Psychiatric Applications of Repetitive Transcranial Magnetic Stimulation

Summary & key facts

Transcranial magnetic stimulation, or TMS, uses brief magnetic pulses over the skull to stimulate a specific brain area without surgery. Repeating these pulses can produce lasting changes in how brain circuits work. TMS is approved in the U.S. for major depression, obsessive-compulsive disorder, and for helping people stop smoking. For people whose depression has not improved with other treatments, TMS leads to symptom improvement in about 40% to 60% of patients. It is usually well tolerated, and the most serious risk is a seizure, which is very rare. This review explains how TMS works, common treatment methods, safety issues, and practical topics like choosing a device and insurance coverag

Key facts:

• TMS uses brief, pulsed magnetic fields applied outside the head to stimulate a targeted brain region without surgery.
• When TMS is given repeatedly, it can make lasting changes in brain activity by changing how brain cells connect and communicate, a process similar to long-term potentiation which strengthens connections.
• Stimulating one brain area with TMS also changes activity in other brain regions that are connected to it, so TMS affects whole brain networks, not just a single spot.
• The U.S. Food and Drug Administration has approved TMS for treating major depressive disorder, obsessive-compulsive disorder, and for helping with smoking cessation.
• For people with depression that did not get better with other treatments, TMS produces response rates of about 40% to 60%, meaning a substantial number of people see meaningful improvement.
• TMS is generally safe and tolerated well. The most serious known risk is a seizure, but that happens very rarely.
• This review summarizes practical issues for doctors and patients, including how to find the right brain target, common treatment protocols and outcomes, how to monitor patients, device selection, treatment setting, and insurance reimburseme

Abstract

Transcranial magnetic stimulation (TMS) is an increasingly popular noninvasive brain stimulation modality. In TMS, a pulsed magnetic field is used to noninvasively stimulate a targeted brain region. Repeated stimulation produces lasting changes in brain activity via mechanisms of synaptic plasticity similar to long-term potentiation. Local application of TMS alters activity in distant, functionally connected brain regions, indicating that TMS modulates activity of cortical networks. TMS has been approved by the U.S. Food and Drug Administration for the treatment of major depressive disorder, obsessive-compulsive disorder, and smoking cessation, and a growing evidence base supports its efficacy in the treatment of other neuropsychiatric conditions. TMS is rapidly becoming part of the standard of care for treatment-resistant depression, where it yields response rates of 40%-60%. TMS is generally safe and well tolerated; its most serious risk is seizure, which occurs very rarely. This review aims to familiarize practicing psychiatrists with basic principles of TMS, including target localization, commonly used treatment protocols and their outcomes, and safety and tolerability. Practical considerations, including evaluation and monitoring of patients undergoing TMS, device selection, treatment setting, and insurance reimbursement, are also reviewed.

Topics

Pain Management and Treatment Spatial Neglect and Hemispheric Dysfunction Transcranial Magnetic Stimulation Studies

Categories

Life Sciences Neurology Neuroscience

Tags

Deep transcranial magnetic stimulation Medicine Neuroscience Physical medicine and rehabilitation Psychiatry Psychology Stimulation Transcranial magnetic stimulation

Conditions & symptoms

Addiction Depression Obsessive-Compulsive Disorder Substance abuse disorder Sadness or low mood