DID YOU KNOW THAT POWERFUL MAGNETIC PULSES applied to the brain can help many with refractory depression? But we have not had a good understanding of transcranial magnetic stimulation’s mechanism of action. New Stanford Medicine (USA) research provides insights into magnetic stimulation and severe depression management.
Today we examine the discovery that transcranial magnetic stimulation (TMS) works by reversing abnormal brain signal direction.
“I didn’t want my picture taken because I was going to cry.
I didn’t know why I was going to cry, but I knew that if anybody spoke to me or looked at me too closely, the tears would fly out of my eyes, and the sobs would fly out of my throat, and I’d cry for a week.
I could feel the tears brimming and sloshing in me like water in a glass that is unsteady and too full.”
― Sylvia Plath
What is Transcranial Magnetic Stimulation (TMS)?
Transcranial Magnetic Stimulation (TMS) uses magnetic fields to stimulate brain nerve cells to improve depression symptoms. The procedure is non-invasive; there is no cutting of the skin.
The US Food and Drug Administration (FDA) approved Transcranial Magnetic Stimulation for refractory Major Depressive Disorder in 2008. Significant improvements have occurred since Neuronetics Neurostar System (DEN070003) became the first treatment delivery system.
Transcranial magnetic stimulation (TMS) uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of major depression, especially when other treatments haven’t been effective.
TMS may be used for other conditions, including obsessive-compulsive disorder (OCD), migraines, and to help people stop smoking. Researchers are examining its use for other diagnoses, including epilepsy.
With deep transcranial magnetic stimulation, a magnetic coil stimulates deeper and wider brain areas than repetitive TMS (rTMS). Deep TMS coils have been FDA-approved for OCD and to stop smoking.
TMS Logistics
TMS is non-invasive; there is no surgery or other skin cutting. The Mayo Clinic explains how transcranial magnetic stimulation works:
During an rTMS (repeated magnetic pulses) session, clinicians place an electromagnetic coil against the scalp. This coil delivers magnetic pulses that stimulate nerve cells in the brain region involved in mood control and depression.
Wikipedia has a nice overview of the physics behind TMS:
Transcranial magnetic stimulation – Wikipedia
en.wikipedia.org
The biology of why transcranial magnetic stimulation can be effective needs to be better understood. TMS is generally a safe and effective treatment for many conditions.
TMS Potential Side Effects
Transmagnetic magnetic stimulation is generally well-tolerated. However, side effects may include:
- Scalp discomfort.
- Headache.
- Facial muscle tingling, twitching, or spasms.
- Lightheadedness.
Serious side effects are rare but may include:
- Seizures.
- Emotional highs (mania), especially in individuals with bipolar disorder.
- Hearing loss (if the ears aren’t well-protected during treatment).
Because it is non-invasive (and does not require surgery or anesthesia), transcranial magnetic stimulation may be done in a doctor’s office or clinic, with each session usually about 30 to 45 minutes. TMS is usually given five days weekly for four to six weeks.
TMS is not curative but can provide symptom relief. If you are considering the approach, your healthcare provider will review the risks and benefits of the procedure.
TMS — Preparing for the Procedure
Before having rTMS, you may need a physical exam and mental health evaluation. Sometimes lab tests are done. Please let your healthcare provider know if you have any of the following:
- You’re pregnant (or thinking of becoming pregnant).
- You have metal or implanted medical devices in your body. In some cases, people with metal implants or devices can have rTMS. But due to the strong magnetic field produced during rTMS, some people with these devices should not have the procedure: Aneurysm clips or coils, stents; implanted stimulators, implanted vagus nerve, or deep brain stimulators; implanted electrical devices, such as pacemakers or medicine pumps; electrodes for monitoring brain activity; cochlear implants for hearing; magnetic implants; bullet fragments; other metal devices or objects implanted in their body.
- You’re taking medicines, including prescriptions or non-prescription medications (and their doses).
- You have a personal or family history of seizures.
- You have other mental health conditions, such as issues with alcohol or drugs, psychosis, or bipolar disorder.
- You have brain damage from illness or injury, such as a brain tumor, traumatic brain injury, or stroke.
- You have frequent or severe headaches.
- You have other medical conditions.
- You have had treatment with rTMS in the past, and whether it helped treat your depression.
Ongoing treatment
If rTMS is effective for you, depression symptoms may improve (or resolve). Symptom relief may take a few weeks of treatment.
Following an rTMS treatment series, clinicians often recommend standard care (medicine and talk therapy). We don’t know if maintenance rTMS sessions help fight depression.
Still, if rTMS improves your depression for at least two to three months and symptoms later develop, rTMS may be repeated.
TMS — New Research on How It Works
New research from Stanford Medicine (USA) scientists illuminates Transcranial magnetic stimulation’s mechanism of action. Here are the findings:
TMS works by reversing the direction of abnormal brain signals.
The findings also suggest that backward streams of neural activity between key brain areas could be used as a biomarker to help diagnose depression.
“The leading hypothesis has been that TMS could change the flow of neural activity in the brain,” said Anish Mitra, MD, Ph.D., a postdoctoral fellow in psychiatry and behavioral sciences. “But to be honest, I was pretty skeptical. I wanted to test it.”
The Stanford approach used magnetic stimulation, personalized to each patient’s brain anatomy, to treat profound depression. The FDA-cleared treatment, known as Stanford neuromodulation therapy (SNT), uses advanced imaging technologies to guide stimulation with high-dose magnetic pulses that can modify brain activity related to major depression.
Compared with traditional TMS ( with daily sessions over several weeks or months), SNT is delivered in 10 daily sessions for just five days.
Stanford Magnetic Stimulation Study Details
The research team recruited 33 patients with treatment-resistant major depressive disorder. Twenty-three received SNT treatment, and 10 had a sham treatment mimicking SNT but without magnetic stimulation. They compared data from these patients with that of 85 healthy controls without depression.
One connection stood out when they analyzed functional MRI (magnetic resonance imaging) data across the whole brain. In the normal brain, the anterior insula, a region integrating body sensations, sends signals to a region governing emotions, the anterior cingulate cortex.
The anterior cingulate cortex receives this information from the body and decides how to feel based on these signals. In three out of four subjects with depression, the typical activity flow was reversed: The anterior cingulate cortex sent signals to the anterior insula.
The more severe the depression, the higher the proportion of signals traveling the wrong way. The sender and the receiver appear to matter greatly in determining whether one is depressed.
Again, Dr. Mitra: “It’s almost as if you’d already decided how you were going to feel, and then everything you were sensing was filtered through that.” He adds, “the mood has become primary.”
This experimental observation jibes with how many experience depression: Things that were normally quite joyful to the patient no longer bring pleasure.
SNT reverses the neural activity flow, shifting the patient back to the normal direction within a week. This timing coincides with when many begin to improve. Moreover, those with the most depression (and the most misdirected brain signals) appeared to be the most likely to benefit from magnetic stimulation.
Researchers plan larger studies to understand their new insights better.
“Because wherever I sat — on the deck of a ship or at a street café in Paris or Bangkok — I would be sitting under the same glass bell jar, stewing in my sour air.”
― Sylvia Plath, The Bell Jar
Key points — Magnetic Stimulation & Depression
Question. How does magnetic stimulation treat severe depression?
Findings. In the normal brain, the anterior insula, a region integrating body sensations, sends signals to a region governing emotions, the anterior cingulate cortex. The anterior cingulate cortex receives this information from the body and decides how to feel based on these signals. In three out of four subjects with depression, the typical activity flow was reversed: The anterior cingulate cortex sent signals to the anterior insula. Magnetic stimulation turns the wrong-way signal back around.
Meaning. Stanford Medicine researchers provide illumination about how magnetic stimulation helps many with depression.
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The information I provided in this blog is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider for medical advice, diagnoses, or treatment. I am not liable for risks or issues associated with using or acting upon the information in this blog.
Thank you for reading “Magnetic Stimulation & Depression.”
