Depression is an illness in which the areas of the brain regulating emotions may shrink (atrophy) by up to 30%. It can be caused by excess stress hormones, by inflammation within the body, by hormone changes, or by problems with neurotransmitters such as serotonin and dopamine. It may be a seasonal illness, linked to the time of year and duration of sunlight, or it may be present year round. 

Depression may come on for no apparent reason, or it may be triggered by a loss of someone or something important. Depression can run in families, or coincide with a family history of substance abuse or other mental health issues. Depression is more common when there is a childhood history of trauma, abuse, neglect, or abandonment but most depression patients do not have such a history. Depression is more common in those with heart disease, autoimmune disease, and weight issues. One in five people who have had COVID-19 develop depression as part consequence of the inflammatory response.

Many people with depression also have anxiety, substance abuse, PTSD, eating disorders, or other conditions. General health problems also become worse when depression is present. For example, people who are depressed are 40% more likely to have a second heart attack than those who are not depressed. Those who are depressed take longer to recover from surgery and have more pain after surgery than those who are not. Those with depression respond less effectively to medications for many chronic health conditions than those without depression. Depression affects your whole life: work, family, and physical health.

There are many different options for treating depression, and for most people, using several options together will produce the best results. Psychotherapy or “talk therapy” is a vital component of recovery for many. Understanding how one experiences stress and loss, and how to best manage it, can be very helpful. There are several styles of psychotherapy, including insight, cognitive behavioral management (CBT), and eye movement desensitization and reprocessing (EMDR). 

Pharmaceutical treatment with antidepressant medications is also common and produces positive results in about 50% to 70% of cases. Like psychotherapy, there are many different types of antidepressant medications, and it can take some experimentation  to find the right fit. Common medication groups include SSRIs, SNRIs, DRIs, MAOIs, atypical antidepressants, and mood stabilizing antidepressants. 

Bright light therapy involves daily use of a light box that imitates daylight. It’s especially effective for seasonal depression, but may also provide relief from MDD. 

Addressing nutritional deficiencies, such as vitamin D and folate (especially activated folate or L-methylfolate), as well as any hormone disturbances, can be helpful as well. 

While the above treatments have improved countless lives, individually and together, about one in three patients with depression do not respond to any combination of these options, or cannot tolerate them due to side effects that interfere with quality of life in their own right. These individuals are considered to have treatment-resistant depression and are ideal TMS candidates.

Yes. One of the most common problems people face while working to overcome depression is the persistence or return of some symptoms, even while on medication. The goal of treating depression is to eliminate all symptoms, a phenomenon called remission. Instead, many people only get a response (defined as a 50% reduction of symptom intensity) or even less. Depression treatment guidelines state that treatment should be adjusted every one or two months until the best possible result is achieved. It’s important not to give up before reaching that best possible result, because the more symptoms of depression you still have, the more likely your depression is to worsen or negatively affect your physical health.

TMS treatment does not involve medication. Medications circulate throughout your whole body and can cause disturbances in many of its systems. Common side effects of psychopharmaceuticals antidepressants include nausea, weight gain, dry mouth, blurry vision, constipation, low sex drive, and problems with sexual performance. TMS side effects are limited to mild headache, mild drowsiness for an hour after treatment, and a very low (1 in 30,000) risk of seizure.

TMS is also more effective than medication. Medications for depression help about 50% of the patients who try them. TMS helps 70%. Even more notably, a patient’s likelihood of success with antidepressants decreases with every medication that fails. After trying four or more antidepressants without success, the chance of the next one working is only 18%. The chance of success with TMS, on the other hand, is still 70%, even after four or more failed medications. This can make a big difference.

ECT (Electroconvulsive Therapy) is a treatment for severe depression that has not responded to medication. During ECT, the patient is given muscle relaxants, general anesthesia, and breathing assistance. A powerful current of electricity is applied to the head to induce a seizure within the brain, hence the more colloquial name, “shock treatment.” It takes several hours to recover from the seizures and anesthesia, so the patient must have someone else drive them to and from the treatment. Side effects include memory loss, which may last 4 to 12 months or longer.

By contrast, TMS treatment uses magnetic energy, not electrical impulses, to prompt healing in the brain. It takes only about three to five minutes per session and requires no anesthesia or other medications. There is no seizure induction or memory loss, and the patient can remain awake and aware and return immediately to normal activities, including driving. TMS also requires a shorter tapering process at the end of a course of treatment, and is less expensive than ECT.

You sit in a chair and watch television, or talk to the technician who will be with you the entire time. A cloth cap is placed on your head, and an MRI coil that has been adjusted to your individual measurements “is then held next to your head”. This coil generates MRI impulses just like a regular MRI machine, but instead of being enclosed in a tunnel, you are simply sitting in a chair. An inflatable neck pillow supports your head in place and helps remind you not to move during the treatment, but you are not restrained in any manner. The treatment lasts around three minutes each day. Depending on your needs, you may receive treatment only on the left side of your head, or our doctor may recommend adding right-side treatment as well. The standard course of treatment is five days per week for six weeks, followed by two days per week for three weeks. Most people begin to experience improvement by the third week of treatment.

TMS MRI treatment works based on the physics principle (Faraday’s law of induction) that a fluctuating magnetic field will generate a flow of electricity in a circuit, in this case a brain circuit. When the coil’s magnetic pulses reach the brain cells of the targeted area, these cells generate normal electrical activity, just like the activity observable in a healthy brain. The pulses from the coil only travel about an inch to an inch and a half deep into the brain, in an area about the size of a quarter. The rest of your body and brain are not exposed to magnetic energy. However, this small area is connected by groups of fibers (axon tracts) to the deeper areas of the brain that regulate mood, specifically the limbic and hippocampus systems. With repeated stimulation over a period of time, the affected brain cells become more active, behave more normally on their own, and regrow to their normal size.

TMS is a very flexible treatment program with a number of different protocols, machines, and approaches. 

rTMS (repetitive TMS) uses high frequency magnetic energy pulses at 10 pulses per second to stimulate the brain on the left side and, if needed, low frequency pulses at one pulse per second on the right side of the brain. Treatment sessions last about 15 to 25 minutes per day.

TBS (Theta Burst TMS) uses the same type of magnetic energy, but the pulse pattern is different than in rTMS. In TBS, clusters of three quick pulses are given five times per second. This method corresponds with normal brainwave rhythm and requires both less time and less total energy than rTMS. A TBS session takes about three minutes on the left side and 40 seconds on the right, if needed. 

aTMS (Accelerated TMS) refers to offering more than one TMS treatment session per day. Medical research shows that aTMS can shorten the recovery process, but most insurance companies do not currently cover this method.

mTMS (maintenance TMS) is using TMS treatments once or twice per month to prolong the effect of an acute course of TMS or TBS treatment.

dTMS (deep TMS) is a type of TMS treatment associated with the Brainsway TMS device. This machine uses a magnetic coil much like that of any other TMS machine, contained within a helmet. The manufacturer reports that the magnetic field generated by a Brainsway machine penetrates more deeply into the brain than the field generated by standard MRI coils. However, angulated TMS coils used in other devices can achieve the same depth of penetration as a Brainsway helmet. The FDA considers rTMS, TBS, and dTMS to be bioequivalent. 

The TMS machine treatments are only one part of what it takes to get better. TMS does help your brain regain normal rhythms, but other changes are necessary to support those rhythms and help them become permanent. If you’ve been living with depression or another mental health condition for a long time, you will have become accustomed to making decisions and life choices with the goal of managing your symptoms, rather than thriving. As your brain improves, you will need to alter your approach to life in order to prevent a relapse.

At the Southern Colorado TMS Center, we offer the following as part of our full treatment program: weekly life skills and decision-making classes, acupressure or acupuncture stress relief sessions, and heartmath breathing regulation training to help manage stress and anxiety. Each patient is also expected to be in individual psychotherapy during the nine-week treatment process. Your therapist will play an important role in helping you learn how to manage the new feelings that will emerge as your brain normalizes and you become less numb to your emotions. 

This comprehensive plan of treatment, minus your individual therapy, is provided at no additional charge as part of your TMS experience.