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When Antidepressants Don’t Work, TMS May Be an Option


Depression (major depressive disorder) is a common and serious medical illness that affects how you feel, the way you think and how you act. An estimated one in six people (16.6 percent) will experience depression at some time in their life. Some research shows that one-third of women will experience a major depressive episode in their lifetime.

For many people, antidepressants provide relief from symptoms, but for others antidepressants do not work or they have difficulty with side effects of the medication. For some, repetitive transcranial magnetic stimulation (rTMS) may be an option.


TMS is a treatment that uses magnetic pulses to stimulate specific areas of the brain affected by depression. An electromagnetic coil is placed on the scalp and short magnetic pulses are administered through the coil. This simulates nerve cells in the targeted part of the brain.

TMS was approved by the Food and Drug Administration in 2008, and has been recommended by the American Psychiatric Association since 2010 for use in people with major depression who have not responded to at least one antidepressant medication.

The treatment does not require anesthesia—patients are awake during the treatment. After treatment, there is no recovery period and people can immediately get back to normal activities.

TMS is prescribed by a physician and the procedure is done by a physician or trained technician supervised by a physician. The patient is awake during the procedure and can return to normal activities right after the treatment. Because the TMS machine is loud, patients are given ear plugs during the procedure.

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The TMS procedure typically lasts 30 to 40 minutes and treatment usually involves sessions five days a week for four-to-six weeks.

Common side effects include headaches and painful scalp sensations. These are usually temporary and diminishing after the first week of treatment.

TMS is often used along with antidepressant medications or psychotherapy. Many people also find practices such as mindfulness meditation, breathing exercises, progressive muscle relation helpful. TMS is covered by most private insurance plans and by Medicare and Tricare.

TMS treatment has been shown effective for depression in numerous studies including more than a dozen meta-analyses. However, TMS is not a cure and often ongoing treatment is needed to prevent the depression from returning.

TMS psychiatrist Kenneth Pages noted in a recent Psychiatric News article: “In my practice, the effectiveness of TMS mirrors results from the clinical trials. About 65 percent of patients respond to the treatment and 35 percent go to remission of their symptoms. On average, these patients have not seen success with upwards of nine antidepressants, and the average length of their current depressive episode is three to five years.”

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