Question 1

Which type of patients with depression should consider TMS?

Accepted Answer

TMS is suitable for those who have exhibited inadequate responses to medication, or those who are concerned with the medication side-effects. TMS offers safe, effective and drug-free alternatives for patients.

Question 2

What are the risks and side effects of TMS?

Accepted Answer

TMS therapy is well tolerated by most patients. Common side effects that may occur during treatment include scalp discomfort at the stimulation area and slight twitching of the forehead muscles. A small number of patients may experience mild headaches after treatment; epilepsy may be induced but they are a rare side effect, which may occur once in about 30,000 treatments, similar to the risk of inducing epilepsy when taking antidepressants. Before undergoing TMS therapy, the doctor will conduct a safety assessment on whether you are suitable for the treatment to minimize the possibility of inducing epilepsy.

There was no evidence that TMS therapy had any negative effects on cognition. There are no restrictions on patients' daily activities, including driving, after each session. There was no evidence of any long-term side effects from TMS.

Question 3

Which type of patients are not suitable for TMS therapy?

Accepted Answer

Patients with non-removable conductive, ferromagnetic, or other magnetic-sensitive metal anywhere in the head or within 30 cm (12 in) of the stimulation coil are not suitable for receiving TMS treatment. Examples include cochlear implants, implanted electrodes or stimulators, aneurysm clips or coils, stents, bullet fragments, ocular implants, and stents.

Patients who have an active or inactive implanted device (including device leads), including deep brain stimulators, cochlear implants, cardiac pacemakers, and vagus nerve stimulators. Contraindicated use could result in serious injury or death.
Patients with increased intracranial pressure or patients with intracardiac lines, intravenous pumps, or dose calculators.
Failure to follow these restrictions could result in serious injury or death.

Dentures are usually not restricted.

Question 4

How long does each treatment take and how many sessions are required for a course of treatment?

Accepted Answer

The FDA-approved standard TMS treatment usually takes 4-6 weeks, 5 days a week, once a day, and each treatment takes about 30-45 minutes. The latest clinical research has found that by changing the frequency of magnetic pulses for each treatment and the number of daily treatments, the course of treatment can be shortened to 1-3 weeks. The exact timetable will be arranged after evaluation by the doctor according to your needs.

Question 5

Where can I get TMS?

Accepted Answer

Although TMS therapy is a low-risk medical procedure, there is a rare risk of inducing epilepsy. Therefore, if patients want to receive TMS therapy, they must be diagnosed and prescribed by an attending doctor. The treatment will then be carried out by  trained professionals like doctors, nurses, or TMS specialists.

Question 6

What will the patient need to do during treatment?

Accepted Answer

Glasses and metal earrings will need to be removed prior to treatment. Any kind of loose hairstyle or clothing is suitable. During the treatment, the patient will sit in a reclining chair with a comfortable headrest, maintaining a relaxed and comfortable posture. Due to the clicking sound of the TMS machine during the treatment, the patient will be asked to wear earplugs for hearing protection.

Question 7

Are there any differences between TMS and ECT (electro-convulsive therapy)?

Accepted Answer

While both approaches are proven effective in treating depression, there are significant differences between TMS and ECT therapy.

Mechanism Differences: 
In electro-convulsive therapy, electric current is conducted from outside the head to inside the brain to induce a seizure within the brain that lasts for approximately a minute. While TMS therapy utilizes the magnetic field around the TMS coil passes through the scalp and generates an electric field into the brain tissue. This electric field induced in the brain is able to activate the neurons.

Process Differences: 
ECT is considered as an invasive procedure that is usually performed in hospitals and requires the patient to be anesthetized. Patients are usually required to stay inside hospital after the procedure and there is a possibility that the patient will not be able to perform daily activities, including going to school and work, for up to 2 - 4 weeks.

On the other hand, TMS can be performed in outpatient clinics. Patients will remain conscious throughout the process and the therapy can be completed in 30 - 45 minutes. Patients are free to continue their daily routine right after TMS treatment. There is less disruption to the patient's daily life, and TMS treatment arrangements can be easily integrated into the patient's daily schedule.

Side Effect Differences: 
One of the common side effects of ECT treatment is temporary confusion and inability to remember what happened during the actual treatment and recent events, while TMS treatment does not. In addition, TMS does not require anesthesia, thereby avoiding the additional risks, complications and side effects associated with general anesthesia.

Cost Differences: 
Since ECT treatment requires hospitalization and requires the use of an operating room and a medical team including psychiatrists, anesthesiologists, and nurses, the cost of a 6-week standard course of 12 sessions of ECT treatment will be approximately 2-3 times the cost of a 6-week standard course of 30 sessions of TMS treatment.