Dr. Dino Santoro preparing for our next TMS treatment

Transcranial Magnetic Stimulation (TMS) is an FDA-cleared outpatient treatment indicated for those who have not received enough benefits from antidepressant medications and other depression treatments.

The TMS treatments are performed in our office by our TMS clinical team. The patient is completely awake and seated in a comfortable chair. The magnetic coil of the TMS device is placed near the front left side of the head (medically defined as the F3 region or the Doral Lateral Pre-Frontal Cortex- DLPFC). The coil will then send magnetic pulses through the scalp and into this area of the brain.

The location for this treatment is a result of scientific research that shows the DLPFC as the area that stimulates local and deeper brain regions.  The magnetic pulses from the TMS coil cause small electrical charges that stimulate the brain cells (neurons) near the magnet to be active and communicate more effectively and frequently with deeper brain regions.  These deeper brain regions include the anterior cingulate and the brain stem, each known to play a role in mood regulation.  The increase in activity by the pulsed magnetic field causes the neurons in the brain to “naturally” release the neurotransmitters in the brain. These include serotonin, norepinephrine, and dopamine.  These are the same neurotransmitters that antidepressants try to increase. The release of these neurotransmitters is thought to “restart or reactivate” areas in the brain to become more active and lead to relief of depression symptoms.


How Effective is TMS therapy?

TMS device companies (Neuronetics and Brainsway) and the National Institute of Mental Health conducted clinical trials to evaluate the effectiveness of TMS for those that had treatment-resistant depression. Treatment-resistant depression (TRD) is defined as having significant depression symptoms after multiple medications.  In general, each of the studies showed that the participants had between a 30 to 33% complete removal of depressive symptoms, with over 50% of individuals reducing their depressive symptoms by half.  This is significant since patients were very ill and TMS was given without any medications or other treatments.


TMS Success in Everyday Medicine

It is important to understand that clinical research trials try to eliminate all variables that may contribute to or hinder the exact results of the treatment.  Although clinical trials are necessary, they are often not how everyday medicine occurs.  TMS therapy in real psychiatric clinical practices has better results.  Several real-world clinical trials show that TMS therapy has over a 50% remission rate and over a 70% success rate to relieve most depressive symptoms. One of the primary reasons for this improvement is the use of current medications and talk therapy to synergize the results of TMS therapy.

1. Neuronetics Clinic  2. Data Data on file.


How Safe is TMS therapy?

Transcranial Magnetic Stimulation is a treatment for major depressive disorder. It was cleared by the FDA in 2008. The most common reported side effects reported are mild scalp discomfort at the treatment site and headaches. Each of these usually subsides after the first week of treatment and typically can be managed with over-the-counter pain relievers.  TMS treatments also have minimal risk of seizure (less than 1%), you should discuss any history of seizures with any of the North Country Behavioral Medicine providers.

Some facts about TMS safety:

  •  It has no systemic side effects, such as weight gain and sexual dysfunction
  •  It is non-invasive, requires no anesthesia or sedation
  • TMS is well tolerated with on average only 6% stopping treatment.


Contraindications for TMS therapy

Because TMS uses a powerful magnet, some implants and conditions restrict the use of TMS therapy. Our doctor will need to know if you have any metal objects that would be affected by the magnetic pulse. These may include:

• Aneurysm clips or coils in your head, neck, or upper body
• Metal plates
• Cochlear implants
• Arterial stents in your upper body
• A cardiac pacemaker
• Tattoos with metallic or magnetic-sensitive ink