PROS & CONS OF TMS THERAPY

If you are looking for the pros and cons of TMS therapy, then you are probably considering TMS therapy as an alternative treatment modality for depression. You want to weigh the benefits vs. the risks of TMS therapy, especially compared to other treatment options available today. In this article, I will walk you through the seven practical pros and cons of TMS therapy, which every depression patient should be aware of when considering TMS therapy for depression. In the end, you will have a table or list comparing the pros and cons of TMS therapy.

Unlike most treatment options for depression (except for talk therapy), TMS is the least invasive treatment method for depression. Other alternative treatments for depression, like ECT, deep brain stimulator, or vagal nerve stimulator, are significantly more invasive. And yes, I am comparing TMS to SSRIs antidepressant, and I am clearly stating that TMS is less invasive than taking Prozac or Zoloft. You see when you take an antidepressant. That particular chemical needs to get absorbed through your GI system, get distributed in your bloodstream, metabolized by your liver, penetrate your brain, to finally cause an alteration of serotonin neurotransmitter in specific circuits of your brain. Meanwhile, it could cause all kinds of side effects because of all the other pathways it altered on the way! Oh, and did I tell you that it also needs to be broken down and excreted out of the body by your liver and kidneys?

Oh, one more thing, your brain might like that particular neurotransmitter. If, for some reason, you stop, a whole bunch of readjustments needs to happen to your body in a phenomenon we call “serotonin discontinuation syndrome”. Taking medications is anything but non-invasive. On the other hand, TMS therapy targets magnetic stimulation directly to the brain’s area responsible for depression. It is non-invasive because magnetic fields can go throughout the body without causing damage. There is none of the systemic side effects associated with medications. This leads me to the number two pro on the list.

TMS has none of the systemic side effects associated with classical antidepressants. No stomach issues, no weight gain, no sexual side effects, no dry mouth. Etc. That’s not to say that TMS is entirely free of side effects. But they are local side effects, mild, and usually go away.

Nowadays, almost all insurance companies recognize TMS therapy as a medical necessity for depression treatment when medications and therapy fail to help. This is a considerable advantage for TMS therapy compared to other alternatives like ketamine infusions. That being said, insurances sometimes have demanding criteria for their TMS coverage policy. We will go over it in the cons section.

TMS therapy doesn’t require sedation or anesthesia. Patients can continue their daily routine as usual before and after the treatment. This means patients can drive themselves to the treatment clinic from home and drive to work after TMS treatment with no issues. Compared to ECT, which requires sedation or Ketamine that could interfere with the ability to drive or work, TMS has a huge advantage here.

This is probably the best pro about TMS compared to most other alternatives. While medication antidepressants can be helpful for some, the chance of someone responding to a medication antidepressant is about one out of three. In comparison, the likelihood of someone responding to TMS therapy is two out of three.

While some medications could be habit-forming, TMS has no addictive properties. Sometimes we entertain continuing spread-out maintenance TMS sessions, but that’s to prevent a recurrent depressive episode. TMS therapy is not habit-forming. There are no discontinuation symptoms to occur after TMS is finished, while many SSRIs and SNRIs can cause serotonin discontinuation syndrome once stopped.

Unlike ECT or shock therapy, which could cause memory issues, TMS therapy doesn’t have a negative effect on cognition or memory. On the contrary, data show TMS enhances the cognitive ability of patients going through TMS. It is being looked at as an HE or a Human Enhancement technology for this particular property.

Yes. TMS therapy needs time investment. A regular TMS session takes about 19 minutes. But one will need to do a session every day, five days a week, for six weeks. That’s a total of 30 treatment sessions. Technically, this is less than 10 hours, less than the total time one should spend with a therapist for a good CBT course. A newer TMS technology called intermittent Theta Burst Stimulation can reduce each treatment session’s duration to about 3 minutes. This is a tremendous time-saving. Lastly, for the VIPs who can’t leave work daily for daily TMS, a new accelerated TMS program is available in which we do 50 treatment sessions in just five days.

We used to think 1 in 30,000 TMS treatments could lead to a benign seizure. Now, as little as 1 in 89,000 TMS treatments could lead to a seizure. This is an extremely low risk of seizure. It is lower than the risk of seizure associated with some antidepressants like Wellbutrin (Bupropion). If you have a seizure disorder, make sure your doctor is aware and discusses the safety of your TMS, which is not recommended for people with an active seizure disorder. 

Some patients may report head discomfort or mild headaches during or after TMS treatments. Usually, it goes away after a few treatment sessions as patients get used to it. For the vast majority of patients receiving TMS, it is very well tolerated.

A few insurance companies still live in the dark ages and require four antidepressants failure before approving a patient to receive TMS therapy. They do it primarily for financial reasons and referring to the STAR*D trial, a study published in 2006, two years before the FDA approved TMS. Technically, if TMS had been available in 2006, the STAR*D trial would have been considered unethical for not trying TMS at the second stage of treatment options. Thankfully many insurance providers are coming to their senses and doing the right thing. Aetna, Cigna, and United require two antidepressant failures. Tricare and Medicare require one failure of treatment before approving TMS.

While TMS clinics are becoming increasingly more available in large metropolitan areas, we still don’t have immediate TMS access in rural areas.

Florida TMS Clinic is proud to be one of the best clinics to provide TMS therapy in the Tampa Bay Area.

Many people who could benefit from TMS therapy had never heard of it before. It will take a long time before they do. Unfortunately, pharmaceutical lobbying dominates mental health care. Many commercials tell you to try new medications, but do they tell you about the alternative? 

Almost all insurance companies cover the cost of TMS therapy. This means the patient is only responsible for the co-pay, if any. That being said, TMS could be costly for patients without insurance.

Table comparing advantages and disadvantages of TMS therapy