Transcranial Magnetic Stimulation

Offered by UT Southwestern’s interventional psychiatry specialists, transcranial magnetic stimulation (TMS) is a noninvasive treatment for people with severe depression who have not had success with psychotherapy and oral medications. TMS is also approved for obsessive-compulsive disorder (OCD).

What Is Transcranial Magnetic Stimulation (TMS)?

Transcranial magnetic stimulation (TMS) is a painless and virtually side effect-free treatment for people with depression who have not responded to conventional pharmacological treatments. It was approved by the FDA for routine clinical use for depression in 2008.

TMS works by sending magnetic pulses into a targeted area of the brain involved with mood regulation. After a series of treatments, the magnetic pulses change how nerve cells function, helping to improve or, in many cases, resolve symptoms of depression.

The field of TMS research has evolved tremendously in the last decade. In 2018, a new TMS procedure, called theta-burst stimulation (TBS), was introduced. TBS delivers magnetic pulses in short bursts patterned after natural brain rhythms and produces similar results to standard TMS in a much shorter session.

More recently, accelerated TBS protocols have been developed, offering several short sessions per day for 1 to 3 weeks instead of a single daily treatment. These accelerated schedules are equally effective as standard protocols but shorten the overall treatment course. This reduces the number of clinic visits required.

In addition, some patients may benefit from neuronavigation, a technique that works like a GPS for the brain. It uses the patient’s MRI scan to guide the magnetic coil to the exact spot in their brain that needs stimulation, improving accuracy. Most patients don’t need neuronavigation, but it can be useful in certain cases.

Why Choose UT Southwestern for TMS?

UT Southwestern Medical Center has one of the largest departments of psychiatry in the United States. Our psychiatric providers possess the expertise and skill to treat the most severe forms of mental illness using an array of innovative and evidence-based therapies, including TMS.

What Conditions Does TMS Treat?

At UT Southwestern, we use TMS to treat people with severe depression who have not had success with other treatments such as medications and psychotherapy.

While TMS does not work for everyone with depression, those who benefit often experience initial signs of improvement within the first two weeks. The goal of every TMS series is complete remission of the depression symptoms, and if remission is achieved, there is a strong likelihood the response will be sustained after completing treatments.

For patients who have responded well to TMS therapy but experience a relapse of their depression despite ongoing psychiatric care, additional courses of TMS can be considered.

TMS is also FDA-cleared for obsessive-compulsive disorder.

Finally, TMS can be used off-label for a variety of conditions. After a comprehensive evaluation, our care team can assess whether TMS is an appropriate treatment option.

What Can Patients Expect with TMS Therapy?

Before TMS Therapy

The first step in the TMS treatment planning process involves a comprehensive evaluation with one of UT Southwestern’s interventional psychiatry specialists to determine if a patient is likely to benefit from TMS therapy or another treatment.

If TMS is recommended, the next step is to identify the optimal treatment location and protocol for the patient.

Before starting TMS therapy, insurance coverage will be verified.

During TMS Therapy

TMS therapy is an outpatient procedure administered in a doctor’s office or clinic, with treatments occurring 5 days per week for up to 6 weeks. Treatment sessions usually last 15 to 30 minutes.

Each TMS procedure typically involves the placement of a magnetic coil over the front left region of the scalp. Once in place, the coil pulses rapidly, providing a gentle electrical stimulus to cells in the outer layer of the brain beneath the coil.

As the magnetic pulses are delivered, it is normal to feel tapping on the head. Some patients may also experience a nonpainful pressure sensation. The strength of the magnetic pulses produced by the TMS coil is similar to that of an MRI machine, and the magnetic pulses do not extend beyond a depth of 2 inches.

What Are the Potential Side Effects and Risks of TMS?

Side effects, which are rare, can include brief headaches, scalp discomfort at the stimulation site, lightheadedness, and tingling or twitching of facial muscles. The only known serious medical risk is a very small chance for seizure activity during the TMS procedure. Fewer than 5% of patients discontinue TMS therapy due to side effects or medical concerns.

People with a history of seizures or any metal foreign objects in or around their head, including surgical hardware, should not have TMS due to an increased medical safety risk. (Dental fillings and braces will not affect treatment.)