TMS

What is TMS and How Does it Work? 

TMS uses a focused series of electromagnetic pulses to stimulate targeted areas of the brain (or, in some cases, neurons in other areas of the body). The charged magnetic fields generated by the magnet alter the action of the neurons in the target areas. Appropriate stimulation over repeated sessions can induce changes in synaptic strength, and this neuroplastic change is generally believed to be a principal factor in the therapeutic effect of TMS to treat conditions such as depression.

In practice, TMS involves receiving repeated sessions of electromagnetic pulses that lasting from about 3 to 15 minutes. For each session the patient sits in a comfortable chair while the provider places a coil against their head using the specifics of their anatomy to position the machine. The provider then runs the session while the patient sits still in the chair. The time between sessions may be a few minutes or a few days – depending on the protocol used.

What is Accelerated TMS?

At Wells Medicine we provide accelerated TMS. The accelerated protocol is much more rapid than the standard protocol (often referred to as rTMS, for repetitive TMS) typically takes about 30 treatment sessions over 6 weeks. Studies have also shown the accelerated protocol to be more effective than the traditional protocol.

The accelerated protocol was originally developed at Stanford University and is often referred to as the SAINT Protocol, for Stanford Accelerated Intelligent Neuromodulation Therapy. This innovative approach was designed to deliver a high-dose, high-frequency regimen of TMS over a compressed timeframe, producing rapid and significant improvements in symptoms. While the researchers behind the protocol have commercialized their work and trademarked the SAINT acronym, the core principles of the protocol are derived from well-established and extensively-published TMS research and techniques, and others can implement accelerated TMS methodologies within the scope of existing evidence-based practices.

At our clinic, we offer an accelerated protocol that adheres to the established principles of intensive neuromodulation therapy. The key aspects of this approach are multiple sessions per day over a condensed period, targeting specific areas of the brain to achieve rapid symptom relief. This approach is grounded in the scientific literature and mirrors the rigorous protocols outlined in the original SAINT studies, while incorporating current best practices and details specific to each patient for efficacy, safety, and patient comfort. 

Benefits of TMS

• Non-Invasive Treatment: TMS is a non-invasive procedure. No anesthesia, sedation or additional medication is required. No surgical intervention is required. 
• Targeted and Personalized: TMS targets specific areas of the brain responsible for mood regulation, offering precise and effective therapy for the conditions being treated. The treatment are personalized for the patient for strength, anatomy and response for comfort and effectiveness.
• Minimal Side Effects: Unlike many medications, TMS does not have systemic side effects such as weight gain, sexual dysfunction, or other issues. Side effects are typically transient and diminish quickly, allowing patients to resume their normal activities immediately following treatments.
• Rapid Results: TMS can provide rapid results, especially when an accelerated or rapid protocol is used – helping many people see results in a few days.
• Sustained Results: Results may last for weeks, months, or longer. In some cases patients see complete remission. Results may be improved and sustained with periodic maintenance treatments or additional treatment series.
• Efficacy: TMS is effective for many people with depression, including for people with acute, chronic, difficult-to-treat, or treatment-resistant symptoms. It may also substantially reduce symptoms for anxiety, OCD, PTSD, and some other mood disorders and pain conditions. It can provide substantial and lasting relief for many people.

Risks and Side Effects

As with any medical procedure, TMS comes with potential risks and side effects. The most common side effects are transient. These include headaches, nausea, and minor itching or irritation of the scalp. These side effects generally resolve shortly after therapy.

Alternatives to TMS

Alternative treatment options to TMS may include medications that address the target symptoms, psychotherapy or talk therapy treatment options, electroconvulsive therapy (ECT), and ketamine treatments. Each alternative has its own set of benefits and considerations, and the best choice will depend on individual patient needs and medical history. TMS is often pursued by people after other interventions or treatment options have proven ineffective – studies consistently demonstrate effective improvements in symptoms with TMS, and it generally has a favorable side effect profile compared to many medications and treatment such as ECT. 

TMS has few contraindications and does not conflict with or prohibit the use of most other treatments or therapies. It is often appropriate to continue your existing medications while receiving TMS treatments. It may also be appropriate to pursue some other treatments while receiving TMS treatments. It can be especially helpful, for instance, to pursue psychotherapy while receiving TMS infusion therapies. Initial research also shows that combining TMS treatments with ketamine treatments can be an especially good treatment combination.

TMS vs Ketamine:

Both TMS and IV Ketamine have good rates of efficacy and are often used for patients for whom other treatments may have been unsuccessful. TMS is generally considered noninvasive as it does not require an injection or similar component. TMS is also considered a medication-free option. Both Ketamine and TMS treatments are excellent options for many people.

TMS AND Ketamine:

Both TMS treatments and ketamine treatments ‘play well with others.’ They can be combined with many other treatments. A particularly good combination for some patients may be TMS treatments combined with ketamine treatments. Both treatments appear to operate by improving the activity of neurons, but in different ways. Studies indicate that combing both likely results in an increased chance of symptom reduction.