TMS Pros & Cons

The pros and cons of TMS therapy

If you are looking for the pros and cons of TMS therapy, then probably you are considering TMS therapy as an alternative treatment modality for depression. You want to weigh the benefits vs. the risks of TMS therapy, especially when compared to other treatment options available for you today. In this article, I will walk you through the practical seven pros and seven cons of TMS therapy; every depression patient should be aware of when considering TMS therapy for depression. In the end, you will have a table or list comparing the pros and cons of TMS therapy.

The seven pros of TMS therapy

Unlike most treatment options for depression (except for talk therapy), TMS is the least invasive treatment method for depression. Other alternative treatments for depression like ECT, deep brain stimulator, or vagal nerve stimulator are significantly more invasive. And yes, I am comparing TMS to SSRIs antidepressant, and I am clearly stating that TMS is less invasive than taking Prozac or Zoloft. You see when you take an antidepressant. That particular chemical needs to get absorbed through your GI system, get distributed in your bloodstream, metabolized by your lived, penetrate to your brain, all of your brain minds you, to finally cause an alteration of serotonin neurotransmitter in specific circuits of your brain. Meanwhile, cause all kind of side effects because of all the other pathways it altered on the way in! Oh, and did I tell you that it also needs to be broken down and excreted out of the body.

Oh, one more thing, your brain might like that particular neurotransmitter. If for some reason, you stop, a whole bunch of readjustments needs to happen to your body in the phenomenon we call “serotonin discontinuation syndrome”. Taking medications is anything but non-invasive. On the other hand, TMS therapy targets magnetic stimulation directly to the brain’s area responsible for depression. It is non-invasive because magnetic fields can go throughout the body without causing damage. There is non of the systemic side effect associated with medications. This leads me to number two pro on the list.

TMS has non of the systemic side effects associated with classical antidepressants. No stomach issues, no weight gain, no sexual side effects, no dry mouth. Etc. That’s not to say that TMS is entirely free of any side effects. But they are local side effects, mild and usually go away. Please read the cons section below to learn more about TMS side effects.

Learn more about the side effects of TMS

Nowadays, almost all insurance companies recognize TMS therapy as a medical necessity for

when medications and therapy fail to help. This is a considerable advantage for TMS therapy when compared with other alternatives like ketamine infusions. That being said, insurances sometimes have demanding criteria for their TMS coverage policy. We will go over it in the cons section.

TMS therapy doesn’t require sedation or anesthesia. Patients can continue their daily routine as usual before and after the treatment. This means patients can drive themselves to the treatment clinic from home and drive to work after TMS treatment with no issues. Compare to ECT, which requires sedation or Ketamine that could interfere with the ability to drive or work, TMS has a huge advantage here.

This is probably the best pro about TMS when compared to most of the other alternatives. While medication antidepressants can be helpful for some, the chance of someone responding to a medication antidepressant is about one out of three. In comparison, the likelihood of someone responding to TMS therapy is two out there.

Click here to learn more about how TMS works.

While some medications could be habit-forming, TMS has no addictive properties of any type. Sometimes we entertain continuing spread out maintenance TMS sessions, but that’s to prevent a recurrent depressive episode. TMS therapy is not habit-forming. There are no discontinuation symptoms to occur after TMS is finished, while many SSRIs and SNRIs can cause serotonin discontinuation syndrome when stopped.

Unlike ECT or shock therapy, which could cause memory issues, TMS therapy doesn’t have a negative effect on cognition or memory. On the contrary, data are showing TMS enhancing the cognitive ability of patients going through TMS. It is being looked at as an HE or a Human Enhancement technology for this particular property.

The seven cons of TMS therapy

Yes. TMS therapy needs time investment. A regular TMS session takes about 19 minutes. But one will need to d a session every day, 5 days a week, for 6 weeks. That’s a total of 30 treatment sessions. Technically this is less than 10 hours total, which less than the total time one is supposed to spend with a therapist for an adequate CBT course. A newer TMS technology called intermittent Theta Burst Stimulation can cut down each treatment session’s duration to just about 3 minutes each. This is a tremendous time-saving. Lastly, for the VIPs who can’t leave work every day for daily TMS, a new accelerated TMS program is available in which 50 treatment sessions can be delivered in just 5 days.

It is estimated that 1 in 30,000 TMS treatment could end up leading to a benign seizure. This is a very low risk. It is a lower risk of seizure than the risk of seizure associated with some antidepressants like Wellbutrin (Bupropion). If you have a seizure disorder, then make sure your doctor is aware and discusses the safety of your TMS, which is not recommended for people with an active seizure disorder.

Some patients may report head discomfort or mild headache during or after their TMS treatments. Usually, it goes away after a few treatment sessions as patients get used to it. For the vast majority of patients receiving TMS, it is very well tolerated.

A few insurance companies are still living the dark ages and require four antidepressants failure before approving a patient to receive TMS therapy. They do it primarily for financial reasons and referring to STAR*D trail, a study published in 2006. Which is two years before TMS was FDA approved. Technically, if TMS were available in 2006, the STAR*D trail would have been considered unethical for not trying TMS at the second stage of treatment options. Thankfully many insurance providers are coming to their senses and doing the right thing. Aetna and Cigna require two antidepressants failures. Tricare requires one failure of treatment before approving TMS.

While TMS clinics are becoming more and more available in large metropolitan areas, we still don’t have immediate TMS access in rural areas.

Many people who could benefit from TMS therapy had never heard of it before. I am afraid it will take a long time before they do. Unfortunately, pharmaceutical lobbying is putting a lot of effort to silence the TMS growth among psychiatrists. You see many commercials telling you to try a new medication, but do they tell you about the alternative?

Almost all insurance companies cover the cost TMS therapy. This means that the patient is only responsible for co-pay, if any. That being said, TMS could be costly for patients without insurance.

Table comparing advantages and disadvantages of TMS therapy

https://www.floridatmsclinic.com/tampa-tms/ocd-treatment-tampa