Transcranial Magnetic Stimulation (TMS)

Is Brainsway Deep TMS better than other types of TMS?

Brainsway Deep TMS is the only type of TMS that has been shown in peer-reviewed clinical trials to be highly effective for treatment of Depression, Anxious Depression, and OCD, including cases that are resistant to conventional treatment with medications and therapy. Furthermore, in a head-to-head study comparing Brainsway Deep TMS with Standard TMS (both groups were also taking medication), 67% of patients receiving Deep TMS achieved a clinical response, while 44% achieved response with Standard TMS. Deep TMS achieved clinically significant improvement in over 50% more patients than Standard TMS.

What makes Brainsway Deep TMS better than other types of TMS?

Brainsway Deep TMS uses patented H Coil technology that allows the magnetic signal to directly reach broader regions of the brain than other types of TMS. It is able to regulate neuronal activity in wider and deeper structures and networks involved in mental health disorders, including the prefrontal cortex, anterior cingulate gyrus, and the default mode network.  

Standard TMS has a relatively narrow, shallow signal. This means the signal will only reach a small area of the brain, and does not effectively reach deeper structures in the brain. This can cause problems targeting the correct areas of the brain during treatment, which can reduce efficacy.

Brainsway Deep TMS is more likely to effectively target the dysfunctional areas of the brain, and less likely to have problems with efficacy due to errors in treatment technique.  In addition, Brainsway Deep TMS sessions for depression and OCD last approximately 20 minutes, as opposed to 40-minute standard TMS sessions, so you can get back to your regular daily activities in half the time. 

Is Deep TMS covered by insurance?

Insurance coverage for Deep TMS depends on your diagnosis, location, and insurance plan. Most private insurers cover Deep TMS for the treatment of Major Depressive Disorder (MDD) and some cover it for OCD. We will conduct a benefits investigation and prior authorization prior to scheduling treatments. If Deep TMS is not covered, we can accept self-payment, and can offer payment plans if necessary.

Is Deep TMS supported by research?

Deep TMS is an evidence-based treatment backed by a large body of research. Repeated peer-reviewed, double-blind, sham-controlled clinical trials have shown that Deep TMS safely and effectively alleviates symptoms of depression and OCD.

Efficacy in Depression

“Response” in clinical trials for depression treatments is defined as a 50% decrease in depression severity score on a validated depression assessment scale, and “Remission” is defined as reaching a normal score (no depression). “Treatment-Resistant Depression” is defined as depression that does not improve after trials of 2 different medications which have each been adequately dosed and administered for a sufficient length of time.

In a study comparing efficacy of medication alone with efficacy of Deep TMS plus antidepressant medication, Deep TMS was shown to be a valuable addition to treatment with medication. Deep TMS plus medication resulted in significantly larger reductions in depression scores than medication alone. In addition, 60% of patients receiving Deep TMS plus medication achieved remission, compared with only 11% achieving remission with medication alone.

Another study demonstrated the efficacy of Deep TMS in patients with treatment-resistant depression, independent of medication effects. This study found that 1 out of 3 patients with treatment-resistant depression achieved remission with Deep TMS alone during the first four weeks of treatment. Nearly 4 out of 5 patients who did not immediately respond went on to experience improvement over the following 12 -week period.

Another trial found that Deep TMS plus medication was significantly more effective at reducing depression symptoms than Standard TMS plus medication. In this study, 67% of patients receiving Deep TMS plus medication achieved a clinical response, while 44% achieved response with Standard TMS plus medication.

In real-life clinical practice, Deep TMS has been shown to have an even stronger effect. Based on a study using recorded data from over 1,300 patients, 80% of patients with Depression who completed at least 30 sessions of Deep TMS achieved response, compared with 30-40% who achieved response with medication alone. Approximately 67% of patients receiving Deep TMS achieved remission, compared to 10-15% of patients who achieved remission with medication alone.

At Owl & Eagle, we measure improvement in depression symptoms using the PHQ9 and MADRS, both well researched and validated assessments. As of 10/4/2024, 100% of our patients who completed a full course of Deep TMS for depression have achieved a treatment response, defined as a 50% decrease in their depression score, using both the PHQ9 and MADRS. A Mild Score on the PHQ9 (<10) was achieved in 83.33%, and 100% achieved a Mild Score on the MADRS (<20). Remission, or complete resolution of depression, defined as a score <5 on the PHQ9 and <7 on the MADRS, was achieved in 67% of patients, using both assessments. 

Efficacy in Obsessive Compulsive Disorder (OCD)

“Response” in clinical trials for OCD treatments is typically defined as a 25-30% decrease in severity score on a validated OCD assessment scale. OCD is considered “Treatment-Resistant” if symptoms do not respond to Standard Treatment for OCD. “Standard Treatment” for OCD is defined as SSRI medication and/or evidence-based psychotherapy for OCD, such as CBT or Exposure Therapy.

Analysis of data from a peer-reviewed clinical trial using Deep TMS in patients with treatment resistant OCD showed that Deep TMS can be a highly effective treatment.  In patients with OCD who had previously tried 3 or more medications without success, 41% who received Deep TMS achieved treatment response, compared with only 8% of patients who received sham TMS. In patients who had previously tried Cognitive Behavioral Therapy (CBT) without improvement, 33% achieved response, compared with 3% of patients receiving sham treatment.

Another clinical trial confirmed Deep TMS’s efficacy. This study demonstrated that focusing stimulation on the medial prefrontal cortex and anterior cingulate gyrus caused statistically significant improvement in OCD symptoms. In the patients receiving Deep TMS, 38% achieved response to treatment, compared with 11% in the sham group. In addition, 55% of patients in the Deep TMS group achieved a partial response, versus just 27% in the sham group.

In real life clinical practice, Deep TMS again showed an even stronger effect than in the research trials. Data from over 200 patients with OCD showed that 70% of patients receiving Deep TMS achieved response, with 58% maintaining response until completion of the treatments, and 52% achieving sustained response at post-treatment follow up. 

These studies show that by safely and effectively targeting and reaching the brain structures involved in OCD, Deep TMS can achieve statistically and clinically meaningful improvement in OCD symptoms. As a result, Deep TMS was the first noninvasive device to be cleared by the FDA for treatment of OCD.

Can Deep TMS be used to treat other psychiatric disorders?

Deep TMS has also shown efficacy in treatment of other mental health conditions, such as Bipolar Disorder, ADHD, PTSD, and Substance Abuse. However, these uses are still considered experimental and are not typically covered by insurance.

Are there any side effects with Deep TMS?

Deep TMS is a safe, effective, and well-tolerated treatment. In patients who experience side effects, most resolve on their own and do not require any special intervention. Only a very small percentage of patients discontinue treatment due to side effects.

The most common side effects of Deep TMS include temporary, mild discomfort in the area of the treatment site, typically occurring only within the first week of treatment; and mild headaches during or after treatments.

Side effects usually diminish over the course of the treatment. Over-the-counter pain medications can be taken if desired.

Less frequent side effects that may occur during treatments include facial muscle twitching and pressure or discomfort in the scalp, face, or jaw. These side effects also tend to lessen over the course of treatment, and adjustments can be made to the helmet’s positioning and stimulation settings to alleviate these symptoms.

Seizure is a very rare side effect associated with TMS. Seizures occur in about 0.087% of patients receiving Deep TMS, which is similar to the rate of seizures in patients taking antidepressant medications. Having a history of epilepsy or head injury, changes in sleep habits, alcohol intake, or medication during treatment can increase risk of seizure. In the unlikely event that a seizure occurs, your providers are trained to respond appropriately.

Deep TMS does not cause many of the side effects that can occur with antidepressant medication, such as nausea, increased appetite, weight gain, loss of sexual desire, fatigue, insomnia, dry mouth, etc.  Furthermore, unlike ECT, Deep TMS does not involve the risks of anesthesia, and does not cause memory loss during or after treatment.

What happens during a Deep TMS session at Owl & Eagle Health and Wellness?

At Owl & Eagle Health and Wellness, Deep TMS treatment is prescribed and supervised by a board-certified Psychiatric Nurse Practitioner. Treatments are administered by a team including a Nurse Practitioner and a Technician, both of whom are specially certified to administer Deep TMS.

When you arrive for your treatment, you will be seated in our cozy treatment room and asked to remove any jewelry or metal hairclips. You will complete pre-treatment assessments, after which your providers will use pillows to help comfortably position you in the treatment chair. They will ask you to put in earplugs, and they will secure a fabric cap over your head, over which the helmet holding the H-coil will be carefully positioned so magnetic pulses can be sent to targeted areas of your brain, regulating neural function in these regions. Each treatment takes about 20 minutes, during which you can read, catch up on social media, or just relax. Immediately after your session concludes, you will be free to drive and return to your regular activities.

What does Deep TMS feel like?

You will hear a clicking sound and feel a tapping sensation on your scalp during each treatment. The earplugs will diminish the sound, but you will still be able to communicate with your provider throughout the treatment. The tapping and clicking feels a little odd at first, but most patients get used to it quickly.

As previously discussed, some patients experience mild temporary discomfort or muscle twitching in the scalp, head, or face during sessions. Most of the time, this only occurs during the first week of treatment. These side effects can often be alleviated by repositioning the helmet or adjusting the strength of the signal, so please notify your providers if they occur. In the unlikely event that you experience a serious side effect such as a seizure, the treatment can be stopped instantly, and your providers are trained to respond appropriately.

You may experience a mild headache after treatments, which can usually be alleviated with over-the-counter pain medication. If you are prone to headaches, you may wish to take pain medication preventively, prior to each treatment.

Will I need to stop my regular medications before starting Deep TMS?

Deep TMS is safe and effective in combination with psychiatric medications, psychotherapy, and as a standalone treatment. Certain medications may reduce treatment efficacy, and your provider will ask you to wait to take these medications until after your treatments. Be sure to notify your provider about all the medications and supplements you are taking and update them if any changes are made to your medication regimen during your course of treatment.

Is Deep TMS like ECT?

While ECT uses electric shocks to induce seizures, Deep TMS therapy stimulates brain regions using brief magnetic pulses similar in amplitude to that used in MRI systems. ECT requires anesthesia and may cause severe side effects, including memory loss. Deep TMS therapy does not involve anesthesia, does not affect memory, and is usually well-tolerated.

Is there anything I can do to help maximize the benefits?

Healthy lifestyle changes can help maximize the improvement you receive from Deep TMS. We recommend adopting a healthy diet including fruit, vegetables, olive oil, and fish; engaging in regular exercise, improving sleep hygiene to optimize your sleep; and using stress management techniques such as yoga, meditation, or breathwork. Your providers can support you in implementing and maintaining these changes.

I want the receipts. Where can I read the research on Deep TMS?

Go to https://www.brainsway.com/knowledge-center/category/clinical-research/

If you would like to learn more about Brainsway Deep TMS at Owl & Eagle Health and Wellness in Golden and Denver, Colorado, Contact Us  to set up a TMS consultation, or Book Now  to schedule an in-person or telehealth intake appointment today.