Brain stimulation is a collective term for various medical treatments that are relatively new, where various energy sources such as electricity, magnetic energy, sound waves, and light are used to change the activity of neurons in the brain.

Brain stimulation has been used to treat a wide variety of neurological and psychiatric disorders.

TMS stands for Transcranial Magnetic Stimulation. Magnetic stimulation is a rapidly growing form of treatment for various diseases, including depression. The treatment is well-tolerated and causes few and mild side effects.

In short, magnetic pulses pass unimpeded 2-4 cm through the scalp and skull, where they either stimulate or inhibit neurons in the cerebral cortex. Magnetic stimulation affects neurons in the brain by inducing a weak electric field in the neurons targeted by the treatment. By changing the electric field of a neuron, its nerve impulses can be either stimulated or inhibited. TMS treatment is non-invasive and requires neither anesthesia nor surgery.

It should be noted that TMS treatment is not the same as electroconvulsive therapy (ECT), which is another useful treatment for serious mental illnesses, including severe depression.

Standard depression treatment consists of psychotherapy and pharmacotherapy, and it can be said to be effective in 60-70% of cases. The group for whom traditional treatment does not work, despite being fully tried, is considered to be dealing with treatment-resistant depression. In cases where traditional treatment has not achieved results, magnetic stimulation or TMS treatment can prove beneficial.

No. In electroconvulsive therapy (ECT), an electric shock is administered that travels non-specifically throughout the body and causes a seizure. For this reason, it is necessary to anesthetize those receiving ECT.

In TMS treatment, however, magnetic pulses are used that only reach about three centimeters inside the skull, making the treatment more targeted. Contraindications for TMS treatment are few, and side effects are most often mild. Clients receiving TMS treatment can go about their day at the end of each session.

TMS technology is young and evolving rapidly. Currently, four indications are recognized by the EMA (European Medicines Agency) and the FDA (Food and Drug Administration) in the United States, but this number is likely to increase in the coming years as there is much promise in the works from researchers worldwide.

TMS treatment is a recognized form of treatment for:

• Treatment-resistant depression (TRD)

• Obsessive-compulsive disorder (OCD)

• As an aid for smoking cessation in adults

• Migraine headaches

Currently, treatment is only offered for treatment-resistant depression at the Capital Area Healthcare Centers' Brain Stimulation Center, though this may change in the near future.

In TMS treatment, magnetic stimulation is directed at an area in the frontal lobe that is underactive in people suffering from depression.

TMS treatment stimulates neurons in the cerebral cortex, which then send signals to nerves in underlying neural nuclei/bundles that have been shown to be less active in people with mood disorders such as depression.

By repeatedly stimulating these areas with magnetic pulses, well-being can be improved.

Most often, treatment begins on the left frontal lobe (F3) with a so-called iTBS treatment (intermittent Theta Burst Stimulation), which is a rapid TMS treatment (3 minutes) that has been shown to be as effective as the traditional 37-minute treatment most commonly used until now.

If for some reason iTBS treatment is poorly tolerated, or if there is significant anxiety accompanying the depression, a psychiatrist may prescribe what is known as rTMS treatment (repetitive TMS treatment) on the right frontal lobe (F4). That treatment takes 25 minutes and focuses on inhibiting the neural pathways (reducing activity) rather than stimulating them.

Brain stimulation treatment with TMS generally takes about 4-6 weeks and requires a commitment to attend sessions on time every weekday (20-30 visits in total). In exceptional cases, TMS treatment may last for a shorter or longer duration.

After four weeks of treatment (20 visits), the effects of the treatment are assessed in an interview with a psychiatrist and with the help of questionnaires. If no results are noticeable, the treatment is discontinued. If, however, the client shows some benefit, the treatment is continued for an additional two weeks.

TMS treatment is generally well-tolerated.

The treatment itself is virtually painless. Once you have settled comfortably into a chair with a supportive headrest that keeps your head stable during the procedure, the practitioner will position the TMS treatment coil.

You might feel the pulses as a tingling sensation or a mild stinging on the scalp, or experience involuntary muscle twitches in the facial muscles, eyes, or nose.

The coil can easily be readjusted to keep these discomforts to a minimum.

Studies show that TMS treatment can significantly reduce symptoms of depression in over half of patients dealing with treatment-resistant depression, and up to 30% of them experience complete remission from symptoms for a longer or shorter period of time.

Family members, relatives, or close friends are often the first to comment on the positive effects of the treatment. The general effects can include feeling better, an improved mood, and increased energy for daily activities. You might also start sleeping better, find it easier to concentrate, or begin enjoying activities that you previously found tedious or unpleasant.

Some people notice changes quickly, even within the first week of treatment, while others do not feel a change until toward the end of the treatment. Some have found it helpful to keep a diary during the course of the treatment.

It should be kept in mind that TMS treatment is not a universal solution for all symptoms of depression, nor does it work for everyone.

Those who do respond to the treatment may feel positive changes during either the first or the final week of treatment. However, it is most common for people to notice real changes after the second week.

The initial positive effects of the treatment may seem minor at first. Examples include changes in mood, sleep, or cognitive ability, and the individual might not necessarily notice them clearly. In those cases, the first signs that something is happening might be when people say things like "suddenly the laundry basket was empty," "I laughed out loud," or "I sang in the car." More often than not, the changes become more tangible as the treatment progresses.

The success of TMS treatment at the Capital Area Healthcare Centers' Brain Stimulation Center (HÖM) for treatment-resistant depression is comparable to the results of international studies, according to a recent BS thesis.

The success of the treatment is measured using depression scales. Nearly 1/3 find some improvement (30-50 percent improvement on depression scales), and over 1/3 experience significant success from the treatment (over 50 percent improvement according to scales). Of those who experience some or significant success, 15-32% achieve full remission. However, one-third find no improvement, and the treatment does not seem to help. No serious side effects occurred during the treatment.

Although TMS treatment is generally safe, it utilizes a strong magnetic field, which leads to certain absolute contraindications. Magnetic stimulation should not be administered if clients have magnetically sensitive metal objects implanted in the head or neck. These objects can both heat up significantly and shift position, with corresponding consequences. Therefore, it is very important during the assessment of clients before treatment to ask whether objects such as metal plates, clips, electrodes, pumps, cochlear implants, or pacemakers have been placed in the head or neck during surgery. This also applies if there might be remnants of metal fragments, arrows, or bullets.

You must not receive magnetic stimulation if... :

• ... you have magnetic objects/fragments in the neck or head (generally, there must be at least 30 cm between the treatment coil and the object in question).

• ... you have a history of seizures or epilepsy.

• ... you are pregnant.

• ... you have a history of a serious underlying disease, such as heart disease, untreated intracranial pressure, etc. Detailed questions about medical history will be asked in an interview before treatment begins.

General contraindications: This refers to diseases or symptoms that can increase the risk of side effects or reduce the effectiveness of the treatment:

• Active substance abuse, including alcohol addiction.

• Bipolar disorder with psychotic symptoms.

• History of brain injury or stroke.

• Certain neurological diseases.

Yes. Most known side effects are harmless and easy to address. The most serious side effect of TMS treatment is seizures/convulsions, but the frequency of this side effect is very low—similar to or even lower than the frequency of seizures caused by taking conventional antidepressants.

Common side effects include:

• Fatigue

• Scalp discomfort at the treatment site

• Mild headache following treatment (approx. 10%)

• Temporary hearing impairment (the use of earplugs during treatment is recommended)