Transcranial magnetic stimulation and depression: How does it work?

In this informative guide, highly respected clinical psychologist Dr Justin Stephenson shares his expert insight on transcranial magnetic stimulation (TMS), including its applications in the treatment of depression. The leading specialist also discusses what treatment with TMS involves and sheds light on safety concerns and success rates for patients suffering with depression.

What is the recommended treatment for depression?

If you have depression that is not improving, your GP should in the first instance recommend a talking therapy. There are different types of talking therapy for depression, such as cognitive behavioural therapy (CBT) provided by self-referral psychological therapy services such as IAPT.

If you have moderate to severe depression, antidepressant medication may be recommended. There are almost 30 different types of antidepressants, which can be prescribed by a doctor.

Your GP should recommend that you take a course of antidepressants plus talking therapy, particularly if your depression is quite severe. Generally, a combination of treatment with antidepressants and CBT is more effective than just one form of treatment.

If you are suffering from severe depression, you should be referred to a multidisciplinary mental health team. These teams should provide intensive specialist talking treatments as well as prescribed medication.

Research indicates that with intensive psychological treatment and several courses of different medication there is a 60 to 70 per cent chance of being cured of depression. However, this unfortunately means that 30 to 40 per cent of people may end up with chronic depression that is resistant to conventional treatment.

It is strongly recommended that patients who have already tried all the conventional treatment for depression or do not like the idea of taking medication should seriously consider rTMS.
 

How does Transcranial Magnetic Stimulation (TMS) work?

TMS is a strong pulsing magnetic field that stimulates brain cells. The passage of an electric current in the coil induces a transient, high-intensity magnetic pulse that penetrates the scalp and painlessly reaches the neurons of the targeted cortical area.

High frequency TMS increases activity in the brain cells of the frontal cortex of the brain. It causes increased connectivity between brain cells and the release of chemical messengers. The treatment of depression requires between 15 and 30 sessions administered over several weeks.

What are the recommendations for TMS?

The Food and Drug Administration (FDA) approved TMS for the treatment of depression in the USA in 2008 following extensive research with multiple randomised controlled studies. The National Institute for Health and Care Excellence (NICE) approved TMS for depression in the UK in 2015 and noted a “consistently positive outcomes in many studies and a good safety profile… commentary from patients was positive and they described significant benefits to their quality of life including the advantages for some patients of being able to stop oral antidepressant medications”.

In 2017, the Royal College of Psychiatrists stated that the “efficacy for rTMS treatment for major depression has been well established over the recent years….over the past decade rTMS has been widely used for the treatment of depression and is now an established safe and effective treatment option for depression and treatment resistant depression.”

How effective is TMS for the treatment of depression?

In a case series from September 2022 involving 276 patients treated at Smart TMS for major depression, who had already failed to respond to psychological treatment and antidepressant medication, seven out of ten (70 per cent) patients saw an improvement in their symptoms of 20 per cent or more.

Furthermore, five out of ten (52 per cent) went into remission and so no longer fulfilled the diagnostic criteria for a depressive illness. Finally, three out of ten (30 per cent) patients completely abolished all of their symptoms of depression. These results are generally better than those reported in the scientific literature.

In 2012, Carpenter reviewed 307 patients treated at 42 TMS clinics in the USA and found that the remission rate for patients with depression was 40 per cent.

Smart TMS is one of the UK’s leading providers of transcranial magnetic stimulation treatment for a range of conditions, with clinic locations in London, Bristol, Edinburgh, Manchester, Birmingham, Norwich and Southampton.

If you think you could benefit from treatment with TMS and wish to schedule an appointment, visit Dr Stephenson’s Top Doctors profile today.