TMS (Transcranial Magnetic Stimulation)

TMS, transcranial magnetic stimulation, is a treatment for depression that uses a magnetic coil held against the scalp to stimulate nerve cells in part of the brain. It is non-invasive, needs no anaesthesia, and is given as a course of short daily sessions in a clinic. It is mainly used when antidepressants have not worked or cannot be taken.

Also called: rTMS (repetitive TMS, the form used in treatment); deep TMS; theta-burst stimulation (a faster protocol); magnetic brain stimulation.

How it works

You sit in a chair, awake. A padded electromagnetic coil is placed against your head, usually on the left side of the forehead over the area involved in mood. The coil switches a magnetic field on and off very rapidly, which induces small electrical currents in the brain tissue underneath and changes how those nerve cells fire. You feel tapping or twitching on the scalp. A session lasts up to about 30 minutes, and a standard course is one session a day, five days a week, for two to six weeks. Some clinics use newer, shorter protocols. You can usually go back to work or drive afterwards, and some people need occasional top-up sessions later.

Uses

Depression that has not responded to medicine. This is the main use. The US FDA cleared the first TMS device in 2008 for depression that had not improved with at least one antidepressant. NICE in the UK reviewed it in 2015 and concluded that the evidence shows no major safety concerns and that short-term efficacy is adequate, though the response varies from person to person.
Obsessive-compulsive disorder. The FDA cleared TMS for OCD in 2018.
Under study. Addiction, schizophrenia symptoms and bipolar depression, among others. Those uses are still research, not routine care.

Guidelines still put talking therapy and antidepressants first. NICE asks clinicians to explain the other options and to be clear that TMS may not help you.

Side effects

The commonest are headache and scalp discomfort during or after a session, twitching of face or jaw muscles while the coil is on, and brief lightheadedness. These are usually mild and fade. A seizure is possible but rare when safety guidelines are followed. Because nothing enters the bloodstream, it does not have the body-wide side effects some antidepressants have. Long-term side effects have not been studied enough to rule out.

Risks

Clinics screen people before treatment. You usually cannot have TMS if you have:

metal in or near your head, such as aneurysm clips, stents in the neck or brain, implants in the ears or eyes, or shrapnel (dental fillings and braces are fine);
epilepsy or a history of seizures, because of the risk of triggering one;
a cardiac pacemaker or another implanted electronic device, on the device makers’ advice.

Tell the team about every medicine you take and about any alcohol or drug use, because both affect seizure risk.

In Nigeria

TMS is not widely available in Nigeria. One private provider, Synapse Services, says on its own site that it runs an rTMS machine at two of its centres, and research teams at Nigerian teaching hospitals, including Ahmadu Bello University Teaching Hospital in Zaria, have run trials of it. A psychiatrist decides whether it suits you after other treatments have been tried. Mytherapist.ng does not provide TMS. Our therapists treat depression with talking therapy, and refer to a psychiatrist for medicine or brain stimulation when that is needed.

TMS vs ECT vs antidepressants

ECT is still considered the most effective treatment for severe depression that has resisted other care, but it needs anaesthesia and can affect memory. TMS is gentler, targeted and done awake, with a weaker effect. Antidepressants, prescribed by a doctor, and CBT remain the first-line treatments, and both are far easier to get in Nigeria. Our guide to therapy or medication explains how that choice is usually made.

When to get help

If you have thoughts of ending your life, call 112 (or 767 in Lagos), or Safe Place Nigeria on 0800 800 2000, now. The full list is on our helplines page. If you have been low for weeks, start with our guide to depression, and you can book a licensed therapist on Mytherapist.ng. If two or more antidepressants have not helped, ask your psychiatrist about the full range of options, including TMS.