Princeton TMS Institute
Who is TMS therapy for?
Transcranial Magnetic Stimulation (TMS) therapy is for those who are struggling with depression, when medication is not an answer. Medication may fail not only because it is ineffective, but also because it may be difficult for a person to take consistently, or it may have side effects that the person finds intolerable.
Complete Trial of Medication:
The primary indication is in those who did not feel better with one 'complete trial' of antidepressant medication. This means the medication was taken for 4-6 weeks at the recommended therapeutic dosage. This is most important for insurance submission - if you would like your insurance to cover TMS, you must have documentation of one complete trial of medication because insurance companies like to see that you tried something else.
TMS is also an option for those who tried an antidepressant and found that the side-effects - such as sexual dysfunction, weight gain/loss, insomnia/hypersomnia (sleeping too little/much) - were too overwhelming to continue with medication. Because TMS is non-systemic, TMS therapy is an ideal alternative for candidates suffering from side-effects. It may just be 'gastrointestinal upset' but we know it means more than that when it comes to your life.
Difficulty taking medication regularly:
TMS should also be considered for those who have difficulty taking medication regularly. Taking your medications irregularly can, particularly with antidepressants, cause memory and other cognitive problems, can increase moodiness, and may even make your depression worse. Like your medications, TMS needs to be administered at the same time each day for optimal effectiveness. But unlike your medications, once you've been treated for 4-6 weeks, you might feel better for up to 2 years or more. You may need occasional 'maintenance' treatments, but these are much less frequent than daily medication regimens, and appointments are typically much more difficult to forget.
Unlike ECT, TMS may be safe with pacemakers, however you should consult your physician as to whether there are any risks of TMS therapy for you if you have a pacemaker. Similarly, insulin pumps and other medical implants should be mentioned to your physician before you undergo TMS therapy.
TMS is NOT for:
TMS is not for patients who have ferrous metals implanted in their head, neck or shoulders. If you have been in an MRI, then TMS is fine, however if you have any metal within 1 foot / 30 centimeters of your left temple (an approximation for the location of the treatment coil) then TMS is potentially not for you. Most modern medical implants are titanium, and safe, however you should be sure to inform the doctor if you have ever had surgery from your shoulders up to be on the safe side.
If you have a history of seizures, TMS may not be an option for you. The doctor should be notified of this before commencing treatment.
If you have any history of mania, TMS may cause you to enter a manic state. Your physician will monitor you more closely, and may recommend mood stabilizing medications during your treatment.