rTMS Therapy

This magnetic field is produced by feeding energy from a standard wall socket through a small transformer, the rTMS machine, which controls the frequency and other aspects of electrical activity, and then onto magnetic wiring that is wrapped and enclosed in plastic. The plastic shell is positioned perpendicular to the scalp, and the varying electric current creates an electromagnetic field as it travels through the wiring and 2-3 cm into the cerebral cortex. Depending on the protocol, these magnetic pulses can either stimulate or depress neural activity. To put it another way, we are safely transmitting a small amount of electrical activity to a small region of the brain using a magnetic field.

Through electrical circuits, the brain communicates and builds new ones. From simple actions like breathing to more complex ones like language, thought, memories, and actions, billions of electrical connections communicate to carry out both voluntary and involuntary life functions. Emotions are also produced by intricate and interconnected "circuits," which in turn affect how we react to and control these emotions. These pathways can occasionally go awry, which causes the electrical activity to malfunction. According to studies and research on brain imaging, certain regions of the brain become inactive or underactive while others become excited and hyperactive, as in the cases of depression and anxiety, respectively.

As previously mentioned, rTMS—Transcranial Magnetic Stimulation—uses magnetic fields or pulses to stimulate electrical connections in the brain in a manner akin to an MRI. There are numerous hypotheses about how rTMS improves brain activity in people who suffer from depression, anxiety, or other conditions, but we are certain that rTMS alters neuronal activity. rTMS can either 'calm' agitated, overactive neurons (like those found in anxiety) or 'wake up' sleepy, low-activity neurons (like those found in depression) depending on the type of stimulation used.

Once a Psychiatrist has determined that the patient is a good candidate for rTMS, a specific rTMS treatment protocol is chosen to address the condition and achieve the desired results. This involves focusing on the DLPFC (dorsolateral prefrontal cortex), which is involved in depression. When people with depression are compared to people without depression, this region consistently displays depressed activity.

The appropriate level of treatment intensity will then be determined by a certified rTMS Psychiatrist using a process known as "mapping," or motor threshold determination. This establishes the precise energy needed to ignite an electrical spark without going overboard. A full treatment session can then start after the magnetic treatment coil has been installed at the DLPFC. The rTMS device starts the protocol that was entered, and pulses begin to occur every few seconds (depending on the protocol), followed by a pause in stimulation for about ten seconds to allow neurons to reset. Although there are different treatment times, it typically takes 18.5 to 3 minutes to complete.

Regardless of the treatment protocol, the rTMS team keeps an eye on how well the treatment is tolerated and can change certain aspects of the treatment to minimise discomfort. Treatment has no systemic side effects, but headaches or tenderness at the stimulation site on the scalp have happened to some patients. This usually goes away after adjusting to the therapy and during the first few sessions. Since there is a tapping sound associated with magnetic pulses, earplugs are worn as a safety measure. The noise level is not overly loud, and different devices produce more or less noise.

The procedure is carried out in a welcoming outpatient office setting. Patients can simply lie in a recliner chair while receiving treatment and can even watch TV, listen to music, unwind or meditate, or speak with their rTMS therapist. There is no need for medication or sedation prior to, during, or after treatment. After a treatment session, patients are free to drive and go back to their homes or places of employment. A course of rTMS treatments typically consists of 36 sessions spread over six weeks, plus a final few weeks of tapering off. Response typically takes a few weeks, but each patient's recovery time is unique.

rTMS for depression typically has a positive response rate of 60–70%, with 40–50% of patients achieving full remission. After a year, two thirds of patients still exhibit this response. The one-third of patients who might require retreatment typically respond well once more, with 80% or more of these patients doing so.

When necessary, maintenance therapy may be used with some patients. Less frequently scheduled sessions, such as once per week, are typical. The full treatment courses as described above are currently covered by insurance for certain indications, including most recently Treatment Resistant Major Depression, OCD, and Smoking Cessation. Maintenance treatment is not currently covered by insurance. Additional conditions will undoubtedly be added over time as research continues. For patients seeking care without insurance coverage, KARLA Neuromodulation affordable rates, and for those who might require ongoing maintenance care, lower rates. Prior to any visit that requires payment, rates are disclosed, and we have a specialised billing team with years of experience working with insurers to ensure coverage when necessary.

There are few contraindications to rTMS, some of the most important are:

Epilepsy or history of seizures - There is a chance that rTMS will cause seizures. However, the risk of seizures is extremely low and comparable to that of taking an antidepressant in general. Most studies show that seizures occur in only 1 in 30,000 or more treatments.

Medical implants - any object made of metal or susceptible to magnetic fields. Likewise, any other metal-containing foreign object close to the treatment area.

Pregnancy or breastfeeding - rTMS safety in these populations is still being studied, but it hasn't been established yet.

Always review all contraindications during a screening evaluation. In the Pricing Guide section of our review of insurance coverage criteria, we also provide a list of additional contraindications.

In 2008, the FDA approved rTMS for the treatment of treatment-resistant major depression, and more recently, it was approved for the treatment of OCD and quitting smoking. It is non-invasive because it modifies the electrical activity of brain surface neurons using electromagnetic fields. As a result, there are no systemic side effects and the procedure is generally well-tolerated and risk-free. For people with psychiatric conditions that are resistant to treatment or who have an intolerance to medications, it offers a fantastic treatment option.