Interest in new therapeutic approaches like transcranial magnetic stimulation (TMS) for mental health treatment has increased in recent years. This article will review the latest evidence for the use of transcranial magnetic stimulation for various mental health disorders.
Increase in Awareness of Mental Health and Mental Health Treatment
Since around 2010, overall awareness of the importance of mental health and treatment for mental disorders has increased dramatically across virtually all demographic groups in the U.S. There are several possible reasons for this transformation in our society. First, an increase in rates of suicide – particularly among adolescents and young adults – shocked experts and laypeople alike. Second, the opioid overdose crisis captured the attention of the entire nation, with rates of fatal overdose increasing a staggering 467 percent between 2001 and 2022. Third, an increase in mental health challenges among teenagers served to galvanize parents and adolescent development experts into action on several fronts.
And finally, the COVID-19 pandemic was a wake-up call for everyone. We learned that we’re vulnerable not only to disease transmitted by viral pathogens, but also vulnerable to the adverse effects of chronic stress, uncertainty, and the emotional, behavioral, and psychological challenges that can lead to the development or mental health disorders.
We can observe the sea-change in our attitude towards and awareness of the importance of mental health and mental health treatment through the advisories and reports published by well-respected authorities on health topics, including the Surgeon General of the United States and the Centers for Disease Control (CDC).
Here are some of the recent publications from these authorities on mental health topics:
On addiction and the opioid crisis:
On youth mental health:
On adult mental health in general, with a focus on loneliness:
Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community
An analysis of overdose on the U.S. since 2001:
Those publications – and the entities that publish them – show that the increase in our general concern about mental health isn’t media hype. It’s very real. It’s based on verified evidence. As dire as the situation appears, there is good news: we’re in a time when treatment for mental health disorders and addiction disorders improves almost every day.
Transcranial Magnetic Stimulation (TMS) for Mental Health Treatment: New Techniques for New Demands
The Food and Drug Administration (FDA) approved transcranial magnetic stimulation (TMS) for major depressive disorder (MDD) in 2008. This was an important day for people with MDD, and an even more important day for people diagnosed with a type of depression called treatment-resistant depression (TRD). To meet criteria for TRD, a patient diagnosed with MDD must make at least two attempts to treat MDD with standard antidepressants and psychotherapy with no symptom relief.
To learn more about depression treatment, please navigate to our depression treatment page here:
Then, in 2013, the FDA approved TMS for the treatment of obsessive-compulsive disorder (OCD). To learn more about obsessive-compulsive disorder, please navigate to our treatment page here:
Most recently, in 2020, the FDA approved TMS for treating tobacco/nicotine use disorder. To learn about how nicotine use can exacerbate the problems caused by mental health disorders, please navigate to the blog section of our website and read this article:
In addition, clinicians and patients around the U.S. and world report TMS is an important new mental health treatment. It helps relieve the symptoms of anxiety, post-traumatic stress disorder, eating disorders, and bipolar disorder. While TMS is not FDA-approved for treatment of these disorders, they allow the off-label use of TMS. Off-label use of a medication is allowed by the FDA in the following situations:
- When evidence shows it can safely reduce symptoms for a specific medical condition
- A licensed, qualified provider thinks it will help a patient with that condition
- The patient consents – with full awareness of the relative risks and benefits of off-label use – to using the medication for their condition
We’ll now review the evidence base for transcranial magnetic stimulation (TMS) for mental health treatment, beginning with depression treatment.
The Growing Evidence Base for Transcranial Magnetic Stimulation (TMS)
TMS and Depressive Disorders
Evidence indicates that for people with treatment-resistant depression (TRD), treatment with TMS can lead to the following positive outcomes:
- Symptom reduction in close to 60% of patients
- Remission of symptoms in close to 40% of patients
- Duration of symptom reduction for at least three months
A research effort that included 100 patients with TRD with at least three unsuccessful attempts at standard depression treatment with antidepressants and psychotherapy showed:
- Over 50% of patients reported reduction of symptoms after a 6 weeks of treatment
- Ove 25% of patients reported full symptom remission after treatment
Additional research shows that people with the mood disorder bipolar I disorder (BD-I) or bipolar II disorder (BD-II), treatment with TMS can lead to the following positive outcomes:
- Reduce symptoms of both types of bipolar disorder as soon as one week after treatment
- Symptom reduction verified for at least 8 weeks post-treatment
- Compared to placebo or sham treatment, TMS improved symptoms for people with both types of bipolar disorder
That’s a compelling body of evidence for TMS for depression and TRD. That’s why the FDA approved the technique: it works.
Next, let’s look at the evidence for TMS for obsessive-compulsive disorder (OCD).
TMS and OCD
A series of studies show that for people diagnosed with obsessive-compulsive disorder (OCD), treatment with TMS leads to the following positive outcomes:
- Symptom reduction in 45% of patients one month after treatment, reported in a study on close to 100 patients with OCD at 11 different treatment centers
- Reduce symptoms in 72.6% of patients one month after treatment, as reported in a study on over 2000 patients with OCD at 22 different treatment centers
That’s also compelling evidence and forms the basis for FDA approval of TMS for obsessive-compulsive disorder.
Next, let’s look at the evidence for TMS treatment for post-traumatic stress disorder (PTSD).
TMS and PTSD
Studies on veterans and people in the general population diagnosed with PTSD show the following positive outcomes:
- Significant PTSD symptom reduction in a study on veterans returning from combat. To read studies on TMS and PTSD published by The Veterans Administration (VA), click here.
- Significant PTSD symptom reduction in a review of several studies on PTSD
- Significant symptom reduction in a review of a large-scale meta-analysis on PTSD that included data from over 350 participants
This data offers evidence that supports the off-label use of TMS for PTSD. To date, the Veterans Administration recommends TMS as a choice for veterans who have not experienced symptom relief from typical treatment, but not as a first-line treatment – yet.
TMS and Anxiety/Anxiety Disorders
A comprehensive review on the impact of TMS on various types of anxiety disorders showed the following positive outcomes:
- Generalized Anxiety Disorder (GAD):
- Reduction of symptoms in 78% of patients (one study)
- Reduction of symptoms in 80% of patients (one study)
- Reduction of symptoms in all patients (two separate studies)
- Panic Disorder (PD):
- Patients reported significant reduction of symptoms that persisted for six months after treatment
- Specific Phobia (SP):
- Patients reported significant reduction after two TMS treatment sessions
The research makes it clear: for people with the mental health conditions above who’ve tried traditional treatments, TMS can lead to significant symptom reduction when other therapies offer little to no symptom relief.
We’ll end this section on evidence for transcranial magnetic stimulation (TMS) for
TMS and Nicotine Addiction
Evidence for TMS for smoking cessation – i.e. nicotine addiction – appeared in a series of studies summarized in this meta-analysis. The data indicates the following positive outcomes for TMS for smoking addiction:
- Close to 30% of patients who engaged in TMS treatment stopped smoking one month after initiating treatment
- Fewer than 12% of patients who received placebo/sham treatment quit smoking one month after initiating treatment
- Almost 20% of patients who engaged in TMS treatment maintained cessation of smoking four months after initiating treatment
- Fewer than 10% of patients who received placebo/sham treatment maintained smoking cessation fours months after initiating treatment
Considering the fact that over 480,000 people die each year from cigarette smoking-related causes, and smoking cigarettes increases risk of lung disease, heart disease, and a dozen types of cancer, this evidence is an important step forward in reducing the harm caused by tobacco use every year.
That’s the end of our evidence review of TMS for mental health treatment. We included the data on smoking cessation not only because it’s important for people to know about, but also because researchers are currently exploring the use of TMS for alcohol use disorder (AUD) and opioid use disorder (OUD). If TMS can help people with alcohol and opioid addiction, then it may become an important part of our national strategy to mitigate the harm caused by the opioid overdose crisis in the U.S. which has claimed over a million lives since 1999.
How Transcranial Magnetic Stimulation (TMS) for Mental Health Treatment Works
In most cases, TMS treatment is part of an integrated, comprehensive treatment plan that includes a combination of psychotherapy, medication, lifestyle changes, community support, and various adjunct or complementary therapies.
TMS itself works by creating small electromagnetic pulses that are directed at the brain areas associated with the symptoms of mental health and addiction disorders. If you understand how an MRI machine works, then you understand how TMS works: magnetics create electrical pulses that are pointed at and area of the body. An MRI machine is large and loud, and collects information from the pulses to create a picture of the body part under examination. In contrast, a TMS machine is smaller and does not collect information from the electrical pulses to create a picture. With TMS, electromagnetic stimulation is the core of the therapy.
Here’s how it works.
TMS: The Treatment Process
- Patients sit in a comfortable medical chair in a doctor’s office or room in a treatment center
- Providers fit a small coil or cap containing electromagnetic coils on the patient’s head
- The coil is connected to the TMS device, which generates the electromagnetic pulses
- A provider activates the device, which generates pulses that pass through the skin and scalp to specific areas of the brain
- Providers monitor treatment with a monitor attached to the TMS device
- Treatment sessions last between 5 minutes and one hour, depending on the treatment protocol established through collaboration between provider and patient
Most TMS treatment plans involve five daily sessions per week over four to six weeks. Treatment with TMS does not require anesthesia, sedation, or a hospital stay. Side effects can include minor pain at the stimulation site, mild headache, lightheadedness, and facial twitching. Most patients who report these side effects say they decrease over time, and with more session. Serious side effects are uncommon, but in very rare cases patients report seizures and elevated mania in people with bipolar disorder. However, these side effects were known before approval, which means the FDA determined they’re rare enough to approve TMS for use in the general population.
Treatment With TMS at Crownview Psychiatric Institute
Crownview Psychiatric Institute specializes in helping adults diagnosed with complex mental health disorders, including depression, treatment-resistant depression, obsessive-compulsive disorder, and post-traumatic stress disorder.
At our location in San Diego, California, we design individualized, custom treatment plans that incorporate medication, psychotherapy, and adjunct services that include transcranial magnetic stimulation (TMS).
To learn more about treatment with TMS at Crownview, please visit our Contact page or give us a call: we’re ready to answer any questions you have, and help you or a loved one start the path to long-term, sustainable recovery.