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TMS therapy is known to be helpful in depression, anxiety, OCD and smoking cessation. It can also be helpful in Bipolar Disorder, PTSD, and Autism Spectrum. In this article, I will explain the conditions that TMS therapy can work for.
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how TMS works.
Though depression is the main indication for TMS therapy, there are many other uses for TMS therapy. Below I will walk you through most of the current TMS therapy uses, both FDA-cleared and off-label uses.
TMS therapy is indicated for the treatment of
Major Depressive Disorder
in adult patients who have failed to receive satisfactory improvement from prior antidepressant medication in the current episode. Also, TMS therapy is FDA-cleared for the treatment of
OCD
in adult patients who have failed to receive satisfactory improvement from prior treatments. Also recently dTMS therapy got FDA-cleared for smoking cessation therapy. TMS is used off label for many other psychiatric disorders like
anxiety
and PTSD.
TMS Therapy is used when talk therapy and antidepressant medications fail to achieve a satisfactory improvement in depressive symptoms. This means that as of 2020 TMS is reserved for severe cases of depression.
Success Rate of TMS Therapy?
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Yes. In fact, It works better than any antidepressant for those suffering from
Treatment Resistant Depression
or TRD. About two out of three patients respond to TMS therapy. About one third will experience a remission of their depressive symptoms.
Yes. We have plenty of data to support the effectiveness of
TMS for anxiety treatment.
That being said, TMS is not FDA-approved for anxiety yet. That is because the anxiety trials were not large enough. Low-frequency right-sided TMS therapy is used for anxiety.
The main ones now are Depression, Anxiety, OCD, and smoking cessation. The current focus is headed towards PTSD, ADHD, Bipolar, and Schizophrenia. Also, TMS there are data supporting the use of TMS for addiction disorders like cocaine use disorder. This is being investigated for other neuropsychiatric disorders like fibromyalgia, chronic pain, insomnia, and dementia.
Yes. A particular type of TMS called Deep Transcranial Magnetic Stimulation is
FDA cleared for OCD. It is done using a machine called BrainWay with a particular H7 coil. Recently, in August 2020 another TMS coil made by MagVenture was FDA cleared for the
treatment of OCD.
Bipolar Disorder is, fundamentally, the combination of depression and mania. Many bipolar patients can experience long periods of severe depressive episodes. TMS can be used during severe depressive episodes that don’t respond to medication treatment. That being said, there might be a risk of inducing a manic episode. Close monitoring is very important. The FDA recently in March 2020 granted a TMS device breakthrough designation for
TMS for bipolar depression.
Yes. TMS can be helpful in postpartum depression. There is no contraindication for TMS in the postpartum phase or with breastfeeding mothers. That being said, there is no specific FDA clearance for TMS for the indication of postpartum depression.
Depression could happen during pregnancy not only postpartum. That’s why we are using a new terminology now for depression related to pregnancy as peripartum depression. It is very common that we get asked if TMS can help depressed pregnant women. The answer is; Yes. TMS can be used during pregnancy. The initial clinical trials for TMS excluded pregnant women, later trials looked into the safety and efficacy of TMS during pregnancy and no absolute contraindication was reported. The magnetic coil is far enough not to cause any harm to the fetus. That being said, there is no specific FDA clearance for TMS for the indication of peripartum depression.
Yes. There are many studies that investigated the use of TMS to treat PTSD. Most showed good results. Some used the same depression protocol of high frequency Left DL-PFC stimulation and others used a different protocol with low-frequency TMS to the right DL-PFC (commonly used for anxiety). That being said, TMS is not FDA-cleared for PTSD for the lack of a large enough randomized controlled trial. The use of TMS for PTSD is considered off-label.
It is being studied. Some results are promising. It needs further investigation though.
Possibly. We have some data for the use of low frequency transcranial magnetic stimulation for the treatment of mild cases of Autism.
Possibly. There was a study that was done at the VA that showed some promise in TMS for tinnitus. That being said, all patients should use earplugs for hearing protection. Exposure to chronic noise could cause hearing loss or tinnitus. This is different from the use of TMS to treat tinnitus which works on neuromodulation of the hearing centers of the brain.
Yes. Preliminary data are currently being revealed proving the effect of TMS for smoking cessation. This will be huge as cigarette smoking is the number one preventable mortality cause in the USA. Helping patients quitting smoking with TMS will open the door wide open for the general public acceptance of majestic therapy or neuromodulation.
August 2020 Update. dTMS is now FDA-cleared for the indication of smoking cessation.
There are some data that support the use of TMS for fibromyalgia and central chronic pain. It is worth noting that Theta Burst Stimulation or iTBS in particular seems to have promising success for fibromyalgia and chronic pain.
There is a single pulse TMS device (eNeura) that has FDA-clearance for migraine headaches. It is different from the device we use for depression which is repetitive transcranial magnetic stimulation.
It is certainly being evaluated for that. There had been a special interest in TMS for reasons of cognitive enhancement. Some trials are looking into performance enhancement with TMS among athletes and surgeons.
TMS is evaluated for Insomnia, Chronic Pain, Fibromyalgia, Movement Disorders, Tinnitus. Also, there is a promise in the early stages of dementia.
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