By: Raul J. Rodriguez MD, DABPN, DABAM, MRO Special to the Boca and Delray newspapers
The first Deep TMS treatment session starts at 100% of the motor threshold, to allow the patient to acclimate to the treatment before going to a higher dose. The 100% dose is generally easier to tolerate than the target 120% dose. If the dose is gradually increased from 100% to 120%, most patients will acclimate well. Patients often describe a tapping sensation on the scalp, in addition to the sound of the electromagnetic pulse generation. The sound is similar to that of an MRI machine and is managed well with earplugs. The tapping sensation is generally tolerable. Some people may also experience headaches in the earlier stages of treatment, which is typically resolved with either ibuprofen (Motrin) or acetaminophen (Tylenol). Many patients report a significant reduction in these side effects after even just the first TMS session. Seizures, the most severe potential complication of TMS treatment, are very rare. Most patients acclimate well to the early stage side effects and can proceed with treatment.
A typical Deep TMS treatment course will consist of at least 5 days a week for 4 weeks, followed by 2 days a week for 8 weeks. Another common treatment course starts with at least 5 days a week for 6 weeks, and then the frequency tapers down from there. The recommended minimum number of treatments is 36 while some TMS courses can have as many as 42 or more. Some patients will note an early response in the first 3 to 4 weeks but many will take at least 6 weeks to really derive substantial benefits. Many of the patients that did not get a response within 6 weeks still derive a good response later in the treatment course, indicating the need to follow through with at least 36 treatments. After a successful course with 36 to 42 treatments, some may not require any further treatment while others may need short booster courses of 3 to 6 treatments a few times a year. Overall the success rate is very high.
In depression treatment, success is defined by rates of response and remission. It is important to note that in TMS studies, the patient population is a “treatment resistant depression” population that has failed 4 or more medications already. This population would be expected to have a significantly lower response rate to any type of therapeutic intervention than a conventional depression case. Even taking that factor into consideration, Deep TMS response rates after 30 sessions have reached 74% while full remission rates reach 49%. In comparison to other forms of depression treatment, these are extraordinarily high rates. Anecdotal reports suggest that response rates in non-treatment resistant depression patients are even higher. This supports the growing belief that TMS may one day become a first line treatment for Major Depression. Patients have increasingly asked for TMS to treat their depression before waiting to fail on 4 different medications. With the unequivocal results, an exceptional side effect profile, and the ability to produce long-standing brain changes through induction of neuroplasticity, this is no surprise. This is why Deep TMS has become the great new hope for treatment resistant depression.
Dr Rodriguez is the founder, CEO and Medical Director of the Delray Center For Brain Science, a true Brain Center which specializes in Treatment Resistant Depression, ADHD, OCD, Memory Disorders, and optimizing brain performance.