Frequently Asked Questions
Repetitive Transcranial Magnetic Stimulation (TMS) is approved in Australia for treatment resistant depression. It involves applying magnetic pulses to the surface of the brain to stimulate the nerve cells . Studies have shown that TMS can work well for patients with treatment resistant depression.
During treatment, the person receiving TMS sits on a recliner chair and a coil is placed against their head. The coil creates a pulsating magnetic field. At the correct strength, the magnetic field activates nerves inside the brain.
Everyone’s experience is different but most patients describe it as a tapping feeling against the side of the head. It may feel strange and, for some people, a little uncomfortable at first. Almost all patients get used to the feeling and it usually only lasts during the treatment.
No, TMS is different from ECT and far less invasive. ECT involves a hospital admission and going under an anesthetic while a seizure is induced by a brief electric current. While for TMS you are in the clinic, awake, relaxing in a chair and can read, watch TV or a DVD while your treatment is taking place. You can drive directly after a TMS treatment. ECT involves giving electric currents but TMS involves giving magnetic pulses.
Please let the treating team know if your physical health changes or you change medications while having TMS treatment. Illegal drugs and too much alcohol should not be used while undergoing TMS as it may increase risk of side effects.
The TGA (Therapeutic goods administration) has approved repetitive Transcranial Magnetic Stimulation (rTMS) for treatment of Major Depressive Disorder, comorbid Anxiety Disorder, OCD and addictions. IT has been used for treatment of PTSD as well. Presence of other psychiatric illness, such as Borderline Personality Disorder, another anxiety disorder or PTSD, does not preclude a patient from receiving TMS treatment.
There are several reasons why someone cannot have TMS. These include:
• a diagnosis of epilepsy
• an active brain illness such as a recent stroke
• anything that may be affected by the magnetic field – such as metal implants in the head, surgical clips, cardiac pacemakers, implanted medication pumps or electrodes
• an unstable medical condition (for example heart disease) that could be exacerbated if they were to suffer a seizure
• pregnancy – the safety of TMS in pregnancy has not been evaluated and is not recommended at this time.
If any of these conditions are relevant to your patient, it is very important that you let us know prior to the person undertaking treatment.
There are several potential side effects that might be experienced during a TMS procedure:
• A headache or neck ache can occur caused by the stimulation of nerves in the scalp and facial region
• It has the potential to cause a fit or seizure. Safety guidelines to limit the dose of TMS have been applied since the late 1990s and there have been very few seizures with the treatment since then. Generally the risk appears quite low.
A standard course of TMS includes treatment of 30 to 40 sessions over 7 to 9 weeks (five a week from Monday – Friday).
Changes to psychotropic medications are best avoided during the course of TMS. As noted above in side effects, the main concern is that of drugs affecting seizure threshold. Any changes should be conveyed to the TMS Clinic as the patient might need a lower or higher dose of TMS. Changes to medications may make it difficult to ascertain the effect of TMS.
Resources
PDF Australian Government Department of Health
Online Resources
racgp.org.au Treatment of depression