What is TMS (Transcranial Magnetic Stimulation) therapy?

TMS (Transcranial Magnetic Stimulation) is a non-invasive neuromodulation technique that works by stimulating brain cells with low-dose magnetic fields delivered through coils placed on the scalp. It has been used in psychiatric and neurological diseases since 2008, and today it offers an important option, especially in the field of mental health, for patients who do not respond to medication.

What is TMS?

A TMS device produces magnetic pulses as powerful as MRI imaging but for a shorter duration. These pulses create electrical currents in the targeted brain region, regulating cell activity. The procedure does not require anesthesia, and the patient can return to daily life on the same day.

Applications of TMS in psychiatry

Over the last 15 years, TMS has shown promising results in many psychiatric conditions resistant to conventional treatments.

Major depression

Transcranial Magnetic Stimulation is recommended as a safe and effective treatment option by the US FDA and European guidelines for adults who do not respond adequately to antidepressant medications. With the standard protocol (1 session per day, 5 days a week, for 4-6 weeks), the response rate is around 50-60%, and the full remission rate is 25-35%; in most responders, the gains are maintained for a long period (6-12 months).

The treatment does not require anesthesia; the most common side effects are temporary headache and a tingling sensation on the scalp. Therefore, in major depression patients who have not benefited from at least one or two pharmacological trials or who wish to avoid drug side effects, TMS is a non-surgical option that is better tolerated compared to electroconvulsive therapy (ECT).

Obsessive-compulsive disorder (OCD)

For patients with obsessive-compulsive disorder (OCD) who are resistant to classical pharmacotherapy and cognitive-behavioral therapy, TMS, particularly “deep TMS” which can stimulate the brain more profoundly, offers promising results.

In a multi-center study involving 219 resistant patients, the initial response rate was reported as 72.6%, and the sustained response rate one month after treatment completion was 52.4%; the response was 57.9% in those who completed 29 sessions. Systematic reviews and randomized controlled trials similarly show that active TMS provides approximately three times higher response than placebo.

The most frequently reported side effects are short-lived headache or a tingling sensation on the scalp; the risk of seizure is very low. These data indicate that TMS is a non-invasive, well-tolerated, and effective option for treatment-resistant OCD.

Post-traumatic stress disorder (PTSD)

In post-traumatic stress disorder (PTSD), TMS can clinically and significantly reduce symptom intensity in cases resistant to medication and psychotherapy. Current data from studies report that remission rates for the disorder can approach 90% with this treatment. These findings highlight TMS as a non-invasive, rapidly effective, and well-tolerated option for PTSD.

Bipolar depression

In bipolar disorder, when medications alone are sometimes insufficient, doctors may consider TMS as an additional option. It has been observed to improve well-being and provide energy, especially during depressive episodes; though rare, sessions can be adjusted under psychiatric supervision to balance the risk of manic episodes.

Substance and behavioral addictions

In substance addictions (e.g., smoking, alcohol, drugs) or behavioral addictions (e.g., gambling, internet, gaming), TMS attempts to blunt the brain’s “craving” alarm with gentle magnetic touches.

Efficacy and safety of TMS treatment

Efficacy: For depression unresponsive to standard protocols, 30-60% full or partial improvement is reported.

Safety: The most common side effects are temporary headache and scalp discomfort (a short-lived and usually mild tingling, tension, twitching, or pain sensation felt on the scalp) during the session; the risk of seizure is 1 in 10,000. No permanent cognitive side effects are expected.

How is a TMS session applied?

The first session lasts an average of 30-40 minutes; subsequent sessions last 20-30 minutes. The patient remains in a sitting position, and earplugs are used. After a personalized stimulation threshold is set, repetitive pulses are delivered to the targeted cortical point. At the end of the treatment, the patient is conscious enough to drive.

Applications in Other Medical Fields

TMS is used in neurology for conditions such as medication-refractory migraine, neuropathic pain, post-stroke motor rehabilitation, and tinnitus. In 2013, the FDA approved a single-pulse TMS device for terminating migraine attacks with aura.