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Transcranial Magnetic Stimulation (TMS) Therapy

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This publication is based on a Mind UK publication and the original version may be found here: https://www.mind.org.uk/information-support/a-z-mental-health/

Thank you to Mind UK for sharing their valuable content with us. Content included in Mental Health A-Z is made available free of charge and does not form part of any commercial activity. The adaptation has been done independently by Mind HK and is intended for general information purposes only.

What is TMS?

There is a growing body of evidence that suggests TMS can be offered as an effective, non-invasive and safe treatment alternative, for treating mental illnesses such as depression. The treatment uses magnetic fields to stimulate areas of the brain that are involved in mood regulation, and is typically used in the treatment of depression when medication has been unsuccessful, or not been well-tolerated.

TMS therapy has been approved by the US Food and Drug Administration (FDA) for the treatment of Major Depressive Disorder (MDD) since 2008 [1-3], and has been approved by the National Institute for Health and Care Excellence (NICE) in the UK. Like psychotherapy and antidepressants, TMS therapy is a well-established effective treatment for depression, and being widely used all over the world.

Neuroscience research have shown that the left dorsolateral prefrontal cortex is underactive in depression [4-6] and results in symptoms of low mood and anhedonia (inability to feel pleasure in normally pleasurable activities). TMS is a procedure that uses magnetic fields to simulate the dorsolateral prefrontal cortex and restoration of normal mood [7-11].

TMS session

A typical course of TMS therapy consists of treatments that are 30-40 minutes in duration, 5 days per week for 4-6 weeks. Patients will remain awake and sit comfortably in a recliner during the TMS session. After each session patients may resume their normal daily activities including driving or returning to work/school.

As with any type of treatment, there is a chance of experiencing side effects. In most cases, this may include headaches and scalp discomfort at the site of stimulation, and mild facial muscle twitching during treatment. A small number of individuals may experience a seizure upon receiving TMS. In the event of any adverse effects, such as a seizure, you should be medically reviewed before any further treatment is offered, and advised on how to manage these problems.

TMS therapy may not be suitable if patients have an implanted medical device, metal in your head, a history of seizure or neurological disorder. Consult a doctor or a TMS specialist for more information.

 

Reference

  1. O’Reardon, J. P., Solvason, H. B., Janicak, P. G., Sampson, S., Isenberg, K. E., Nahas, Z., . . . Sackeim, H. A. (2007). Efficacy and Safety of Transcranial Magnetic Stimulation in the Acute Treatment of Major Depression: A Multisite Randomized Controlled Trial. Biological Psychiatry, 62(11), 1208-1216.
  2. Lisanby, S. H., Husain, M. M., Rosenquist, P. B., Maixner, D., Gutierrez, R., Krystal, A., . . . George, M. S. (2009). Daily left prefrontal repetitive transcranial magnetic stimulation in the acute treatment of major depression: Clinical predictors of outcome in a multisite, randomized controlled clinical trial. Neuropsychopharmacology, 34(2), 522-534.
  3. Carpenter, L. L., Janicak, P. G., Aaronson, S. T., Boyadjis, T., Brock, D. G., Cook, I. A., . . . Demitrack, M. A. (2012). Transcranial Magnetic Stimulation for Major Depression: A Multisite, Naturalistic, Observational Study of Acute Treatment Outcomes in Clinical Practice. Depression and Anxiety, 29(7), 587-596.
  4. Baxter, L. R., Jr., Schwartz, J. M., Phelps, M. E., Mazziotta, J. C., Guze, B. H., Selin, C. E., . . . Sumida, R. M. (1989). Reduction of prefrontal cortex glucose metabolism common to three types of depression. Arch Gen Psychiatry, 46(3), 243-250. doi:10.1001/archpsyc.1989.01810030049007
  5. Bench, C. J., Friston, K. J., Brown, R. G., Scott, L. C., Frackowiak, R. S., & Dolan, R. J. (1992). The anatomy of melancholia–focal abnormalities of cerebral blood flow in major depression. Psychol Med, 22(3), 607-615. doi:10.1017/s003329170003806x
  6. George, M. S., Ketter, T. A., & Post, R. M. (1994). Prefrontal cortex dysfunction in clinical depression. Depression, 2(2), 59-72. doi:https://doi.org/10.1002/depr.3050020202
  7. Hadas, I., Sun, Y., Lioumis, P., Zomorrodi, R., Jones, B., Voineskos, D., . . . Daskalakis, Z. J. (2019). Association of Repetitive Transcranial Magnetic Stimulation Treatment With Subgenual Cingulate Hyperactivity in Patients With Major Depressive Disorder: A Secondary Analysis of a Randomized Clinical Trial. JAMA Network Open, 2(6), e195578-e195578.
  8. Eshel, N., Keller, C. J., Wu, W., Jiang, J., Mills-Finnerty, C., Huemer, J., . . . Etkin, A. (2020). Global connectivity and local excitability changes underlie antidepressant effects of repetitive transcranial magnetic stimulation. Neuropsychopharmacology.
  9. Weigand, A., Horn, A., Caballero, R., Cooke, D., Stern, A. P., Taylor, S. F., . . . Fox, M. D. (2018). Prospective Validation That Subgenual Connectivity Predicts Antidepressant Efficacy of Transcranial Magnetic Stimulation Sites. Biol Psychiatry, 84(1), 28-37. doi:10.1016/j.biopsych.2017.10.028
  1. Rosen, A. C., Bhat, J. V., Cardenas, V. A., Ehrlich, T. J., Horwege, A. M., Mathalon, D. H., . . . Yesavage, J. A. (2021). Targeting location relates to treatment response in active but not sham rTMS stimulation. Brain Stimulation, 14(3), 703-709.
  2. Modak, A., & Fitzgerald, P. B. (2021). Personalising transcranial magnetic stimulation for depression using neuroimaging: A systematic review. The World Journal of Biological Psychiatry, 1-23. doi:10.1080/15622975.2021.1907710
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Improving Access to Community Therapies (iACT®) is one of the services from Mind HK. Trained Wellbeing Practitioners will offer initial assessment and early intervention for people dealing with mild to moderate symptoms of depression, anxiety, or other emotional difficulties.

 

The service includes 6-8 sessions of low-intensity psychological support, the flexibility of the service allows individuals to receive free and timely support when needed.

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This programme welcomes anyone between the ages of 18 and 65 who may be feeling lost or facing emotional difficulties. Please note that this programme is not suitable for individuals diagnosed with severe or complex mental health conditions.

This programme is not suitable for individuals diagnosed with severe or complex mental health conditions, but suitable for those who experience mild to severe moderate anxiety, mild to moderate depression, or other emotional challenges. If you are currently experiencing a major setback or even having thoughts of suicide or self-harm, please visit the “Find Help Now” page on our Mind HK’s website for immediate information and services.

After signing up, our Wellbeing Practitioner will contact you within two weeks to schedule a convenient time for a 45-minute conversation, either via video or phone call, according to your preference. During the conversation, the Wellbeing Practitioner will understand your current situation and help you gain a better understanding of your emotional state based on the questionnaire you filled out during application. Additionally, they will provide recommendations for appropriate community resources based on your needs, helping you take an important first step in taking care of your mental health.

Although the intervention procedure is mostly standardised, Wellbeing Practitioners will work flexibly with clients to address individual presenting problems and unique characteristics.

Our Wellbeing Practitioners are trained to support people who experience mild to moderate mental health difficulties primarily. This programme is not suitable for the situations mentioned above. If you are currently experiencing a major setback or even having thoughts of suicide or self-harm, please visit the “Find Help Now” page on our Mind HK’s website for immediate information and services.

Your conversations with the Wellbeing Practitioner are absolutely confidential. Any information about you will not be shared with anyone without your consent unless you or others are at immediate risk or the Wellbeing Practitioner has reason to believe that you may be in imminent danger.
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For adults who are suitable for this service, all Wellbeing Practitioners have received training on how to identify and respond to safety and risk issues. If you have any concerns about the support process, the Wellbeing Practitioners have appropriate measures in place and will develop response plans based on the urgency of the situation. They can also access support from clinical practitioners from Mind HK or participating organisations.

What private training does Mind HK provide?

Mind HK provides 4 themes of mental health training, including: Supporting Self, Supporting Others, Family Wellbeing and DEI (Diversity, Equity and Inclusion).

 

Check out the brochure here for more information.

Mind HK provides a wide range of standardised mental health training, which can be tailored to different circumstances. Chat with our team to explore more! 

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We are here to support your mental health education journey! Reach out to us and chat with our team.

What is TMS?

What is TMS?

There is a growing body of evidence that suggests TMS can be offered as an effective, non-invasive and safe treatment alternative, for treating mental illnesses such as depression. The treatment uses magnetic fields to stimulate areas of the brain that are involved in mood regulation, and is typically used in the treatment of depression when medication has been unsuccessful, or not been well-tolerated.

TMS therapy has been approved by the US Food and Drug Administration (FDA) for the treatment of Major Depressive Disorder (MDD) since 2008 [1-3], and has been approved by the National Institute for Health and Care Excellence (NICE) in the UK. Like psychotherapy and antidepressants, TMS therapy is a well-established effective treatment for depression, and being widely used all over the world.

Neuroscience research have shown that the left dorsolateral prefrontal cortex is underactive in depression [4-6] and results in symptoms of low mood and anhedonia (inability to feel pleasure in normally pleasurable activities). TMS is a procedure that uses magnetic fields to simulate the dorsolateral prefrontal cortex and restoration of normal mood [7-11].

TMS session

A typical course of TMS therapy consists of treatments that are 30-40 minutes in duration, 5 days per week for 4-6 weeks. Patients will remain awake and sit comfortably in a recliner during the TMS session. After each session patients may resume their normal daily activities including driving or returning to work/school.

As with any type of treatment, there is a chance of experiencing side effects. In most cases, this may include headaches and scalp discomfort at the site of stimulation, and mild facial muscle twitching during treatment. A small number of individuals may experience a seizure upon receiving TMS. In the event of any adverse effects, such as a seizure, you should be medically reviewed before any further treatment is offered, and advised on how to manage these problems.

TMS therapy may not be suitable if patients have an implanted medical device, metal in your head, a history of seizure or neurological disorder. Consult a doctor or a TMS specialist for more information.

 

Reference

  1. O’Reardon, J. P., Solvason, H. B., Janicak, P. G., Sampson, S., Isenberg, K. E., Nahas, Z., . . . Sackeim, H. A. (2007). Efficacy and Safety of Transcranial Magnetic Stimulation in the Acute Treatment of Major Depression: A Multisite Randomized Controlled Trial. Biological Psychiatry, 62(11), 1208-1216.
  2. Lisanby, S. H., Husain, M. M., Rosenquist, P. B., Maixner, D., Gutierrez, R., Krystal, A., . . . George, M. S. (2009). Daily left prefrontal repetitive transcranial magnetic stimulation in the acute treatment of major depression: Clinical predictors of outcome in a multisite, randomized controlled clinical trial. Neuropsychopharmacology, 34(2), 522-534.
  3. Carpenter, L. L., Janicak, P. G., Aaronson, S. T., Boyadjis, T., Brock, D. G., Cook, I. A., . . . Demitrack, M. A. (2012). Transcranial Magnetic Stimulation for Major Depression: A Multisite, Naturalistic, Observational Study of Acute Treatment Outcomes in Clinical Practice. Depression and Anxiety, 29(7), 587-596.
  4. Baxter, L. R., Jr., Schwartz, J. M., Phelps, M. E., Mazziotta, J. C., Guze, B. H., Selin, C. E., . . . Sumida, R. M. (1989). Reduction of prefrontal cortex glucose metabolism common to three types of depression. Arch Gen Psychiatry, 46(3), 243-250. doi:10.1001/archpsyc.1989.01810030049007
  5. Bench, C. J., Friston, K. J., Brown, R. G., Scott, L. C., Frackowiak, R. S., & Dolan, R. J. (1992). The anatomy of melancholia--focal abnormalities of cerebral blood flow in major depression. Psychol Med, 22(3), 607-615. doi:10.1017/s003329170003806x
  6. George, M. S., Ketter, T. A., & Post, R. M. (1994). Prefrontal cortex dysfunction in clinical depression. Depression, 2(2), 59-72. doi:https://doi.org/10.1002/depr.3050020202
  7. Hadas, I., Sun, Y., Lioumis, P., Zomorrodi, R., Jones, B., Voineskos, D., . . . Daskalakis, Z. J. (2019). Association of Repetitive Transcranial Magnetic Stimulation Treatment With Subgenual Cingulate Hyperactivity in Patients With Major Depressive Disorder: A Secondary Analysis of a Randomized Clinical Trial. JAMA Network Open, 2(6), e195578-e195578.
  8. Eshel, N., Keller, C. J., Wu, W., Jiang, J., Mills-Finnerty, C., Huemer, J., . . . Etkin, A. (2020). Global connectivity and local excitability changes underlie antidepressant effects of repetitive transcranial magnetic stimulation. Neuropsychopharmacology.
  9. Weigand, A., Horn, A., Caballero, R., Cooke, D., Stern, A. P., Taylor, S. F., . . . Fox, M. D. (2018). Prospective Validation That Subgenual Connectivity Predicts Antidepressant Efficacy of Transcranial Magnetic Stimulation Sites. Biol Psychiatry, 84(1), 28-37. doi:10.1016/j.biopsych.2017.10.028
  1. Rosen, A. C., Bhat, J. V., Cardenas, V. A., Ehrlich, T. J., Horwege, A. M., Mathalon, D. H., . . . Yesavage, J. A. (2021). Targeting location relates to treatment response in active but not sham rTMS stimulation. Brain Stimulation, 14(3), 703-709.
  2. Modak, A., & Fitzgerald, P. B. (2021). Personalising transcranial magnetic stimulation for depression using neuroimaging: A systematic review. The World Journal of Biological Psychiatry, 1-23. doi:10.1080/15622975.2021.1907710