Transcranial Magnetic Stimulation in New York City

How Long Do TMS Therapy Results Last and What Happens if TMS Therapy Doesn’t Work for Me?

Many people are turning to new technology, called transcranial magnetic stimulation, in New York City for depression treatment. Transcranial magnetic stimulation (TMS) is proven to help people who do not see improvement of depressive symptoms with antidepressants—these patients are said to have treatment-resistant depression (TRD). (1,2) In addition to the positive effects for patients with TRD, TMS is not a medication and therefore does not come with the long list of side effects associated with antidepressants.

Many of my patients and potential patients contact my office with questions about TMS therapy in NYC. Some of the most common questions patients ask me in my clinic are: “How long do TMS results last?” and “What happens if TMS doesn’t work for me?” To understand the answer to these questions, we must first take a look at how TMS works to relieve depressive symptoms.

How Does TMS Therapy Relieve Depressive Symptoms?

Essentially, TMS works by electrically stimulating neurons (brain cells). This is different from antidepressants that chemically stimulate neurons. At the start of a TMS session, your doctor will carefully position a coil over your head. During the 20 minute appointment, this coil emits magnetic pulses that create an electrical current within the brain. This electrical current stimulates neurons in certain areas of the brain (more specifically in the region where the coil is placed). Stimulation of the brain’s neurons helps them become more active than they were before, allowing them to better communicate with other neurons. (3,4)

Scientists know that TMS can “reset” connections between neurons. By “resetting” neuronal connections, brain cells can communicate with each other in new ways. This allows them to form new neuronal pathways and therefore new patterns of behavior. (5,6)

One course of TMS in New York City is typically administered over 9 weeks. The patient receives 5 sessions per week for the first 6 weeks, and then gradually tapers off to fewer treatments for the remaining 3 weeks. Since TMS in NYC is an outpatient procedure that does not require any type of anesthesia, patients can return to work immediately following a TMS session. Most patients are able to easily fit TMS appointments into their schedules.

How Long Do Results Last After Getting TMS in NYC?

The effects of TMS have been proven to last at least as long as one year. One study showed that as much as 62.5 percent of patients who achieved remission with TMS, continued to show a response to treatment and/or remission even one year after the initial course of treatment. (3,7) Many of my patients are still in remission one year after treatment.

However, just how long the results of TMS therapy last vary from person to person. Multiple studies have aimed to identify predicting factors of TMS response. Some of the possible factors that may predict TMS response include:

  • Age: TMS is less effective with age. More specifically, people under the age of 55 are more likely to respond to TMS. (8,9)
  • Gender: Study results show that women are more likely to respond to TMS. (9,10)
  • Early response to TMS: Patients who respond early to TMS are more likely to achieve remission. (10) However, this isn’t a definitive indication of who will achieve remission and who will not. The time it takes to start seeing the effects of TMS varies from patient to patient. I have patients who do not start to see results until week 4 or 5 of treatment who achieve remission.
  • Personality characteristics: Patients who scored higher for persistence on the Temperament and Character Inventory (TCI) are more likely to respond to TMS after just 2 weeks of treatment, compared to patients with lower persistence scores. (11)

Maintenance sessions may be needed for patients who notice a return of symptoms after TMS therapy. A new round of TMS treatment may be needed for patients who experience a full relapse. Researchers have found that reintroducing TMS when patients notice recurring symptoms can restore the positive effects of the initial round of treatment. (12,13)

What if TMS Therapy Doesn’t Relieve Depressive Symptoms?

While TMS has helped thousands of people find relief from depressive symptoms, it does not work for everyone. If TMS therapy doesn’t work, are there other options for depression treatment in NYC? Yes.

If TMS does not work for you, don’t lose hope. TMS is just one of many options for depression treatment in NYC. It’s important to understand that depression treatment is a trial-and-error process that takes time. Here’s what we do in my clinic if a patient doesn’t respond to an initial course of TMS treatment.

Try Another Course of TMS Treatment

Some patients may need more than one course of TMS before they see results. TMS can be done alone or combined with another treatment like antidepressants or talk therapy. Studies show that TMS can augment or enhance the effects of antidepressants. (14,15) A recent study shows that TMS in combination with talk therapy also results in high response and remission rates. (16)

Look at Your Supplemental Treatments: Do They Need Tweaking?

If an initial course of TMS treatment was completed in combination with another depression treatment, I work with the patient to see if any adjustments can be made to the supplemental treatment. For example, should we adjust the dose of the medication or try a different antidepressant? Are you making progress with your therapist? An important part of any depression treatment is the ability to manage symptoms daily. If you feel that you and your therapist don’t “click,” and his/her methods are not helping you manage symptoms, consider finding a new therapist.

Confirm Your Diagnosis

Depression and bipolar disorder share many of the same symptoms. Although uncommon, people with bipolar disorder can be misdiagnosed with depression. Neither TMS nor antidepressants are effective treatment options for bipolar disorder. If you’ve been diagnosed with depression and have a family history of bipolar disorder, or if you’ve ever experienced signs of mania or hypomania (like racing thoughts, being more talkative than usual, and getting distracted easily), consider getting a second opinion.

Consider an Alternative to TMS Therapy, NYC Has Options

If you decide not to continue with TMS, NYC has other depression treatment options available, including:

  • Ketamine infusions: Ketamine is a drug that was once used as an anesthetic, but is now being noticed for its antidepressant qualities. Initial research efforts show that regular ketamine infusions relieve depressive symptoms for patients with treatment-resistant depression. (17,18) Ketamine must be administered by a healthcare professional in a medical setting.
  • Electroconvulsive therapy: Electroconvulsive therapy (ECT) is successful in treating patients with treatment-resistant depression. (19) But it is generally only recommended when other depression treatments have failed, because it involves a procedure that requires the patient to go under general anesthesia and stay in the hospital. During ECT, a doctor places electrodes on the patient’s scalp. These electrodes deliver small electrical pulses to the brain.

Want to Learn More About TMS Therapy in NYC?

If you’d like to learn more about transcranial magnetic stimulation in New York City, consider scheduling a consultation with a psychiatrist who offers TMS therapy. If you’re currently working with a psychiatrist, ask him/her if TMS might work for you.

Resources:

1. Carpenter LL, Janicak PG, Aaronson ST, et al. Transcranial magnetic stimulation (TMS) for major depression: A multisite, naturalistic, observational study of acute treatment outcomes in clinical practice. Depression and Anxiety. 2012;29(7):587-96. https://www.ncbi.nlm.nih.gov/pubmed/22689344. Accessed April 07, 2020.

2. Avery DH, Isenberg KE, Sampson SM, et al. Transcranial magnetic stimulation in the acute treatment of major depressive disorder: clinical response in an open-label extension trial. J. Clin Psychiatry. 2008; 69:441-451. https://www.ncbi.nlm.nih.gov/pubmed/18294022. Accessed April 07, 2020.

3. Dunner DL, Aaronson ST, Sackeim HA, et al. A multisite, naturalistic, observational study of transcranial magnetic stimulation for patients with pharmacoresistant major depressive disorder: Durability of benefit over a 1-year follow-up period. The Journal of Clinical Psychiatry. 2014;75(12):1394-401. https://www.psychiatrist.com/jcp/article/Pages/2014/v75n12/v75n1207.aspx. Accessed April 07, 2020.

4.Neurostar mechanism of action. YouTube: Neurostar Advanced Therapy. https://www.youtube.com/watch?v=r4WISNwv3nc&t=. Published on Nov 29, 2016. Accessed April 07, 2020.

5. Kozyrev V, Staadt R, Eysel UT, and Jancke D. TMS-induced neuronal plasticity enables targeted remodeling of visual cortical maps. Proceedings of the National Academy of Sciences of the United States of America. June 2018;115(25):6476-6481. https://www.pnas.org/content/115/25/6476. Accessed April 06, 2020.

6. Ruhr-University Bochum. What effect does transcranial magnetic stimulation have on the brain? Published June 5, 2018. https://www.sciencedaily.com/releases/2018/06/180605103511.htm. Accessed April 06, 2020.

7. Dunner DL, Aaronson ST, Sackeim HA, et al. A multisite, naturalistic, observational study of transcranial magnetic stimulation for patients with pharmacoresistant major depressive disorder: Durability of benefit over a 1-year follow-up period. Psychiatrist.com: The Journal of Clinical psychiatry. https://www.psychiatrist.com/jcp/article/Pages/2014/v75n12/v75n1207.aspx. Accessed April 06, 2020.

8. Pallanti S, Cantisani A, Grassi G, Antonini S, Cecchelli C, Burian J, Cauli G, and Quercioli L. rTMS age-dependent response in treatment-resistant depressed subjects: a mini-review.

CNS Spectrums. March 2012;17(1):24-30. https://www.ncbi.nlm.nih.gov/pubmed/22790115. Accessed April 06, 2020.

9. Lauren LeBano. Transcranial magnetic stimulation may be more effective for women than men. Psychiatry & Behavioral Health Learning Network. Published October 03, 2013. https://www.psychcongress.com/article/transcranial-magnetic-stimulation-may-be-more-effective-women-men. Accessed April 06, 2020.

10. Kar SK. Predictors of Response to Repetitive Transcranial Magnetic Stimulation in Depression: A Review of Recent Updates. Clinical Psychopharmacology and Neuroscience. February 2019;17(1):25–33. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361049/. Accessed April 06, 2020.

11. Siddiqi SH, Chockalingam R, Cloninger R, Lenze EJ, and Cristancho, P. Use of the temperament and character inventory to predict response to repetitive transcranial magnetic stimulation for major depression. Journal of Psychiatric Practice. May 2016;22(3):193-202. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852279/. Accessed April 05, 2020.

12. Demirtas-Tatlidede A, Mechanic-Hamilton D, Press DZ, Pearlman C, Stern WM, Thall M, and Pascual-Leone A. An open-label, prospective study of repetitive transcranial magnetic stimulation (rTMS) in the long-term treatment of refractory depression: reproducibility and duration of the antidepressant effect in medication-free patients. Journal of Clinical Psychiatry. 2008;69(6):930–934. https://www.ncbi.nlm.nih.gov/pubmed/18505308?dopt=Abstract. Accessed April 05, 2020.

13. Fitzgerald PB, Benitez J, de Castella AR, Brown TL, Daskalakis ZJ, and Kulkarni J. Naturalistic study of the use of transcranial magnetic stimulation in the treatment of depressive relapse. Australian and New Zealand Journal of Psychiatry. 2006;40(9):764–768. https://www.ncbi.nlm.nih.gov/pubmed/16911751?dopt=Abstract. Accessed April 05, 2020.

14. L Bangshan, Zhang Y, Zhang L, and Li L. Repetitive transcranial magnetic stimulation as an augmentative strategy for treatment-resistant depression, a meta-analysis of randomized, double-blind and sham-controlled study. BMC Psychiatry. 2014; 14: 342. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4264336/. Accessed April 06, 2020.

15. Rumi DO, Gattaz WF, Rigonatti SP, Rosa MA, Fregni F, Rosa MO, Mansur C, Myczkowski ML, Moreno RA, Marcolin MA. Transcranial magnetic stimulation accelerates the antidepressant effect of amitriptyline in severe depression: a double-blind placebo-controlled study. Biol Psychiatry. 2005;57(2):162-6. https://www.ncbi.nlm.nih.gov/pubmed/15652875. Accessed April 06, 2020.

16. Donse L, Padberg F, Sack AT, Rush AJ, and Arns M. Simultaneous rTMS and psychotherapy in major depressive disorder: Clinical outcomes and predictors from a large naturalistic study. Brain Stimulation. 2018;11(2):337-345. https://www.sciencedirect.com/science/article/pii/S1935861X17309609. Accessed April 07, 2020.

17. Kevin Kunzmann. Weekly Ketamine infusions show initial, repeated depression benefits. MDMag.com. Published April 08, 2019. https://www.mdmag.com/medical-news/weekly-ketamine-infusions-show-initial-repeated-depression-benefits. Accessed April 07, 2020.

18. Phillips JL, Norris S, Talbot J, Birmingham M, Hatchard T, Ortiz A, Owoeye O, Batten LA, Blier P. Single, repeated, and maintenance ketamine infusions for treatment-resistant depression: A randomized controlled trial. The American Journal of Psychiatry. 2019:1;176(5):401-409. https://www.ncbi.nlm.nih.gov/pubmed/30922101. Accessed April 07, 2020.

19. Kellner CH, Greenberg RM, Murrough JW, Bryson EO, Briggs MC, and Pasculli RM. ECT in treatment-resistant depression. The American Journal of Psychiatry. 2012;169(12):1238-44. https://www.ncbi.nlm.nih.gov/pubmed/23212054. Accessed April 07, 2020.

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