The Role of TMS Therapy in Psychiatry: A Complementary Approach to Medications and Therapy

The Role of TMS Therapy in Psychiatry: A Complementary Approach to Medications and Therapy

The field of psychiatry is undeniably beneficial to individuals who live with a mental health condition, and there are a number of available treatment options for those who have a psychiatric diagnosis. Meta-analytic research has shown that both psychotherapy and psychopharmaceutical agents offer benefits to patients with mental health disorders, but some patients do not achieve clinically significant improvements with these treatments. In some cases, patients may benefit from adding additional modalities to their usual treatment regimens. When patients do not achieve adequate symptom relief with therapy or medication, transcranial magnetic stimulation (TMS) may be beneficial.

What is TMS?

Before jumping into specific uses for TMS in the field of psychiatry, it’s helpful to understand what this modality entails. TMS is a non-invasive treatment modality that uses a device placed against the head to generate pulses via electromagnetic coils. These pulses target neurons that are responsible for mood.?

The benefit of TMS is that it does not interfere with antidepressant medications, so a patient can continue to take these medications while undergoing TMS treatment. Patients can also return to work or go about their usual business after a TMS session, as no anesthesia is required.?

A TMS session can be completed in just under 20 minutes, and most patients require 6 to 8 weeks of treatment, making it easy to add this modality to a patient’s existing treatment plan.

Uses of TMS in Psychiatric Patients

TMS has several FDA-approved uses for psychiatric populations. It is most commonly used in the treatment of depressive episodes that do not respond to one or more trials of medication. TMS devices were initially approved for treating depression in 2008, and in 2021, TMS was approved for treating anxiety that occurs concurrently with major depression. This treatment modality is also approved for obsessive compulsive disorder (OCD).?

Fortunately, there is plenty of empirical support for the TMS modality. A recent meta-analysis of 23 studies found that repetitive TMS was highly effective for treating depression symptoms, including helplessness and lack of pleasure. Meta-analytic research has also demonstrated the effectiveness of TMS for alleviating symptoms of OCD.?

Beyond its FDA-approved uses, researchers are studying the benefits of TMS for a range of other mental health conditions, including PTSD and bipolar disorder. In addition, the modality is already FDA-approved for smoking cessation, which can be beneficial for patients who are seeking counseling to help with giving up smoking, or who feel their mental health is worsened by cigarette use.?

Common Patient Concerns and Misconceptions

If you’re treating a patient for depression or OCD, and their symptoms are not improving with medication and/or talk therapy, you might consider talking with them about adding TMS on to their treatment plan. It’s helpful to be able to discuss common patient concerns and misconceptions before referring them to a TMS provider.

Some common concerns patients may have include:

• Worrying they'll have to stop taking their medications if they undergo TMS: Patients often worry that if they choose to try TMS, they will have to stop taking antidepressant medications, but this is not the case. If patients have found some relief from these medications, they can continue to take them while undergoing TMS.

• Fear of potential side effects: As is the case with most medical procedures, patients considering TMS are likely to have questions about potential side effects. Since the procedure involves electromagnetic stimulation, they may even worry that TMS will be significantly painful. Fortunately, side effects are often mild, and the most commonly reported side effect is headaches, which can be treated with over-the-counter medications if necessary.?

• Belief that TMS is the same as ECT: Some patients may mistakenly believe that TMS is the same as electroconvulsive therapy (ECT), but it’s important for patients to realize that these are two separate treatment modalities. Studies have shown that TMS is superior to ECT, as TMS is less costly and produces better outcomes for patients when compared to ECT. Furthermore, ECT requires anesthesia and is more invasive than TMS.?

• Financial concerns: Patients are likely to have questions about the cost of TMS. While the cost can vary depending upon where a person lives and where they seek treatment, many TMS providers do accept insurance, which can offset some of the costs of treatment.?

When to Make a Referral

When you’re treating a patient who has depression or OCD, and they aren’t responding to treatment, it may be time to make a referral. According to BrainsWay, the company that manufactures TMS devices, patients who have recurrent episodes of depression may not benefit from psychotherapy; therefore, they can be strong candidates for TMS. Those who do not respond to medications for OCD or depression, or who find side effects to be too severe to continue taking medication, may also benefit from trying TMS.?

BrainsWay offers referral consultations to help psychiatrists determine whether it’s time to refer a particular patient for TMS. BrainsWay also offers brochures to help you communicate with patients about the ins and outs of TMS. It can be helpful if you can answer basic patient questions about the procedure, to make them more comfortable with being referred for this treatment. It’s also beneficial to develop a referral network of TMS providers in your area.?

TMS can be used as an add-on tool, incorporated into a patient’s comprehensive treatment plan. If a patient chooses, they may continue to take medication while in TMS treatment, and they can certainly still see you for therapy.?

If you’re treating patients in the Los Angeles area, Pulse TMS is an invaluable resource for your practice. We will coordinate our treatment with whatever plan you already have in place for your patient, in addition to updating you with regard to your patient’s progress. Contact us today to make a referral.?

Sources:

1)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8751557/

2)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8864803/

3)https://www.nature.com/articles/s41398-020-01055-2

4)https://journals.lww.com/ectjournal/Abstract/2016/12000/Transcranial_Magnetic_Stimulation_for.10.aspx

5)https://journals.sagepub.com/doi/pdf/10.1177/0706743719890167

6)https://www.brainsway.com/how-do-we-help/referral-guidance/