TMS Plus Therapy

3 Minute Read

By Dr. Bowarshi

Florida TMS Clinic

We already established that TMS therapy is an effective alternative for treating depression and other psychiatric disorders. We also know that psychotherapy is also useful in treating depression and other psychiatric disorders. How about combining both Transcranial Magnetic Stimulation plus Psychotherapy? Is it better than TMS alone or psychotherapy alone? In this blog post, you will learn the fact about combined TMS plus Psychotherapy.

TMS therapy was FDA cleared in 2008 to treat depression that doesn’t respond to psychotherapy and medications. Deep TMS therapy was FDA cleared for adjunct treatment of OCD in 2017. That “adjunct” was added because of the design of the trial that granted the approval. In that trial, the patient will go through the provocation of obsessions before starting the TMS treatment session. It seems that getting the “state of mind” to a certain level of activation in specific brain pathways was necessary to induce the therapeutic effect of TMS. 

That same phenomenon of prepping the state of activity of the brain was necessary to show the efficacy of deep TMS as an adjunct treatment for smoking cessation. Which also got FDA clearance in 2020. Both of the above examples hint that the active brain is more responsive to stimulation than a non-active one. This forms the basis of why TMS Therapy + Psychotherapy Can be superior to either one alone. 

Let’s examine the evidence!

Combining transcranial magnetic stimulation with psychotherapy

In combination with psychotherapy, response and remission rates may have the potential to increase further and sustain long-lasting effects. In a large study, Dr. Donse and colleagues reported that TMS and psychotherapy’s simultaneous application resulted in a 66% response and a 56% remission rate at the end of treatment with 60% sustained remission at a 6-month follow-up.

Click here to learn how TMS works.

Behavioral activation therapy during transcranial magnetic stimulation

Behavioral Activation (BA) Therapy and Transcranial Magnetic Stimulation (TMS) have each been shown to be effective in the treatment of adult outpatients with major depressive disorder (MDD). Combining both treatments may produce synergistic antidepressant outcomes. A group of researchers at Brown University reported their data on this methodology in 2018. They concluded that incorporating a modified version of BA therapy into a standard acute course of TMS therapy is feasible, well-tolerated, and holds the potential for augmenting the efficacy of TMS treatment for patients with depression.

Dr. Kozel and colleagues at the University of South Florida combined efforts with James A. Haley Veterans' Hospital and Clinics, Tampa, FL, to study TMS plus therapy’s efficacy. They aimed to test whether repetitive Transcranial Magnetic Stimulation (rTMS) just before Cognitive Processing Therapy (CPT) would improve the clinical outcome compared to CPT alone. They did this randomized clinical trial in veterans with PTSD. The study was done on 62 participants split into two groups. The group reported that the TMS+CPT group showed more significant symptom reductions from baseline compared to CPT alone.

Conclusion

It is apparent so far that the combination of TMS plus Psychotherapy can augment the antidepressant effect of both. 

At Florida TMS Clinic, we have a strong network of psychotherapists in our area that we refer our patients to. We want our patients to maximize their chance of recovery from depression. If you are a licensed therapist in the Tampa Bay area and interested in learning more about the TMS program for your patients or are interested in helping our patients with CBT while going through TMS therapy, please contact us.

Success Rate of TMS? Click find out today.

References

Donse L, Padberg F, Sack AT, Rush AJ, Arns M. Simultaneous rTMS and psychotherapy in major depressive disorder: Clinical outcomes and predictors from a large naturalistic study. Brain Stimul. 2018 Mar-Apr;11(2):337-345. doi: 10.1016/j.brs.2017.11.004. Epub 2017 Nov 11. PMID: 29174304.

Kozel FA, Motes MA, Didehbani N, DeLaRosa B, Bass C, Schraufnagel CD, Jones P, Morgan CR, Spence JS, Kraut MA, Hart J Jr. Repetitive TMS to augment cognitive processing therapy in combat veterans of recent conflicts with PTSD: A randomized clinical trial. J Affect Disord. 2018 Mar 15;229:506-514. doi: 10.1016/j.jad.2017.12.046. Epub 2017 Dec 28. PMID: 29351885.

Russo GB, Tirrell E, Busch A, Carpenter LL. Behavioral activation therapy during transcranial magnetic stimulation for major depressive disorder. J Affect Disord. 2018 Aug 15;236:101-104. doi: 10.1016/j.jad.2018.04.108. Epub 2018 Apr 25. PMID: 29723763.

Baeken C, Brem AK, Arns M, Brunoni AR, Filipčić I, Ganho-Ávila A, Langguth B, Padberg F, Poulet E, Rachid F, Sack AT, Vanderhasselt MA, Bennabi D. Repetitive transcranial magnetic stimulation treatment for depressive disorders: current knowledge and future directions. Curr Opin Psychiatry. 2019 Sep;32(5):409-415. doi: 10.1097/YCO.0000000000000533. PMID: 31145145; PMCID: PMC6688778.