Transcranial Magnetic Stimulation (TMS) is successful for many, and not for all. There will be patients who feel lighter, sleep better, return to feeling energetic, and there are patients who may show some mild variation or sometimes nothing at all.
Read more on this link https://en.wikipedia.org/wiki/Transcranial_magnetic_stimulation.
How Response Varies
The importance of individual variability in response to TMS is huge. For example, someone who has had long-standing, treatment-resistant depression may require a different treatment time and protocol than someone who just had an episode. Additionally, they may have concurrent conditions of anxiety, PTSD, ADHD, or substance use which will affect how (and when) that improvement may show itself.
Although TMS targets the dorsolateral prefrontal cortex, it will not be exactly the same in everyone. The shapes of our skulls, the thickness of the cortex, and network connectivity all have small individual differences that impact how much stimulation lands where it needs to land. For all of the care that a provider may take to put the coil in the right spot, TMS is a non-invasive brain stimulation. So even at the same prescribed dose there will be instances a subject will feel a stronger or weaker effect; it is just part of the reality of non-invasive brain stimulation.
Common Reasons TMS Fails
When TMS does not provide enough help, there are usually some identifiable and remedial reasons. Identifying them removes blame and creates possibilities.
- Targeting location was off. Without imaging-guided mapping, the coil cannot be exactly where it needs to be, diminishing the signal from where it matters.
- Dose was too low or too brief. Some patients may need more than protocol, more sessions, more pulses, more ramping up across the whole.
- Too infrequent of schedule adherence. Missed sessions or spaced sessions can interrupt the progression of neuroplasticity day to day. This can occur with unattended conditions, for example, treating sleep apnea, thyroid issues, or active substance use can dampen mood improvements until these conditions are treated. Additionally, medication interactions or adverse effects with medications can interfere with either mood improvement or potentially increase seizure discharges.
- Timing of TMS. TMS typically increases energy and ability to concentrate before mood elevation. Judging TMS improvement too early can lead to stopping right before a pattern emerges.
The Importance of Personalization
Personalization can turn a “nonresponse” into an improvement. Clinicians are personalizing coil and site selection, frequency of stimulation, and number of sessions based on your presenting syndromes and brain targets. Standard high frequency stimulation, accelerated or theta burst neuromodulation have a different commitment of time and tolerability, which are all custom steps—for example, Rancho Santa Fe TMS Therapy incorporates careful mapping with supportive psychotherapy and sleep hygiene strategies.
The aim of TMS therapy is to utilize potential for neuroplasticity for the brain to re-learn new patterns in a way that sticks and continues to develop beyond the treatment chair.
What Happens After?
Completing a course of TMS is not an end of the care—it is the beginning of consolidation. Many patients who improve with TMS carry on with some maintenance plan, for example: a boost session, continuation of medications, or engaging in therapy.
In those patients who did not improve enough, a thoughtful review takes place. Clinicians ask if the patient is experiencing good life stress, sleep issues, or medical problems that would have diluted the gains from TMS. Sometimes a second trial with better targeting achieves change, while other times the best option would be to switch to another methodology. For those with major depressive disorder, it is appropriate to have a flexible roadmap that recognizes dips in presentation are inevitable.
Other Treatment Options
Should TMS be ineffective or only have limited success, there are still options you can use which are evidence-based and will help you move ahead. Combining treatments increases your chance of relief, and switching to a different mechanism may help you break an impasse.
- Optimizing medications. If medications are being taken, re-evaluating selective serotonin reuptake inhibitors (SSRIs), consider augmentation add “broader treatments” such as mood stabilizers or atypical antipsychotics, simplify complex regimens will have a positive impact on your day-to-day functional life.
- Engaging in psychotherapy. Cognitive behavioral therapy, behavioral activation, or trauma-focused therapies can enhance skills and work at social patterns that TMS does not.
- Ketamine or esketamine. Rapid-acting medications work through glutamatergic pathways. Ketamine or esketamine can help those who did not respond to TMS.
- Electroconvulsive therapy (ECT). ECT remains a highly effective and often lifesaving treatment for severe, urgent depression and psychotic depression. Click here to learn more.
- Lifestyle and sleep interventions. Treating insomnia, improving circadian rhythm, and increasing activity are often effective for improvements in mood and energy and protect gains made from other interventions.
- Clinical trials and specialties. Research programs can offer new combinations for treatment-resistant depression or new devices.
Conclusion
TMS is a powerful intervention, but it is just one tool in the toolbox. A clear-eyed review of what happened, what could have been refined, and what could be tried next can bring momentum back. With either the right fit in relation to their TMS plan or something different, many people can still move towards a steadier mood state and fuller life.
