Coping with depression can be overwhelming. Suffering through medication side effects while trying to find an effective combination can be emotionally and physically exhausting. Individuals living with treatment-resistant depression may benefit from alternative treatments, such as transcranial magnetic stimulation (TMS) or Deep TMS.
Deep TMS is a version of TMS that employs a different type of technology. When it comes to standard TMS vs. Deep TMS, both treatments can be effective. Understanding the differences will help you decide which option will most likely meet your needs.
Understanding TMS
TMS is a non-invasive procedure that uses the technology of magnetic fields to stimulate certain brain cells. When stimulated, these cells can decrease the symptoms of major depression. The FDA approved the marketing of TMS for depression treatment in 2008, but treatment of major depressive disorder isn’t the only use for TMS.
The technology has also been approved for the treatment of migraines, smoking cessation, and obsessive-compulsive disorder. In order to be effective for depression, the magnetic stimulation must be delivered in repeated pulses. TMS is sometimes referred to as repetitive TMS or rTMS for this reason.
When used for depression, the TMS electromagnetic coil is placed on the scalp. The coil produces pulses that stimulate the brain region that controls mood. It is believed that TMS activates the parts of the brain that display less activity during depressive episodes.
Standard TMS vs. Deep TMS
Deep transcranial magnetic stimulation is also FDA-approved for treating depression, obsessive-compulsive disorder, and tobacco addiction. DTMS also sends impulses to the brain but with improved technology. A unique and patented electromagnetic coil known as the “H-coil” stimulates deeper and broader areas of the brain.
All Points North uses dTMS technology from BrainsWay. The BrainsWay method offers a variety of coils that are each uniquely designed to treat either depression, OCD, anxiety, or smoking addiction.
DTMS is also CE-marked (conforms to standards in the European Union) to treat:
- Alzheimer’s disease
- Autism
- Bipolar disorder
- Chronic pain
- Multiple sclerosis
- Parkinson’s disease
- Post-stroke rehabilitation
- Post-traumatic stress disorder
- Schizophrenia
While approved in the EU, using dTMS to treat these conditions is considered off-label use in the United States.
What Are the Risks of Standard TMS vs. Deep TMS?
Both methods of TMS are considered generally safe. Because the procedure is non-invasive and does not include any type of surgery, it can be received as an outpatient service. Little to no downtime is required, and no anesthesia or other medications are needed.
Serious side effects are rare, especially when TMS/dTMS is administered by a trained health professional in a clinical setting. Common side effects can be mild to moderate and typically improve shortly after the session is done. For most people, the severity of side effects decreases with subsequent sessions.
Possible side effects include:
- Headache
- Tingling, twitching, or spasms in the facial muscles
- Scalp discomfort
- Lightheadedness
Speak with your provider if you experience any side effects. Adjusting the level of stimulation can reduce or eliminate symptoms. Over-the-counter pain medication may be recommended to ease discomfort. There are no known long-term side effects from TMS or dTMS.
Are TMS and DTMS Effective?
Both TMS and dTMS have been widely studied and are considered effective for treating the conditions for which they are FDA-approved. A report from the National Library of Medicine concluded that the trials and literature on TMS confirm the treatment’s efficacy.
Over 60 clinical studies have been conducted on Deep TMS. Not only is the treatment approved by the FDA, but it is also available in Europe and South America. As a treatment for medication-resistant depression, dTMS has a high response rate.
Advantages: Standard TMS vs. Deep TMS
TMS is effective, but Deep TMS offers several benefits that standard TMS can’t. BrainsWay’s coil technology allows for the activation of more neurons per treatment. With all methods of TMS, the intensity of stimulation decreases as it goes deeper into the brain.
The unique H-coil maintains effective levels of stimulation while reaching deeper into the brain than standard TMS. This can be especially important for older patients who often require deeper penetration for a therapeutic effect.
Effective Dose Delivery
The innovative technology of Deep TMS allows for the patient’s scalp to have consistent contact with the cushioned helmet. Securing the coil to the patient’s head ensures more reliable clinical outcomes by reducing the chances that the coil will move during the therapy session, even when the patient does.
Reliable Clinical Experience
According to the manufacturer, the BrainsWay system has been validated in over 60 controlled trials involving more than 3,000 patients. More randomized controlled trials are currently ongoing. Almost 600 BrainsWay systems are in use across North America, and nearly 100,000 patients have received treatments in over 2.5 million sessions.
Reduced Likelihood of Errors
The coils used in Deep TMS generate a larger magnetic field than those used in standard methods. With standard TMS treatment, a small mistake in positioning — as little as 1mm — can decrease the effectiveness.
With Deep TMS, the likelihood of missing the target is greatly reduced, and so is the need for expensive MRI-based navigation.
Superior Comfort
Standard TMS units require patients to sit in a specific treatment chair with their heads immobilized. The H-coils of the BrainsWay system are integrated into a cool, cushioned helmet that allows the patient to remain mobile if they wish.
This flexibility makes it easier for patients with mobility issues, including those in wheelchairs, to receive DTMS.
Proven Increased Effectiveness
The only independent study that compared standard TMS vs. Deep TMS head-to-head concluded that DTMS, along with standard depression medications, was significantly more effective for reducing the symptoms of major depressive disorder.
In addition, Deep TMS presents no additional risks or tolerability issues when compared to standard TMS. Individuals who have tried TMS with little or no results may be good candidates for Deep TMS.
Who Qualifies for TMS/dTMS Treatment?
To prepare for a TMS or DTMS appointment, you will need to have a physical exam and mental health evaluation. These steps are necessary to ensure TMS treatment is safe for you. Make sure to tell your provider if you are pregnant or trying to become pregnant or if you have:
- Implanted stimulators or electrodes
- Cochlear implants
- Bullet fragments or any other metal devices implanted in your body
- A history of seizures
- Frequent headaches or migraines
- Brain damage caused by injury or illness
- Substance use disorders or other mental health concerns
- Other medical conditions
Make sure to tell your provider about any medications, including supplements, vitamins, over-the-counter medications, or illicit drugs, you take.
Having any of these conditions doesn’t automatically mean you are excluded from receiving TMS/dTMS. In fact, most TMS/dTMS patients are seeking treatment because they have a mental illness or other condition that is resistant to medication.
Your provider needs to have a full understanding of your health history to confirm you are a good candidate for TMS therapy and that it can meet your needs.
What to Expect During Your First TMS/dTMS Treatment
Whether you are trying standard TMS or Deep TMS, the process is the same. The procedure will be done in a clinical setting after you complete a thorough health evaluation. After an evaluation, your provider will discuss treatment options, payment, and insurance coverage.
You can expect the first appointment to last approximately 60 to 90 minutes. Your provider will allow time to answer questions, discuss your expectations, and complete any further assessments. Mapping your brain is also included in the first visit. Subsequent appointments will only take about 20 minutes.
While there is no anesthesia used and no requirement to arrange for a ride home, you may prefer not to drive yourself after the initial session just in case you experience side effects.
Inside the treatment room, you will sit comfortably as the technician places a helmet containing the electromagnetic coil on your head. You will feel a tapping sensation and hear clicking as the coil prepares to deliver stimulating pulses.
Once the coil has located the proper brain region, treatment will begin. The coil alternates between weak and strong pulses in the treatment area. Stimulation patterns vary according to each individual’s treatment needs.
Regardless of the pattern, you will hear a clicking sound and feel tapping on your scalp. You may experience some slight scalp discomfort during the treatment, which may last as little as 3.5 minutes and up to 20 minutes.
When the treatment is complete, you may return to work or perform other normal daily activities.
How Many Treatments Are Needed?
Each person’s treatment plan is different, but it may require as many as 36 sessions over 12 weeks to reactivate neurotransmitters. You may begin to notice improvement in your mood at any time during the course of treatment. The greatest effects occur two to six weeks after the last TMS session.
Comparing the Results of Standard TMS vs. Deep TMS
There is no guarantee that either TMS or dTMS will work for every person. If the treatment is effective, depression symptoms may not go away completely. Because of the advantages offered by Deep TMS, this method provides a greater likelihood of symptom relief. However, with both treatments, it is common for patients to continue to use antidepressant medications and participate in talk therapy.
For those for whom TMS/dTMS is effective, a decrease in symptoms may be noticed in as little as a few weeks after starting treatment. If standard or Deep TMS does alleviate your depression for at least two months, you can undergo repeated sessions if symptoms reoccur.
Can Deep TMS Help You?
Transcranial magnetic stimulation (TMS) is a treatment that uses magnetic pulses to stimulate neurotransmitters that become inactive when a person is depressed. Deep transcranial magnetic stimulation (dTMS) is a type of TMS that involves specific technology that allows for stronger doses at deeper levels of the brain. Both treatments are non-invasive and considered safe for most people.
Both have been found effective for treating medication-resistant depression and other conditions, such as OCD and smoking addiction. However, Deep TMS offers several advantages when compared to standard TMS.
Deep TMS provides better patient comfort and more effective dosage delivery. The technology decreases delivery errors, and the potential for deeper stimulation may help more people who need mental health treatment.
TMS and dTMS both require several sessions over several weeks to be fully effective, but you may notice improvement in symptoms after just a few sessions. Most healthy people are good candidates for TMS/dTMS, but a physical and mental health evaluation is necessary before treatments can begin.
If improvement of your depression symptoms lasts at least two months after completing TMS/dTMS treatment, you may be eligible to repeat a second course of treatment.
To learn more about Deep TMS and the BrainsWay technology call us at 424.644.6486 or fill out our online contact form.
References
- “Deep TMSTM vs TMS: What Is the Difference?” BrainsWay, 10 July 2024, www.brainsway.com/how-does-it-work/build-deep-vs-traditional-tms/.
- Filipčić I, Šimunović Filipčić I, Milovac Ž, Sučić S, Gajšak T, Ivezić E, Bašić S, Bajić Ž, Heilig M. Efficacy of repetitive transcranial magnetic stimulation using a figure-8-coil or an H1-Coil in treatment of major depressive disorder; A randomized clinical trial. J Psychiatr Res. 2019 Jul;114:113-119. doi: 10.1016/j.jpsychires.2019.04.020. Epub 2019 Apr 26. PMID: 31059991.
- McClintock, Shawn M et al. “Consensus Recommendations for the Clinical Application of Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Depression.” The Journal of clinical psychiatry vol. 79,1 (2018): 16cs10905. doi:10.4088/JCP.16cs10905