TMS and tDCS for depression – what can you expect?

TMS (Transcranial Magnetic Stimulation) has proven to be surprisingly effective for treatment-resistant depression. Even though it’s time consuming, it should be worth a try. Especially if you’ve undergone other treatments without results.

Of course, there are much less impractical forms of brain stimulation available, using the same basic principle and targeting the same brain region. But we’ll get to that in a bit.

First, let’s focus on what TMS can do for you.

Depression is associated with reduced activity in the left dorsolateral prefrontal cortex of the brain (the DLPFC). The brain cells in this area don’t fire electrical impulses to each other with the same frequency as within a non-depressed brain. It can result in mood, sleep and appetite disturbances, concentration difficulties and other depressive symptoms.

What TMS does is send repeated magnetic pulses through an electromagnetic coil to the DLPFC. There, it creates an electric field which helps the brain cells activate. When they do, brain activity is restored and depressive symptoms improve.

The procedure is completely non-invasive. There is no surgery, injections or cutting of the skin. And you are fully awake during the entire treatment.

This is basically what you can expect:

Typically, TMS sessions are given once a day, five days a week for 4-6 weeks. So, the treatment requires some planning and free time.

During your first TMS session, a clinician will figure out where to place the electromagnetic coil on your head.

You will be seated in a chair and they will place the coil on your head and switch the machine on and off repeatedly to produce magnetic pulses. This feels like someone is tapping on your head. And you hear a loud clicking sound.

The coil is moved around your head in search of the brain region which controls the movement of your fingers. So, your fingers and hands will twitch a little. From there, the clinician can calculate the exact location to place the coil and how much energy is needed for your stimulation. This measurement is usually done only once.

During the following sessions you will:

Sit comfortably in a chair and watch a movie (or whatever you prefer to do in a chair).

The machine will turn on and produce rapid tapping sensations on your scalp and a loud tapping sound. The tapping will follow a repeated pattern of a few seconds of tapping and then a short pause. You may notice some discomfort in your scalp.

Depending on the TMS pattern used by your clinic, each procedure will typically last around 20-40 minutes.

Most people can return to their usual activities after a session. But arrange for someone to drive you back from your first appointment to get a sense of how you feel afterwards.

There are some notable benefits to TMS. First of all, it’s well tolerated. Common side effects usually improve shortly after your sessions and include:

• Headaches
• Scalp discomfort or pain
• Spasms or twitching of facial muscles
• Feeling lightheaded

These sensations do seem mild in comparison to sexual dysfunction, insomnia, diarrhea, weight gain and many other consequences associated with antidepressant medication.

And what about the results?

As with all depression treatments, there are no guarantees. Some people experience an almost miraculous response to TMS, while others don’t improve. Most research studies show that the effectiveness is comparable to or better than antidepressant medication (SSRIs).

But the best thing about TMS is that it brings hope to those who’ve tried several antidepressants or talk therapies without results. TMS has been shown to significantly improve symptoms in at least 30% of people with treatment-resistant depression.

In the world of depression research, those numbers are impressive.

However, if your depression is not treatment resistant, or if you can’t find the time to travel back and forth to the clinic daily, you might want to try a less effortful form of brain stimulation.

tDCS (transcranial Direct Current Stimulation) uses the same basic principle. It targets the DLPFC, but instead of electromagnetism it uses a direct electric current.

As long as you have a diagnosis of depression, you can order a device online without prescription and use it at home. Just make sure it’s medically approved (CE-marked).

Side effects are milder than those from TMS and less than 2% report any side effects at all. Skin irritation under the electrodes and mild headaches are the most common ones.

tDCS is effective against mild, moderate and severe depression (MDD). It shows similar results to antidepressant medication and psychotherapy. Though it probably can’t compete with TMS when it comes to treatment resistance, the procedure is practically effortless in comparison.

The entire treatment can be performed at home on your couch.

Here’s how to start the treatment:

• Order a medically approved tDCS headset from Flow Neuroscience.
• Download the free depression app.
• In a few days, your headset is delivered. Unpack your headset. Start the app and follow the instructions.

You put the tDCS device on your head and stimulate for 30 minutes, five times a week for the first 3 weeks. After that, you stimulate 1-3 times a week.

If your brain responds to this type of treatment, you will likely notice an improvement within 3 weeks. But it’s recommended to keep stimulating for at least 6-10 weeks.

Read more about tDCS for home use here.

Hope this helps.