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Transcranial Magnetic Stimulation

What is transcranial magnetic stimulation (TMS)?

TMS is a non-invasive brain stimulation treatment for patients whose psychiatric or neurological symptoms have not improved with routine treatments like medications and therapy. The United States Food and Drug Administration (FDA) has cleared TMS for the following indications:

  • Major depressive disorder (2008)
  • Migraine headaches (2013)
  • Obsessive-compulsive disorder (2018)
  • Short-term smoking cessation (2020)
  • Depression with anxious distress or comorbid anxiety (2021)

The FDA has also granted TMS a “breakthrough device designation” for bipolar depression, but it has not yet cleared it for this indication. Nearly all insurance companies cover TMS for depression, but they may or may not cover TMS for other indications. Please contact your insurance directly for further information. This page will focus on treatment-resistant depression, the illness most commonly treated with TMS.

Read our TMS therapy FAQs

Why should I consider TMS?

Depression is among the leading causes of disability worldwide. Two out of three people taking antidepressant medications continue to experience symptoms of depression. Moreover, the probability of getting well and staying well decreases each time a patient tries a new medication. TMS is a safe and effective treatment that can work even after psychotherapy and medications have not worked. Many patients consider TMS before other FDA-approved or cleared treatments for depression such as esketamine (brand name Spravato) or electroconvulsive therapy (ECT) because TMS does not require anesthesia, medication, or invasive procedures. TMS is usually well tolerated, and patients can drive themselves to and from treatment.

How does TMS work?

TMS uses an electromagnetic coil to create magnetic pulses (similar to an MRI), which pass through the skull to stimulate the brain network involved in regulating mood. As such, it is generally not recommended for patients with seizure disorders or patients who have metal in the head area. Daily (weekday) treatment sessions for 6-8 weeks (30-36 treatments total) are typically required.

During treatment sessions, patients recline in a chair while a TMS coil rests on the specific part of their head. The TMS coil makes a clicking sound and produces a tapping sensation when it is stimulating the brain. Patients are awake for the entirety of the session, which ranges from 3 to 37 minutes, depending on the treatment protocol prescribed. Studies have shown that the antidepressant effects of TMS last after the acute series of treatments ends.

TMS treatment room
TMS treatment room at the Center for Brain Circuit Therapeutics.

What are the side effects and risks of TMS?

Common

  • Scalp discomfort or pain during treatment
  • Muscle twitching during treatment
  • Mild headaches during or after treatment, especially in the first week
  • Feeling Lightheaded during or after treatment

Uncommon

  • Moderate or severe headaches after treatment
  • Hearing loss (prevented by use of ear plugs during treatment)
  • Hypomania/mania (typically reported in patients with a history of bipolar I)
  • Seizure (1 out of every 30,000 treatments, usually in patients with seizure risk factors)

Does insurance cover TMS?

Most insurance plans cover TMS after a patient does not benefit from or cannot tolerate 3-4 antidepressant medications.

Why choose Brigham and Women’s Hospital for TMS?

  • Interdisciplinary team of neurologists and psychiatrists who are leaders in TMS, brain stimulation, and interventional psychiatry
  • Part of an innovative Center for Brain Circuit Therapeutics in the Hale Building for Transformative Medicine
  • Access to TMS observational studies and clinical trials
  • Insurance authorization handled by administrative staff
  • Subsidized parking

We are optimized to reduce exposure to the virus that causes COVID-19 and offer:

  • Remote consultations with new and established patients
  • Video monitoring during treatment
  • FDA-cleared TMS-Cobot, a robotic system that uses optical tracking or MRI neuronavigation to improve TMS precision and reduce exposure
  • Theta-burst stimulation, a treatment protocol that reduces treatment time without compromising treatment effectiveness

TMS research and clinical trials

Our physician scientists specialize in discovering and testing new treatment targets for brain stimulation therapies like TMS. We offer observational trials that do not affect routine TMS treatment as well as clinical trials that test new treatment strategies. If interested, please e-mail bwhtmstrials@bwh.harvard.edu or check clinicaltrials.gov.

Our team

How do I schedule an appointment or refer a patient?

All patients must have a referring clinician, someone who follows them longitudinally for psychiatric care. Referral methods are listed below:

  • EPIC electronic health record referral (search “TMS”)
  • Clinician referral form (submit via fax or encrypted e-mail)

For more information:

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