The Actual Pros and Cons of Deep TMS (dTMS)
Clinically Reviewed and Written By Ben Spielberg, PhD Candidate, Neuroscientist & Managing Director, California
Deep Transcranial Magnetic Stimulation (dTMS) Therapy is an advanced technique used to treat a number of mental health disorders including depression, anxiety, and obsessive-compulsive disorder. An offshoot of the original research on rTMS, dTMS allows for providers to target deeper and broader regions of the brain, which traditional rTMS devices can't typically reach.
Unlike most treatments for the above disorders, dTMS does not involve oral medication nor does it involve lengthy talk therapy—patients can simply come in once a day for 8 weeks, or do treatment on an accelerated schedule in as few as 5 days.
However, dTMS has many pros and cons, and it's important to understand these before deciding that this is the right treatment for you or your loved one.
Pros and Cons of TMS Therapy
In general, all forms of TMS work by placing a device atop a patient's scalp and then turning on an invisible magnetic field, which can activate the brain cells directly underneath the scalp. This works of treatments like depression, where certain regions of the brain have been scientifically proven to be underactive relative to the rest of the brain.
By re-activating these neurons, the disorders in question begin to improve and normalize over time. For example, a depressed patient may notice that their energy level, motivation level, and sleep quality increase drastically after attending treatment for two weeks.
Advantages of TMS Therapy
TMS as a number of positive qualities that differentiate it from any other psychiatric treatment available:
1. It doesn't involve medication. TMS is a drug-free therapy, meaning that you don't have to wait up to 6 weeks for it to work, and you don't have to manage sometimes nasty side effects from antidepressant medication.
2. The benefits can persist for decades. The research shows that when TMS works, the mood benefits can last for years, decades, and for many patients, a lifetime. The key is remaining in remission for 6 months post-treatment and ensuring that you attend a clinic with knowledgeable enough staff to ensure consistent follow-up appointments and intervening with necessary.
3. The treatments can be short. New techniques in TMS have allowed for treatment sessions to be as short as 3 minutes, so it's easy to pop in for a session whenever scheduling allows.
4. Almost all insurance companies cover TMS. For many, a copay as little as $5 per day will fully cover an entire 36-session course.
5. You can personalize the treatments. When you find a clinic certified in TMS therapy, you can rest assured that your treating provider is personalizing the therapy to your brain and symptoms, as opposed to giving you a one-size fits all protocol.
Limitations of TMS Therapy
1. The treatment must be highly precise. Unlike dTMS, traditional rTMS doesn't give providers much room for error—they have to ensure proper placement and targeting so that the correct symptoms are being addressed.
2. The time commitment can be overwhelming. It's not always easy to come to a clinic every day—although as long as patients attend at least 3 days a week, there will still be benefits.
3. Provider consistency varies. Some clinics may not have the proper training or certification from highly regarded programs like Solstice Training Institute, which means that approaches between providers can be highly variable with effectiveness waning from clinic to clinic.
Pros and Cons of dTMS
Deep TMS can be considered superior to traditional rTMS in a number of ways:
1. It can target deeper and broader networks in the brain. The actual regions of the brain that can be targeted using Deep TMS is substantially higher than other types of TMS, which means that patients receive the most advanced TMS therapy commercially available.
2. The real-world effectiveness is higher than standard rTMS. Studies have proven that dTMS has higher rates of remission at over 72%, compared to a paltry 33% for most rTMS studies.
3. Deep TMS has the most FDA approvals. Not only is dTMS FDA approved for generic depression, but it's also FDA approved for OCD, anxious depression, smoking cessation, and was awarded Breakthrough Status by the FDA for bipolar depression.
However, dTMS is not without its cons! The drawbacks of dTMS is as follows:
1. It can be harder to tolerate as a patient. While not painful, it's a less pleasant feeling than most other types of TMS due to the higher volume of brain area that's stimulated. Even though it's not particular comfortable, competent providers can nevertheless use a number of tips and tricks in ease patients into the full treatment intensity.
2. The treatment schedule can be limiting. Deep TMS also requires that patients attend treatment daily for 8 weeks, regardless of what patients are coming to treatment for. Even though it's available and even more effective on an accelerated schedule, insurance companies don't cover accelerated dTMS just yet.
3. Noisier. Deep TMS machines like Brainsway tend to run slightly louder than other, as they require more power and subsequent cooling to properly operate. Many patients opt to use ear plugs during dTMS treatment.
Is Deep TMS Right For You?
Deep TMS offers profound hope for people who haven't responded to other treatments—but like any therapy, it's not one-size-fits-all. It can reach deeper brain areas and has shown impressive results in depression and OCD, yet the experience can be more intense and the logistics demanding.
If you're considering TMS or Deep TMS, you can book an appointment online with your provider of choice today to discuss whether dTMS is right for you or your loved one.