This website is made possible by third party financial support from Sage Therapeutics, Inc. and Biogen Inc.

This website is made possible by third party financial support from Sage Therapeutics, Inc. and Biogen Inc.

Transcranial Magnetic Stimulation Therapy in Depression and Refractory Depression

Transcranial Magnetic Stimulation Therapy in Depression and Refractory Depression

September 15, 2022

Ashley Hanson, a Physician Assistant with a Master’s Degree in Public Health, describes her experiences as a technician administering transcranial magnetic stimulation to patients with major depressive disorder.

crying face
Remote video URL

Ashley Hanson, a Physician Assistant with a Master’s Degree in Public Health, describes her experiences as a technician administering transcranial magnetic stimulation to patients with major depressive disorder.

Transcript:

Hi, my name's Ashley. I am a recent graduate from Touro University, where I graduated with my physician assistant and master's in public health degree. I am one of the 2022 Elevate Scholars, and I'll be talking a little bit about my experience with TMS. Before PA school, I was actually a TMS technician for 2 years, so I got to work with patients directly and saw the effects of TMS on a really personal level with the patients.

What is TMS and how is it currently used to treat depression?

So, basically, how TMS works is that it sends a current through a metal coil placed on the patient's head, and it generates rapidly alternating magnetic fields. It passes through the skull and induces an electrical current, and it depolarizes neurons in the brain. This magnetic field is pretty comparable to an MRI. Generally, for depression, the area of the brain that's targeted is the left dorsal lateral prefrontal cortex, but other areas may be targeted depending on the indication that you're using TMS for. And repetitive TMS, it has similar molecular effects to ECT, so increasing of monoamine turnover, normalization of the HPA axis, but unlike ECT, it doesn't require anesthesia and there's no side effect of memory loss.

Do patients have any preconceived perceptions of this treatment; ie symptoms resolution, rapid remission?

Like many other medical treatments, I feel patients have a lot of thoughts about the treatment. They don't realize how long it is. Sometimes, average treatment for depression could be anywhere between 4 to 6 weeks, sometimes longer, and they don't realize patients have to come in every day for treatment, sessions maybe averaging around 30 minutes. Also, like other treatments, they think that after 1 treatment, they should feel the effects. But similarly to other pharmacological therapies, it takes a few weeks before they start noticing the difference. Then, from my experience, I also noticed that sometimes patients confuse it with ECT, and [those are] some of the preconceived notions that they have.

Does TMS have any contraindications?

Some of the contraindications: patients with high risk of seizures, if they have implanted metallic hardware, such as a pacemaker, cochlear implants, and just basically any other implanted electrical devices.

Can TMS treat any other disorders aside from depression?

When I was a TMS technician, actually, it was only indicated for depression, but since then, they actually approved it for OCD in 2018, and more recently approved for smoking cessation and anxious depression.

Any final thoughts?

From my experience as working with the TMS technician, so I'm working with the patients on a daily basis, I saw the progression of patients with mostly refractory depression get better, which is amazing. I think it's always good to have multiple treatment options for patients, so the more options you have for them, the better. Then, I think it's also really important to explain the treatment in a way that the patient can understand. Again, like I said earlier, it's a longer course. It's a big time commitment, so it's important that patients know what they're getting into, and I think that it's really important to be supportive to the patient and be there, because that also affects how well their treatment's going to go.