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Transcranial Magnetic Stimulation (TMS) FAQ

One of the Interventional Psychiatric Services offered at Yale New Haven Psychiatric Hospital is Transcranial Magnetic Stimulation or TMS. FDA cleared for certain patients, TMS is a non-invasive treatment used for the treatment of depression. Unlike other common treatments for depression, TMS does not require medication.

“It’s a very well tolerated and safe procedure and can provide significant relief for patients,” said Rachel Katz, MD, Assistant Professor of Clinical Psychiatry, and psychiatrist at Yale New Haven Psychiatric Hospital.

Dr. Katz and Nora Proops, MD, who both specialize in the delivery of Interventional Psychiatric services at Yale New Haven Psychiatric Hospital answered some frequently asked questions about TMS. Learn more below.

How does TMS work?

TMS uses pulsatile magnetic fields to stimulate parts of the brain thought to be underactive in people with certain forms of depression. During treatment, an electromagnetic coil is placed against the side of the patient’s head to target certain portions of the brain.

What should patients expect?

TMS is a daily treatment that takes approximately 35 minutes per session for about six weeks. Patients receive their treatment in a private room at Yale New Haven Psychiatric Hospital.

During the treatment, patients wear earplugs to protect their hearing. Many patients choose to listen to music during their treatment.

One of the benefits of TMS is there are no medications or anesthesia required and patients can drive themselves to and from their appointments. Patients who currently take antidepressants can also continue to take their medications while undergoing this treatment.

How does it feel?

Patients experience a range of sensations but most experience a clicking sensation over the site of stimulation. Over time, tolerability for the treatment improves. This is not a “one size fits all” treatment and there are ways to adjust treatment parameters for each patient’s needs and comfort level.

Are there side effects?

TMS is a very well tolerated and safe treatment with few side effects. There are no known cognitive side effects. Some patients may experience minor sensitivity at the stimulation site, mild headache or light-headedness. Very rarely, some people will have vasovagal or fainting episodes. There is also a very small risk of seizure, lower than the risk associated with many commonly used medications.

Are there any contraindications?

Patients with metallic objects in the head or neck will not be able to undergo treatment because of the magnetic fields used. Patients with a history of seizure or traumatic brain injury will also need to consult their neurologist first to understand their possible risks.

How is the success of this treatment monitored?

There are several ways to monitor the reduction of depressive symptoms in patients, including regular evaluation with the treating psychiatrist, the use of validated psychometric scales, and collaboration with the patient’s primary psychiatric provider.

What are the benefits of TMS?

TMS can offer relief for patients who have not responded to or who have been unable to tolerate antidepressants. It is also safe in patients who may not be able to take certain medications due to comorbid medical problems.

One important study to note is the STAR*D trial. It looked at the chances of achieving response and remission in depressive symptoms after successive trials of medications. For patients that meet the criteria of treatment resistant depression (TRD), or have failed to respond to at least two antidepressant trials, the likelihood of achieving response or remission with additional medications drops to about 13%.

However, naturalistic studies have shown that similar patients who undergo TMS can achieve response up to 50% of the time.

How do I know TMS is safe?

TMS is not an experimental treatment. FDA cleared in 2008, thousands of people have safely undergone treatment.

“It’s well established in terms of safety and how well it will work,” said Dr. Proops.

Interested in TMS? Talk to your doctor to get a referral.