The term “treatment options” may seem indifferent to some because traditional treatments have been satisfactorily effective. However, for patients with depression who have been treated with medication for a period but have not yet achieved the desired results, the term “options” becomes an important consideration. “Transcranial Magnetic Stimulation” is one of the treatment options for depression that is safe and standardized. Let’s get to know this treatment method.
Transcranial Magnetic Stimulation (TMS) is the use of a device that generates a magnetic field to stimulate nerve cells in the affected area, such as stimulating the left dorsolateral prefrontal cortex in patients with depression. This involves repetitive stimulation (repetitive TMS or rTMS) using appropriate frequency, energy level, and duration.
Currently, rTMS is used to treat central nervous system disorders and peripheral nerve rehabilitation. For psychiatric disorders approved by the U.S. Food and Drug Administration, these include treatment-resistant depression and obsessive-compulsive disorder.
Treatment of Depression with rTMS
When providing rTMS treatment, doctors consider patients aged 18 and over with depression who do not respond to two or more types of medication. Doctors will assess the appropriate brain stimulation site for each patient before treatment. The suitable duration for each session depends on the stimulation frequency, generally about 30-40 minutes per session. In the initial phase, it is recommended to stimulate the brain with magnetic fields 5 times per week continuously for 20-30 sessions.
Common Side Effects of rTMS
- Annoyance from the loud noise of the rTMS machine during treatment, which can be prevented by wearing earplugs or noise protection devices
- Headache due to slight stimulation and contraction of the scalp muscles during magnetic field stimulation
- Tightness or pain in the area where the magnetic coil is placed on the head
Contraindications for rTMS Treatment
- Patients with unstable physical conditions, especially heart disease, stroke, or cerebral infarction with symptoms within 6 months before magnetic stimulation treatment
- Patients with metal implants in the body, especially in the face, head, neck, or chest, such as medical devices including certain types of pacemakers
- Patients at risk of seizures, such as those with a history of epilepsy or alcohol withdrawal syndrome
Can rTMS Be Combined with Other Treatments?
Depression treatment with rTMS can be combined with antidepressant medication. During rTMS treatment, the type and dosage of medication should remain stable to accurately evaluate the treatment effect of rTMS and reduce the risk of side effects.
Treatment Outcomes
The response to rTMS treatment is generally observed after about 2 weeks, which is similar to the time frame for patients to respond to medication. However, depression treatment also involves other important components such as follow-up care. Patients should regularly attend medical appointments and practice good self-care, starting with monitoring their symptoms to provide accurate information for treatment evaluation, ensuring adequate sleep, and avoiding all types of substance abuse.
rTMS treatment can help patients with treatment-resistant depression and is considered a treatment with few side effects. You can consult with a specialist doctor beforehand for effective treatment outcomes.
Assoc. Prof. Dr. Kitikan Thanaudom
Psychiatrist
Brain and Nervous System Center
Phyathai 3 Hospital
