rTMS

Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive treatment that uses a magnetic field administered externally on the scalp to stimulate specific areas of the brain to treat depression, anxiety, and other clinical conditions used globally for over 20 years.

A magnetic coil is placed externally on the scalp of the individual at a predetermined site. The rTMS device then delivers a series of focused, strong, MRI-strength magnetic pulses, which are painless and go 2 to 3 centimeters deep into the brain. These magnetic pulses create a weak electrical current which can either increase or decrease activity in specific, targeted, brain areas. The strength and frequency of the pulses can be varied depending on the clinical condition and the targeted area of the brain. No sedation is required, individuals are awake and alert during rTMS treatment and can even drive themselves home, or resume work immediately following treatment. rTMS sessions are typically administered daily for 3-6 weeks, for about 20 to 30 minutes per session.

rTMS is a safe and effective treatment and has been in use globally for over 15 years to treat various neuropsychiatric illnesses. It was approved by the United States Food & Drug Administration (US-FDA) for the treatment of depression in 2008.

Individuals with the following conditions can benefit significantly from rTMS treatment:

• Major depressive disorder (FDA Approved in 2008)
• Bipolar mood disorder
• Anxiety Disorders: including Post-Traumatic Stress Disorder (PTSD) & Obsessive-Compulsive Disorder (OCD)
• Schizophrenia (certain symptoms)
• Eating disorders – Anorexia Nervosa and Bulimia
• Chronic pain
• Parkinson’s disease

Research Studies have shown that the therapeutic effect of rTMS in depression matches the effect produced by antidepressant medication. However, rTMS has a relatively rapid onset of action and the beneficial effects are usually noticeable in the second week of treatment. rTMS is especially useful among individuals who do not show a good response to antidepressant medication, who experience significant side-effects from medication, or in whom a rapid response is desirable. rTMS also has very few side effects. The possibility of achieving remission is greater with the combination of rTMS and antidepressant medication than with conventional medicine alone.

rTMS can be used either alone or in combination with antidepressant medication, depending on the type and severity of the medical condition being treated. The combination of rTMS and antidepressant medication shows a relatively quick onset of response, a decrease in the dose of required medication, and hence a decrease in the various side effects of medication.

rTMS is generally safe and has few or no side-effects if the correct protocol and procedures are followed. The most common side effect of rTMS treatment is mild discomfort in the scalp or a headache immediately following treatment; this can be treated with analgesics. Some individuals may experience ringing in the ears from the noise of the treatment. Hence, earplugs are worn during treatment to reduce exposure to the sound. The most serious risk of rTMS is seizures, but they are rare and occur in fewer than 1 in 1,000 patients. The risk is even lower in healthy individuals who do not have other risk factors for seizures. A careful pre-treatment evaluation can identify any such risks. rTMS safety guidelines were developed in the 1990s and when these are followed, no seizures are reported. Research until now has not shown any undesirable long-term side-effects of rTMS

Subjects with the following may not avail of rTMS or would need to consult their physician/psychiatrist on the following contraindications:
Metal objects in the head and neck region, cardiac pacemakers and implanted medication pumps, orthopedic implants, serious heart disease, increased intracranial pressure, history of seizures, family history of epilepsy, and individuals taking medication that might increase the risk of seizures.

It is advisable to continue the regular dosage of medication after initiating rTMS treatment. Medication should be tapered only after consulting the treating psychiatrist. In many individuals, the dose of medication can be substantially reduced after completing rTMS treatment and some individuals may even be able to stop their medication. However, this must be done under medical supervision.

Chronic illnesses such as major depression and the obsessive-compulsive disorder usually require maintenance treatment. This can most often be achieved using a medication, once the individual is better. Some individuals, however, can benefit from a repeat course of rTMS 6-12 months post-initial treatment; this is usually done after a re-evaluation and discussion of maintenance treatment options.

Electro-convulsive therapy (ECT) requires the administration of anesthesia and the induction of a seizure. Its efficacy is well documented in the literature. However, the electrical stimulus to the brain is scattered (and not focused on precisely on the targeted brain regions), and may produce undesirable side effects, such as transient memory loss.
Repetitive Transcranial Magnetic Stimulation (rTMS) does not involve anesthesia, electric shock, or seizure induction. In rTMS treatment, the electromagnetic stimulus is focused on targeted brain areas, avoiding undesirable side-effects such as memory loss, as shown by research.