Transcranial Magnetic Stimulation (TMS) is an exciting and revolutionary approach to treating psychiatric and neurological conditions without medication.

TMS treatment involves 20-40 minute outpatient sessions over a course of 4-6 weeks. This treatment is:

  • Safe – No long-term side effects.
  • Non-invasive, meaning that it does not involve surgery.
  • Does not require any anesthesia or sedation, as the patient remains awake and alert during the treatment.
  • Non-systemic, meaning nothing circulates in the bloodstream throughout the body.
  • FDA cleared for people suffering from Major Depression who do not benefit sufficiently from medication treatment.
  • A potential treatment option for many psychiatric and neurologic conditions.

How TMS Works

The principle behind TMS is the discovery that magnetic pulses focused on a brain region can be used to stimulate brain cells in that brain region. TMS applied over time at high frequency stimulates brain activity, whereas TMS applied over time at low frequency reduces brain activity.  Since the symptoms of every psychiatric and neurological condition are associated with a unique pattern of abnormal activity (too high or too low) in certain brain regions, TMS aimed at those abnormal function areas can be used to alter their activity over time toward a more normal and healthy level. Major depressive disorder is the most common condition that TMS is used to treat.  Activity in the left frontal area of the brain, in a region called the dorsolateral prefrontal cortex, is reduced in patients with depression. High frequency TMS aimed at the left prefrontal cortex is used to return normal activity to that part of the brain and thereby eliminate or reduce the symptoms of depression.  The safety and efficacy of TMS for treating depression has been established in several well controlled research studies including a study sponsored by the National Institute of Mental Health. Based on this body of scientific evidence, in 2008 the FDA cleared TMS as treatment for patients with depression who have not benefited from antidepressant medication. Since 2008 over 18,000 patients have undergone TMS treatment.

Dorsolateral prefrontal cortex

TMS to treat depression targets the dorsolateral prefrontal cortex which is underactive in patients with depression.

Different TMS Devices: Patients have a choice

Currently five TMS systems are approved by the FDA for treating patients with depression who have not benefitted from antidepressant medication or who cannot tolerate them. The first system, Neurostar, is based on the standard “figure-8” coil design. Dr. Feifel was the first provider in San Diego to offer Neurostar TMS therapy starting in 2009. Three other TMS devices have more recently cleared by the FDA that use the figure-8 coil, Magventure, Magvita and Neurosoft. The limitation of standard coils designs such as the figure-8 coils is that they are only safely able to activate brain cells at up to 1-2 cm below the brain surface. The ability to activate brain circuits deeper than this without using unsafe and uncomfortable settings was a dilemma for the TMS field for years until a new coil design was invented.

In 2013 the FDA cleared Brainsway TMS system for the treatment of Depression. This system uses a revolutionary coil called the ‘H’ coil, invented at the National Institute of Health (NIH). The H-coil is able to directly stimulate deeper into the brain than the any of the TMS devices that use the figure-8 coil (Neurostar, Magventure, Magvita, Neurosoft) allowing it to reach ‘limbic’ areas of the brain that regulate mood and motivation. The H-coil is integrated into a ‘helmet’ that sits over patient’s scalp.  A session of “Deep TMS” or “dTMS”  the name given to TMS  treatment using the H-coil is typically 20 minutes, which is about half the duration of a typical Neurostar (figure-8 coil) TMS session. Brainsway Deep TMS is considered the most advanced TMS system currently available.  In addition to FDA clearance for Major Depressive Disorder, the Brainsway system is currently approved (has CE mark) for several neuropsychiatric conditions in the European Union including:

  • Autism
  • Major Depressive Disorder
  • Bipolar Disorder
  • Schizophrenia
  • Post-Traumatic Stress Disorder
  • Parkinson’s Disease
  • Chronic Pain
  • Multiple Sclerosis
  • Stroke
  • Obsessive Compulsive Disorder
  • Smoking Cessation

In 2013 Dr. Feifel was the first provider in San Diego to acquire and use Deep TMS in addition to Neurostar (figure-8) TMS he acquired several years before. While many centers prefer TMS systems that use that older, figure-8 coil designs because they are less expensive, Kadima Neuropsychiatry Institute now uses Deep TMS as it primary TMS treatment due to its advanced technology.