rTMS TREATMENT: A Clinically Proven Treatment for Major Depression
What is Repetitive Transcranial Magnetic Stimulation (rTMS)?
Repetitive Transcranial Magnetic Stimulation is an entirely new approach to treating patients with treatment resistant major depression. Using magnetic pulses, the treatment stimulates an area of the brain that is involved in the regulation of emotion and mood. That area is underactive in many cases of depression and is made more active by the treatment. The treatments take about 45 minutes and are given five days a week for six weeks. Multiple research studies have shown that rTMS treatment outperforms an additional medication trial in patients with depression who have failed at least three medication trials, and it has been cleared as effective by the FDA.
Depending on the frequency and location of stimulation, the treatment can increase or decrease excitability in the target areas. In the standard protocol, activity in the left dorsolateral prefrontal cortex is increased. In this way, TMS is hypothesized to lead to durable changes via long-term potentiation of connections in the regulatory networks and increased neural plasticity.
The treatment involves the use of brief, highly focused magnetic pulses to stimulate the left dorsolateral prefrontal cortex, (dlPFC) designated with a “*” in the diagram above. This region is part of a cortical network, which acts to regulate and inhibit negative affect originating from limbic structures.
rTMS Treatment Procedure
The patient is seated comfortably in the treatment chair and remains awake and alert throughout the procedure. The Patient may watch television, use a tablet, or converse with a friend. In the initial session, the psychiatrist determines the patient’s motor threshold and treatment location. The patient’s head remains free, resting on a head rest, while the treatment coil is placed in contact with the forehead. The treatment lasts 37.5 minutes, and involves 75 trains of pulses. Each train consists of 40 pulses over 4 seconds, or 10 Hz. There is then a 26 second rest period before the next pulse train. The experience is similar to having someone tap firmly on the forehead with their finger. Muscle twitching around the eye is common, but generally well tolerated. Due to the noise produced by the electromagnetic coil, patients are required to wear disposable earplugs. At the end of the session, the patient may immediately resume normal activities, drive, and return to work.