Many people with depression find that traditional treatments like antidepressants and psychotherapy aren’t enough. That’s where TMS comes in.
Tune into our podcast episode with host Gabrielle Sivertsen, a psychologist at South Coast Private Hospital, Medical Superintendent and psychiatrist, Associate Professor Irwin Pakula and Director of Transcranial Magnetic Stimulation (TMS) Outpatient Service and psychiatrist, Dr Nalin Wijesinghe as they explore TMS, a treatment option for those dealing with treatment-resistant depression, PTSD and anxiety.
Or continue reading this blog, where we explore what TMS is, how it works and why it’s becoming an increasingly popular treatment for those with treatment-resistant depression.
TMS is a non-invasive procedure that uses magnetic fields to stimulate specific parts of the brain associated with mood regulation. Unlike electroconvulsive therapy (ECT), which involves electrical shocks and sedation, TMS employs powerful magnetic pulses to activate or modulate brain activity without causing seizures or significant side effects.
The treatment focuses on a region called the dorsolateral prefrontal cortex, a part of the frontal lobe involved in executive functions and emotional regulation. Using precise measurements, clinicians position a magnetic coil over the forehead, just above the hairline, aiming at this specific brain area. The magnetic pulses induce electrical currents that stimulate neural activity, promoting neuroplasticity. This is the brain’s ability to reorganise itself and improve connections related to mood.
Each session usually lasts about 30-40 minutes. Patients sit comfortably in a chair, listening to music or watching TV. The technician places the coil on the scalp and the magnetic pulses can produce a tapping or knocking sensation on the head. Some patients may experience a mild twitch of the eyebrow or scalp muscle tension, but most find the procedure painless and easy to tolerate. Importantly, there’s no anaesthesia involved and patients can resume their daily activities immediately afterward.
Before considering TMS, a thorough assessment ensures the right diagnosis. Treatment-resistant depression (TRD) typically refers to cases where patients have failed to respond to two or more adequate trials of antidepressant medications combined with psychotherapy over several months.
Dr. Irwin Pakula explains that TRD involves a clinical diagnosis supported by classifications like DSM-5 or International Classification of Diseases (ICD). Key features include:
TMS is typically recommended when standard treatments have failed and the depression is categorised as treatment-resistant. It’s particularly useful for patients with concomitant anxiety or PTSD, as recent protocols also target these conditions by stimulating both hemispheres of the brain.
Most patients undergo around 20 sessions, spread over 4-6 weeks. The clinician first determines the appropriate intensity based on motor thresholds, using the motor cortex to calibrate the magnetic strength. Over sessions, the brain’s neuroplasticity is stimulated, leading to gradually improved neural connections.
Research shows that approximately 60-70% of people with treatment-resistant depression show improvement with TMS, with 20-30% achieving remission, meaning a significant reduction or absence of symptoms. While not a guaranteed cure, TMS offers a substantial alternative for those who have exhausted other options.
The benefits of TMS can last anywhere from six months to a year. Some patients may return for booster sessions if their symptoms re-emerge. Dr. Pakula notes that combining TMS with ongoing psychotherapy can enhance and prolong treatment effects.
TMS is considered very safe, with side effects being generally mild. The most common include scalp discomfort or headaches, which can be managed easily with over-the-counter pain relievers. A rare side effect is mild scalp twitching or muscle contraction.
Patients can resume normal activities immediately after a session. The treatment is non-invasive and usually feels like a tapping or knocking sensation. Many find it comfortable, and due to its safety profile, it’s possible to have treatments on an outpatient basis, even while continuing regular therapy and medication.
At South Coast Private Hospital, we offer outpatient appointments for TMS in a safe and non-invasive setting. Our Outpatient Clinic is located on Level 1 and operates 7 days per week. Bulk Billing (all costs are covered) for all eligible Medicare Patients for a course of up to 35 treatments available.
