I started working at Mid City TMS in February 2022. I had learned about Transcranial Magnetic Stimulation (TMS) in one of my psychology classes at Dartmouth. I thought the concept was super fascinating. Basically, a machine sends an electromagnetic pulse through the skull into the brain. This energy acts to activate the neurons in the area of the brain that is underactive in people with Major Depressive Disorder. The hope is that by constantly stimulating the area (5 days a week for 36 days), the brain area will “learn” to be more active. This is called neuromodulation. TMS is used for people who have “treatment resistant depression.” In other words, they have tried several different medications, augmentation therapies, and/or psychotherapies (CBT/DBT), and have not achieved any relief from their depressive symptoms. TMS provides relief in about 60-80% of these patients. While not perfect, these numbers are higher than the success rate of SSRIs (a common antidepressant).
Over my 6 months working at the clinic, I have learned a lot about how difficult this disease is to treat. While some symptoms of depression are fairly consistent across patients, others are impossibly dissimilar. The disease takes hold of people in unique ways. While one person cannot fall asleep, the other sleeps way too much. While one person overeats, the other does not eat enough. What is debilitating for one patient is tolerable for another. This means that everyone diagnosed with depression undergoes a different course of treatment. Think about how crazy that is…they are all diagnosed with the same illness, yet all of their treatments are different.
Yet, by targeting the same area of the brain with TMS, we are able to provide relief for 60-80% of people with treatment resistant depression. I think this shows just how complicated the brain is. These patients have different symptoms, but the left-dorsal-lateral prefrontal cortex (LDLPFC) is underactive for all them. This means two things: 1) underactivation of the LDLPFC presents differently in individuals, and 2) brain activity is not the only thing underlying this disease.
TMS amazes me. In 36 treatments, people’s scores on the Beck Depression Inventory have gone from 50 to 20 (as an example). In other words, people come in with severe depression and leave with moderate/mild depression. For people who have battled depression for decades, this is pretty good.
Unfortunately, TMS does not cause complete remission. About 30-40% of our patients return year after year for further TMS treatments. The depression sneaks its way back, causing people to need further treatments. Does this make me less positive about TMS? Yes, but only slightly. I would still recommend it to someone who has been failing to find relief from other treatment options. I would just make sure they went in to treatment with the right understanding of how TMS works and how likely it was to succeed.
Overall, the success rate of TMS proves how complex depression is as an illness. We can’t just zap people and make them happy. Maybe we will figure out how to do that one day, but for now, we can continue to do our best to support those battling this disease. We can continue to experiment with novel treatments. We can continue to do research. And most importantly, we can continue to break the stigma around mental health.