stands for “repetitive transcranial magnetic stimulation.” rTMS is a non-invasive FDA-cleared medical procedure for the treatment of depression in adults. rTMS is a brain stimulation technique that depends on the generation of brief magnetic fields using an insulated coil that is placed over the scalp.
These magnetic fields are the same type and strength as those used in magnetic resonance imaging (MRI) machines. The magnetic pulses generate a weak electrical impulse in the brain that briefly activates neural circuits at the stimulation site. rTMS has been shown to be a safe and well-tolerated procedure that can be an effective treatment for adult patients with depression who have not benefitted from antidepressant treatment.
During an rTMS session, a magnetic coil is placed against over scalp near your forehead. The magnet painlessly delivers a pulse that stimulates nerve cells in the region of your brain involved in mood control and depression. It's activates the regions of the brain that have decreased activity in depression.
The FDA approved rTMS to treat Treatment Resistant Depression in 2007.
Since then, rTMS has been used to treat a variety of psychiatric and neurological disorders with mixed results.
rTMS seems to be particularly most effective for:
Yes. This treatment will not interfere adversely with medication. Rather, both will have a complimentary effect on the underlying disease process.
rTMS is used to treat very severe cases of depression, especially those patients who do not adequately respond well to medications, or those in whom high dose medications are not usually well tolerated.
For Medical Treatment Resistant Depression: 40 Sessions
For Depression Not Resistant to Medical Treatment: 20-30 Sessions
(Note: This will depend on the clinical status and response to medications)
Duration of a Session: 30 minutes approximately Two such sessions can be given simultaneously.
A form of treatment where such 4 sessions or 12000 pulses/day can be given safely.
With accelerated TMS, patients only need 10 days to complete the entire course of treatment.
rTMS is a procedure carried out on OPD basis and doesn’t require patient to be admitted in the hospital. There are no post-procedure complications or side effects and hence patient can go home after the session.
Response is usually seen after 10-15 sessions are completed. Patients start feeling distinct changes in mood and energy levels.
In cases of accelerated rTMS, positive changes from treatment can continue up to 1 month post the delivery of rTMS.
In our clinical experience, patients who undergo adequate rTMS treatment, maintain the therapeutic effect for >1-2 years.
All patients who are started on rTMS need to continue with medications as prescribed before the start of rTMS treatment.
Symptoms can re-appear post an rTMS course, under two conditions:
a) If you are a treatment non-responder: Consider alternative form of brain stimulation, such as Brief Pulse Therapy
b) If you have relapsed: Consider maintenance rTMS.
To understand the answer to this question, one must understand some other aspects.
| CONDITIONS REQUIRING ECT | |
|---|---|
| SUICIDAL THOUGHT/ACTIONS/ATTEMPTS | |
| Melancholic Depression Depression with Psychosis | Previous history of good response to ECT |
| Aggression/ Severe Irritability | Complete social isolation/ poor functioning |
| Significant feeling of hopelessness/worthlessness | Severely reduced appetite |
| Severe slowing of actions and thoughts | Residual symptoms not responding to medications |
| ADVANTAGES OF rTMS | |
|---|---|
| Mild-moderate depression | Improve treatment response at early stages of illness |
| stigma attached | No memory issues |
| Non-invasive Minimal-no side effect |
Safe in patients with other physical conditions such as cardiac patients/renal pateints/liver damage patients |
| PREGNANCY: NO SIDE-EFFECT TO MOTHER/BABY. ABSOLUTELY SAFE | |
All these side effects are self-limiting. Some patients need to consume an over the counter analgesic for the resolution of headache (e.g. Ibuprofen)
The most serious side effect with rTMS treatment is the possibility of a seizure occurrence. The probability of a seizure is ~0.01% to 0.1%
When any of the above mentioned symptoms are present, ECT is the treatment of choice and the effectiveness of ECT is far superior to rTMS.
| rTMS | Anti-Depressant Medicines | Normal Population | |
|---|---|---|---|
| Seizure Risk |
0.01% to 0.1% | 0.1% to 0.6% | 0.07% to 0.09% (Chances of spontaneous seizure generation) |
| Contraindications | Anti-Depressant Medicines | Normal Population |
|---|---|---|
| History of Seizure Episodes/ Epilepsy or Brain Damage Metallic implants in the brain |
Cardiac Pacemakers Implantable Defibrillators |
