It's all too clear that while many of you experience a dramatic positive response to antidepressant medications, others are frustrated and angry with the ineffectiveness of the treatment you've received.

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It's long been recognized that electroconvulsive therapy is an effective treatment, but the cost is high and problems with memory following treatment are not uncommon. For many years, treatment resistant patients have been waiting for an alternative treatment. In 2009, the FDA approved transcranial magnetic stimulation (TMS) as an alternative form of treatment for these individuals.

While transcranial magnetic stimulation has its own limitations, it can be quite effective for those of you who don't tolerate treatment with medications and aren't willing to consider electroconvulsive therapy. Since the FDA approval, the treatment has become much more widely available. While new strategies for providing TMS are being developed, the basic strategy is to provide daily treatments that last for approximately 40 minutes and don't require anesthesia.

A real advantage of transcranial magnetic stimulation is that it has a very low incidence of side effects. While some patients can begin to feel better during the first week, others require as many as six weeks before their depression resolves. While we are only beginning to understand the factors that increase the risk for relapse following a full course of treatment, some evidence suggests that a relatively modest number of ongoing treatments will maintain a positive effect.

The biggest barrier to obtaining transcranial magnetic stimulation at this point in time is concern about insurance coverage. However, as the efficacy of TMS becomes more firmly established, it's likely that insurance coverage will become more universal. The bottom line if you've struggled with antidepressant medications is that there's now an effective and safe alternative treatment.

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Who should receive transcranial magnetic stimulation (TMS)?

Experience with TMS makes it clear that not all patients respond to this treatment, but it also demonstrates that some do.  The success rate varies as a consequence of a number of factors, but the type and severity of the depression makes a difference.

National Suicide Prevention Lifeline
1-800-273-TALK (8255) Go to the nearest hospital or emergency roomCall your physician, health provider or clergyNational Alliance on Mental Illness
www.nami.org
1-800-950-NAMI (6264)

TMS works best for patients with moderate depression who don't tolerate antidepressant medications.  TMS is unlikely to work if you've received electro-convulsant therapy (ECT) and weren't helped by it.

TMS is still a quite new treatment. Psychiatrists vary in their experience using it and their confidence in its effectiveness. The most attractive features of TMS are that it's quite safe and effective for some patients. The biggest drawbacks are that it doesn't help some patients, it can take several weeks to begin to work, and is quite expensive.

If you're struggling with depression, you must ultimately decide whether TMS is the right treatment. A decision should be made on the basis of a frank discussion between a knowledgeable psychiatrist and an informed patient.  Once you understand the potential benefits and risks as well as the cost, the decision should be made as to whether the potential gain is worth the cost. Beginning a new treatment is not usually an easy decision, but it should be a joint decision based on the available evidence.

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