TMS Therapy And Treatment: Pros & Cons
Transcranial magnetic stimulation therapy (TMS therapy) is a relatively new treatment for a range of mental health conditions. These include things like depression, anxiety, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD).
It is not the go-to treatment that people with, say, depression opt for. Antidepressant medications and psychotherapy remain the conventional options. However, there is now a wealth of research to support the efficacy of TMS for treating depression and other forms of psychological distress.
However, as with any mental health treatment (especially a new one being lauded as revolutionary by providers), it’s important to remain balanced. TMS can be effective and offer many advantages over traditional treatments, but there are certain downsides, too, as well as potential quackery involved.
In this comprehensive guide on this treatment option, we will be exploring the following topics and questions:
- What is TMS therapy?
- TMS therapy for different psychological and physical conditions
- The pros and cons of TMS therapy
- Success rate of TMS therapy
- The cost of TMS therapy
What Is TMS Therapy?
TMS therapy and treatment is a non-invasive method of brain stimulation that relies on electromagnetic induction using an insulated coil placed over the scalp.
The coil generates brief magnetic pulses, which pass easily and painlessly through the skull and into the brain, targeting brain regions thought to play a role in mood regulation. For example, TMS used to treat depression focuses on the patient’s left dorsolateral prefrontal cortex (DLPFC). This brain region is underactive in depressed patients and it has deep connections to other areas heavily involved in mood regulation, including the insula, anterior cingulate, and amygdala.
The idea behind TMS is that the magnetic pulses will stimulate the nerve cells in these underactive regions, so that they return to a normal level of activity, thus alleviating the negative patterns of thoughts and feelings that people get stuck in.
The pulses generated are the same type and strength as those created by magnetic resonance imaging (MRI) machines. When a clinician administers these pulses in rapid succession, the treatment is referred to as repetitive TMS or rTMS, which can produce longer-lasting changes in brain activity. There is also deep TMS treatment (dTMS), which targets larger regions, deeper within the brain.
TMS Therapy Can Treat A Range Of Conditions
TMS treatment can be used to alleviate the symptoms of several mental health conditions, which also applies to patients who struggle with severe, chronic, or treatment-resistant symptoms. In addition, TMS therapy may be helpful for people with certain physical conditions, including migraines and Parkinson’s disease.
TMS Therapy For Depression
It is estimated that five percent of adults worldwide suffer from depression. It is a leading cause of disability worldwide and a major contributor to the overall global burden of disease.
Depression is characterized by the following:
- Persistent depressed mood (feeling sad, irritable, empty)
- A loss of pleasure or interest in activities
- Poor concentration
- Feelings of excessive guilt or low self-worth
- Thoughts about suicide
- Disrupted sleep
- Feeling especially tired or low in energy
Doctors usually treat depression with medication and therapy. However, these approaches do not always relieve a person’s symptoms.
Someone may try different SSRI antidepressants or various forms of psychotherapy but still not experience the relief they’re looking for. Around 30 percent of people with depression don’t respond to these treatments. In these cases, a doctor may recommend other treatments, including TMS.
As already mentioned, during TMS therapy for depression, doctors focus on the DLPFC. This part of the brain is responsible for various cognitive processes, including memory, mood regulation, and conflict management. And it is often dysregulated in people with depression. This dysregulation can make it hard for people to manage their emotions, make decisions, and think clearly.
Research has shown that TMS therapy can be effective in relieving depression symptoms and improving mood. We do not fully understand how TMS treatment works. However, some scientists suggest that it can help by increasing synaptic plasticity (the brain’s ability to adjust how neurons connect to each other) and by enhancing functional connectivity (a measure of how brain regions interact with each other).
Marta Moreno, Ph.D., fMRI-TMS Director at Neurotherapeutix had this to say of TMS treatment for depression:
Standard TMS and fMRI-guided TMS have been approved by FDA for treatment of depression. Its approval required demonstration of efficacy that was proven in a series of research and clinical studies. At Neurotherapeutix, we use resting-state fMRI (rsfMRI) to guide TMS. This rsfMRI-guided TMS is a very advanced technique that has shown to be more effective than standard TMS. Neurotherapeutix is the only clinic that offers rsfMRI for functionally mapping the brain of patients with depression and uses the pattern of brain networks function to find targets for TMS treatment. The same technique is used to assess the post treatment efficacy of the treatment. This approach makes rsfMRI-guided TMS highly effective in treatment of depression.— Marta Moreno, Ph.D.
According to the FDA, people receiving TMS therapy for depression should have treatment daily for 4-6 weeks. Although people generally respond well to TMS for depression, the antidepressant effect can wear off over time.
TMS Therapy For Anxiety
An estimated 275 million people suffer from anxiety disorders, which is around 4 percent of the global population.
Anxiety disorders can follow different courses, especially since some are related to specific aspects of life (e.g. social anxiety and health anxiety), yet the most commonly experienced symptoms include:
- Apprehension. Worrying about future misfortunes, feeling on edge, having difficulty concentrating.
- Motor tension. Restlessness and fidgeting, tension headaches, trembling, inability to relax.
- Autonomic overactivity. Lightheadedness, sweating, abnormally high heart rate or abnormally rapid breathing, pain in the upper abdomen, dizziness, dry mouth.
It is normal to experience occasional anxiety, but if someone feels frequently or constantly anxious, then this can become a source of severe distress, as well as make it difficult for that person to function as normal. Psychotherapy and anti-anxiety medications may help, but if first-like treatments are not effective, people may try TMS therapy.
A systematic review of studies on TMS therapy for generalized anxiety disorder (GAD) concluded:
“…the meta-analysis findings indicate robust response in GAD using TMS…TMS represents an emerging treatment that may have significant clinical utility in patients with GAD, a debilitating psychiatric disorder with modest responsiveness to conventional treatment strategies. Currently, however, there are few randomized sham-controlled clinical trials, and further research is warranted, including in the adolescent population.”
One limitation that the researchers of this review noted is that there were only six studies available, each with relatively small sample sizes. This contrasts with studies on TMS therapy for depression, of which many more exist.
TMS Therapy For PTSD
PTSD is another type of anxiety disorder, suffered by people who experience or witness one or more traumatic events. Symptoms include:
- Recurrent and unwanted distressing memories of the traumatic event
- Reliving the traumatic event (flashbacks)
- Upsetting nightmares
- Severe emotional distress or physical reactions in response to reminders of the event
- Trying to avoid thinking or talking about the traumatic event
- Avoiding places, activities, or people that remind you of the event
Negative Changes In Thinking And Mood
- Negative thoughts about yourself, other people, or the world
- Hopelessness about the future
- Memory problems, including not remembering important aspects of the traumatic event
- Difficulty maintaining close relationships
- Lack of interest in activities you once enjoyed
- Difficulty experiencing positive emotions
- Feeling emotionally numb
Changes In Physical And Emotional Reactions
- Being easily startled or frightened
- Always being on guard for danger
- Self-destructive behavior, such as drinking too much or driving too fast
- Trouble sleeping
- Trouble concentrating
- Irritability, angry outbursts, or aggressive behavior
- Overwhelming guilt or shame
Many TMS providers offer the treatment for PTSD, although there is limited research on this application. Nonetheless, a review has summarized over 20 years of the existing literature on TMS as a PTSD treatment, including nine randomized controlled trials and five randomized controlled trials investigating TMS combined with psychotherapy.
The majority of studies utilize rTMS targeted to the right DLPFC, although others targeted other regions (most commonly the left DLPFC). The research has shown positive outcomes, although more work needs to be done.
The authors of the review conclude: “Effects on PTSD are often sustained for up to 2–3 months, but more long-term studies are needed in order to understand and predict duration of response. In short, while TMS appears safe and effective for PTSD, important steps are needed to operationalize optimal approaches for patients suffering from this disorder.”
TMS Therapy For OCD
OCD is another form of anxiety disorder, the population prevalence of which is between 1-3 percent. It also comes in different types.
- Doubt and Harm: Worries about accidental harm, which can involve excessive double-checking of things, such as locks, alarm systems, ovens, or light switches.
- Contamination: A fear of things that might be dirty or a compulsion to clean.
- Symmetry and Ordering: The need to have things lined up in a certain way.
- Unacceptable/taboo Thoughts: Unwanted obsessions that are often of a religious, violent, or sexual nature. This is often referred to as “pure OCD” due to the lack of overt rituals, although individuals tend to engage in covert rituals, such as mental compulsions (e.g. silent counting, mentally replaying events over and over again, repeating phrases in your head, obsessively examining bodily sensations).
Regardless of type, OCD involves obsessions and compulsions — obsessive thoughts (e.g. worries about yourself or other people getting hurt) and compulsive habits (e.g. doing tasks in a specific order every time or needing to count things).
The compulsions are a person’s way of dealing with the anxiety that the obsessions cause. Someone with OCD simply feels they have to engage in these anxiety-relieving habits. However, the anxiety keeps coming back, and the habits themselves can interfere with one’s daily activities and quality of life.
Therapy, medication (e.g. SSRIs), or a combination of both is usually used to treat OCD. Common psychotherapeutic approaches include:
- Exposure and response prevention therapy (ERP): This helps people to expose themselves to thoughts that trigger their obsessions and not act on the mental or behavioral compulsion that follows. Over time, obsessions and compulsions can dissipate.
- Mindfulness-based cognitive therapy (MBCT): This approach teaches people with OCD that intrusive thoughts have no power over them and shouldn’t be a source of distress.
About 70 percent of people with OCD will experience at least some benefit from medication and/or these approaches in psychotherapy. But they aren’t always effective. For these people, TMS may be helpful.
A meta-analysis of available research on TMS therapy for OCD looked at 22 randomized controlled trials. It found that rTMS treatment was more effective than sham rTMS (placebo), although the researchers stress that “the quality of evidence regarding efficacy was evaluated as very low.”
They add: “High-quality RCTs with low selection and performance bias are needed to further verify the efficacy of specific rTMS strategies for the OCD treatment.”
TMS Therapy For Bipolar Disorder
Bipolar disorder is a mood disorder that affects 0.3-1.2 percent of the global population. The condition is characterized by extreme mood swings, ranging from extreme highs (mania) to extreme lows (depression).
We have already seen what the symptoms of depression can include, but the manic phase of bipolar may involve:
- Talking very quickly
- Feeling full of energy
- A feeling of self-important
- Feeling full of great new ideas and having important plans
- Being easily distracted
- Becoming easily irritated or agitated
- Delusions, hallucinations, and illogical thinking
- Not feeling like sleeping
- Lack of appetite or avoidance of eating
- Doing things that often have disastrous consequences, such as spending large sums of money on expensive items
- Making decisions or saying things that are out of character and that others may see as being risky or harmful
There are also several types of bipolar disorder, which differ in terms of the pattern of symptoms.
Primary treatments for bipolar include medications (mood stabilizers, antipsychotics, antidepressants, anti-anxiety medications) and psychotherapy to control symptoms. When these options don’t work, however, a patient may consider TMS therapy and treatment.
TMS therapy for bipolar disorder has shown some promising results.
In a 2019 review of published studies on the use of TMS for bipolar disorder, researchers noted the following:
- People’s depressive symptoms improved across multiple studies
- Mixed results in terms of improvements to mania symptoms across multiple studies
- Only a few studies looked at people living with bipolar disorder during phases outside of manic or depressive states, making a conclusion difficult
In 2021, experts noted that more research is necessary to understand the optimal frequencies to use in TMS therapy to treat bipolar disorder.
Nonetheless, in 2020, the FDA gave TMS a “breakthrough device designation” for the treatment of bipolar disorder. While not a formal approval for treatment, it does indicate that sufficient evidence supports its effectiveness and that it meets an unmet clinical need.
TMS Therapy For Autism
The World Health Organization (WHO) estimates that around one in 100 children has autism. Characteristics may be detected in early childhood, but autism is often not diagnosed until much later. The condition can involve social communication and social interaction challenges, as well as severe anxiety.
Signs of autism in children include:
- Not responding to their name
- Avoiding eye contact
- Not smiling when you smile at them
- Getting very upset if they do not like a certain taste, smell, or sound
- Repetitive movements, such as flapping their hands, flicking their fingers, or rocking their bodies
- Not talking as much as other children
- Repeating the same phrases
Signs of autism in adults include:
- Finding it hard to understand what others are thinking or feeling
- Getting very anxious about social situations
- Finding it hard to make friends or preferring to be on your own
- Seeming blunt, rude, or not interested in others without meaning to
- Finding it hard to say how you feel
- Taking things very literally
- Having the same routine every day and getting very anxious if it changes
There is no one standard treatment for autism. However, appropriate specialist education, speech and language therapy, occupational therapy, and behavioral management strategies can all help individuals with autism.
TMS therapy may also be helpful. In one systematic review, researchers conclude:
“Existing evidence supports that TMS could be useful to treat some dimensions of ASD [autism spectrum disorder]. However, such evidence must be regarded with care, as most studies did not adequately control for placebo effects. Moreover, little is known regarding the most effective stimulation parameters, targets, and schedules. There is an urgent need for further randomized, double-blind, sham-controlled trials, with adequate follow-up periods, to test the efficacy of transcranial magnetic stimulation to treat these disorders. Available evidence must be regarded as preliminary and insufficient, at present, to support offering TMS to treat ASD.”
The dimensions of AS that TMS may be helpful in treating include repetitive and stereotyped behaviors (e.g. tapping feet and nail biting), as well as social behavior.
TMS Treatment For Migraines
If you’ve experienced a migraine before, then you know it’s not just a headache. This is a type of headache that can cause severe throbbing pain (usually on one side of the head). But there can be other unpleasant symptoms, too, such as feeling sick, increased sensitivity to light, and migraine aura (usually a visual disturbance, but it can involve auditory, motor, and verbal disturbances as well).
Migraine affects an estimated 12 percent of the world’s population. In some individuals, the condition is chronic, which can be debilitating and lead to a significantly lower quality of life. Chronic migraine affects 1-2 percent of the global population. It is associated with cardiovascular disease, severe emotional distress, and sleep disorders.
Standard treatments for migraines include over-the-counter painkillers, such as paracetamol, aspirin, and ibuprofen. These can effectively reduce symptoms and tend to be most effective if taken at the first signs of a migraine attack.
However, people who struggle with severe migraines might find that painkillers don’t offer the relief they’re looking for. Also, those with chronic migraine might not want to continually use these drugs, as doing so can lead to side effects, including making headaches worse.
TMS treatment for migraines can be effective, although not for everyone. A meta-analysis of five randomized controlled trials found that TMS is effective for the acute treatment of migraine with aura after the first attack.
However, the efficacy of TMS on chronic migraine was not significant.
A systematic review of studies on TMS treatment for migraines found that high-frequency rTMS over the motor cortex areas improved migraine frequency in seven out of eight studies.
Moreover, two of the eight studies were randomized controlled trials at low risk for biases, and these studies helped to improve not just the frequency of migraines but severity as well. The authors also noted that the treatment had minimal side effects.
In a 2021 study on TMS treatment for migraines, the researchers state “there was a significant reduction in pain intensity, frequency and duration of migraine attacks, migraine disability scores, and number of pills taken as abortive treatment for attacks after rTMS.”
In addition, this low-frequency rTMS was effective for migraine with and without aura.
The Pros And Cons Of TMS Therapy
TMS treatment has many advantages over conventional mental health treatments. As we will see, there are some disadvantages to be aware of as well. Treatment can include side effects; however, many people find these are not as likely to occur — or not as troublesome — as the side effects of many psychiatric medications.
The Advantages Of TMS Treatment
There are a number of reasons why you might want to opt for TMS therapy.
TMS treatment is less invasive than electroconvulsive therapy (ECT), another brain stimulation therapy used to treat depression when other options fail. ECT is generally considered a last-resort option, due to the procedure being more invasive and entailing some unique risks.
ECT passes electrical currents through electrodes placed on the head, inducing seizures in the process. Although ECT patients are given muscle relaxants whilst under general anesthesia, it’s common to wake up feeling achy as a result of the seizures.
In contrast, TMS does not require muscle relaxants or any anesthesia (it’s a painless treatment).
A Good Safety/Side Effect Profile
Since TMS is a non-invasive, targeted treatment, it tends to have a better safety and side effect profile than antidepressant medications. Medications are ingested, so they have diffuse and systemic reactions throughout the entire body. This can lead to a wide range of side effects, including weight gain, fatigue, nausea, dizziness, headaches, stomach aches, agitation, insomnia, and sexual dysfunction.
Meanwhile, the side effects of ECT can include difficulty remembering and/or retaining new information, long-term memory loss, headache, nausea, and confusion.
TMS treatment is not side effect free, but side effects tend to be minimal; these may include minor headache, lightheadedness, and scalp discomfort during the procedure.
Technically, there is a risk of seizures, but this adverse event is rare. There is only a 0.1 percent risk of developing seizures during a course of TMS therapy.
Results May Appear Before Those Of Antidepressants
Antidepressants can take six weeks before they start working. That can be a long time to wait for relief from emotional suffering. While the results of TMS therapy don’t show up immediately, you can experience benefits in as little as two weeks after treatment.
TMS is different from psychiatric medications because the results persist long after the treatment is over. In contrast, you need to stay on medications indefinitely, otherwise symptoms can return or you may experience withdrawal symptoms.
According to Marta Moreno, Ph.D., fMRI-TMS Director at Neurotherapeutix, “One of the most important properties of TMS therapy is its localized nature, i.e. it only stimulates the brain regions that are identified in brain maps as malfunctioning. As such, a vast majority of brain regions are spared. Furthermore, because rsfMRI-guided TMS is highly personalized the treatment plans are designed to specifically treat each patient different from any other patients. This aspect of TMS therapy is the cause of its long-lasting effect.”
In a 2012 study, 29 of 50 patients with treatment-resistant depression, so 58 percent of participants, were classified as in remission after three months following TMS therapy. Multiple studies have demonstrated that patients are in remission or experience a significant reduction in symptoms several months after their last TMS session.
While the criteria for insurance coverage may be strict depending on the particular insurer, TMS can certainly be 100 percent covered by insurance. This is because TMS therapy is an FDA-approved treatment for depression and migraine. The FDA has also approved deep TMS treatment for OCD.
Marta Moreno, Ph.D., of Neurotherapeutix said, “Standard TMS for treatment of depression is covered by insurance. fMRI-guided TMS is FDA approved and more effective than standard TMS, so it is possible to receive post treatment re-imbursement from insurance companies.”
In contrast, the FDA has only approved ketamine-assisted therapy for treatment-resistant depression. This alternative treatment can be expensive if it’s not covered by insurance.
No Possibility Of Addiction
Some psychiatric medications carry a risk of addiction, especially benzodiazepines, which can involve distressing withdrawal symptoms.
Doctors do not consider antidepressants addictive in the traditional sense, but they can absolutely cause physical dependence, as evidenced by the withdrawal symptoms that can show up when you stop or reduce your use.
TMS, on the other hand, does not carry a risk of addiction, and you won’t experience withdrawal symptoms when treatment stops. This may appeal to those with anxiety, in particular, who don’t want to rely on benzodiazepines for dealing with their symptoms, due to the risks involved.
The Disadvantages Of TMS Treatment
Before signing up for treatment, you should be aware that TMS therapy has some downsides, too.
Regular Office Visits
This is probably one of the biggest disadvantages of TMS treatment: the actual length of the course of treatment. Patients typically need to come in five days per week for six weeks, followed by optional (and usually recommended) “taper” sessions.
When tapering is included, there may be 36 treatments in total, lasting up to nine weeks. While it is not a problem to miss a couple of days here and there, it is recommended to be consistent with treatments.
This pitfall has less to do with the treatment itself and more to do with getting your insurance company to approve you for TMS therapy. Each insurance company has different criteria, with most changing their policies throughout each year.
For instance, some insurance companies require that a patient has tried two antidepressants in the past, while others require that a patient has tried four antidepressants, plus a form of talk therapy.
If you’re ever unsure about whether or not your insurer will approve you, you can always fill out a TMS treatment center’s pre-approval form and then patient care coordinators will let you know the likelihood of your insurance covering TMS therapy.
If your insurer won’t cover TMS therapy, the treatment can end up being quite expensive (perhaps unaffordable), given how many sessions and office visits you need to commit to.
While TMS therapy is painless, this doesn’t mean you’ll feel nothing during the treatment session. Don’t expect to feel any positive feelings either, as you might do during ketamine-assisted therapy, for instance.
Most patients describe the sensations experienced during TMS as ‘uncomfortable but tolerable’.
According to Dr. Owen Muir of Hudson Mind in NYC, “TMS treatment can be uncomfortable, and the good news is that gets better over time. The reason it’s uncomfortable has to do with the very mechanism of the treatment. It is an electromagnet, and when electricity runs through it, it heats up and then cools down very quickly, (which creates the noise) and this creates a magnetic field that makes neurons fire. Most of the sensation people experience has to do with the fact that this magnetic field makes neurons in your brain fire, but on the way in it also makes neurons that control the muscles of facial expression and sometimes even eye-movement fire. In this case, your face will scrunch and your scalp will move around a little bit because the muscles are contracting. “
Even though the device is only emitting magnetic pulses, it may feel like a tapping or knocking sensation on the scalp during stimulation.
Dr. Muir adds, “The good news is people get pretty used to this over time. It feels a lot like a baseball helmet that you’re wearing getting tapped with a ball peen hammer at higher power, and being pecked by a hummingbird at lower power.”
Also, depending on the angle that a patient reclines in the treatment chair, they may feel some jaw or eyebrow movement during the stimulation. Crucially, however, these effects are not permanent and subside immediately after the session is over.
“The best description I’ve heard that helps people understand this is when they asked children in a research study to rate the experience. They rated TMS as not as good as a good cartoon show but better than a long car ride,” adds Dr. Muir.
“Keep in mind, kids really hate long car rides. So it’s not supposed to be fun or exciting in the middle of it, but feeling your depression and anxiety melt away on the time scale of days to weeks and not months and months and months and months to never is a massive relief,” Dr. Muir continues. “It doesn’t come with the same revelatory experience as psychedelic medicine can, but it can be a revelation none the less!”
Any discomfort during TMS therapy is typically minor and well worth the relief from emotional pain that the treatment offers.
Lack Of Standardization
If you get in touch with 10 different TMS centers, you’ll most likely hear 10 different responses regarding their processes and methodologies. Many providers use the exact same treatment protocols for every patient they see, whereas others might rotate between one or two protocols.
Moreover, the barrier to entry for a practice to start offering TMS is relatively low. It’s also not that difficult to get certified. This means that a lot of practitioners without TMS experience can purchase a machine and start using it on patients without the proper education.
TMS Treatment Is Not Suitable For Everyone
TMS is not safe for everyone. You should avoid this treatment if you have metal in your head, such as:
- Deep brain stimulators
- Neck or brain stents
- Aneurysm clips or coils
- Shrapnel or bullet pieces
- Facial tattoos with metallic ink
- Metal plates
- Cochlear implants
- Permanent piercings
The magnetic fields in TMS can make these implants heat up or move, which may cause serious injuries. If you have braced or dental fillings, however, you don’t need to worry about any complications occurring. You’ll be fine.
You should also avoid TMS if you exhibit the following:
- Have a history of epilepsy or seizures
- Are taking stimulants
- Having a medical condition that increases the risk of seizures
Success Rates For TMS Therapy
To understand the success rates of TMS therapy, we need to look at particular conditions and how they respond to treatment.
TMS Therapy Success Rates: Depression
TMS centers often claim that TMS therapy offers higher success rates than traditional medication for depression, for instance. With antidepressants, about 40 to 60 out of 100 people who took one of these medications noticed an improvement in their symptoms within six to eight weeks.
When it comes to the TMS therapy success rates, studies show a range as well, with the low end of this range still showing an advantage over antidepressants.
A 2020 study published in the Journal of Affective Disorders, for example, found that TMS was effective at reducing depression in 53-83 percent of patients and led to remission of symptoms in 28-62 percent of people.
The high end of these ranges is impressive. It means that many people with depression will be more likely to benefit from TMS than an antidepressant. In clinical trials, only 25-35 percent of patients experience full remission after taking antidepressants.
TMS Therapy Success Rates: Anxiety
TMS is effective for various anxiety disorders, as we have already seen. In one study, anxiety scores decreased by 33 percent after TMS treatment. In the same study, depression also decreased by 40 percent. This is important, too, as anxiety and depression often go hand-in-hand.
A separate study found that rTMS offered 23.3 percent of patients with depression and a comorbid anxiety disorder remission, while 39.5 percent experienced a reduction in symptoms.
In another study, 11 of 13 (84.6 percent) patients diagnosed with GAD responded to the rTSM treatment and were in remission. And in a case study, low-frequency TMS was able to decrease anxiety and panic symptoms in a patient by up to 78 percent.
Using benzodiazepines (e.g. Valium, Xanax) for anxiety can have high success rates, too, but it is estimated that 10-25 percent of chronic benzodiazepine users experience long-lasting withdrawal symptoms when they stop taking the drug.
Professor Malcolm Lader, a leader in addictions research, estimates that “about 20-30 percent of people who are on a benzodiazepine like diazepam have trouble coming off and of those about a third have very distressing symptoms.” These downsides don’t apply to TMS therapy for anxiety, yet the latter treatment still has high success rates.
TMS Therapy Success Rates: OCD
Although it takes a while before SSRIs have a noticeable effect on OCD, the success rate of this treatment is 40-60 percent. However, many patients experience side effects from these medications, which may be intolerable for some.
In a study looking at six weeks of TMS treatment for OCD, 47.1 percent of patients responded to the treatment. In another study, 67 percent of patients responded to rTMS treatment after four weeks. Separate research has shown that after eight weeks of rTMS treatment, there was a 40 percent decrease in OCD scores, along with improvements in anxiety and depression symptoms.
TMS Therapy Success Rates: PTSD
Per one study, about 33 percent of people who have PTSD don’t respond to treatment. The non-response rates for cognitive behavioral therapy (CBT) may be as high as 50 percent and for SSRIs, it’s about 20-40 percent. The success rates of conventional treatments for PTSD are therefore not very high. But TMS can help many individuals who don’t see success with medication or talk therapy.
Since PTSD has close ties with depression and anxiety, it makes sense that many patients experiencing PTSD will benefit from TMS. Indeed, a study published in Biological Psychiatry found that TMS led to a 39.3 percent reduction on a PTSD scale containing avoidance symptoms.
Another study showed a success rate of 44 percent for deep TMS treatment for PTSD.
Long-Term Benefits Of TMS
A 2015 placebo-controlled trial found that deep TMS treatment can provide relief for patients with major depression for up to 16 weeks.
However, there is also research showing that patients can experience benefits for up to a year after treatment. One study found that 45 percent of patients with treatment-resistant depression had experienced complete remission one year after receiving TMS.
TMS Therapy Quackery
The science-backed benefits of TMS don’t mean that quackery hasn’t infiltrated the industry. People often buy the notion that TMS is a breakthrough treatment, one with impressively high success rates. Yet there are many cases of people who don’t respond to treatment. But worse than this is the experience of suffering from persisting negative effects.
TMS centers don’t highlight many of these reactions, nevertheless, which can include memory problems and a range of distressing physical sensations. This is despite the fact that these symptoms and events have been reported to the FDA for years, with the FDA also reporting them to the device manufacturers.
Also, as one paper states, “the physiological mechanisms underlying the effects induced by TMS and rTMS have not yet been clearly identified.” This doesn’t mean that explanations for how TMS works in the brain are invalid, but more research needs to be done to understand the mechanisms behind the benefits.
If a TMS clinic is being dishonest about success rates and risks, as well as claiming some knowledge about TMS that they’re not justified in having, then this would be a kind of quackery. You should only ever opt for a TMS provider that is honest with you about benefits and risks so that you can make an informed decision about proceeding with treatment.
How Much Does TMS Therapy Cost?
There is no simple way to determine the costs of TMS treatment. Like most treatments, these will vary depending on a variety of factors.
The Cost Of TMS Therapy Without Insurance Coverage
One course of TMS can cost between $6,000 to $12,000 out of pocket. Prices will vary depending on how your treatment plan, as well as which provider you opt for.
Well-established clinics with a strong track record will tend to charge more than newer clinics.
The Cost Of TMS Therapy With Insurance Coverage
Your health insurance provider might offer coverage, but this could depend on your medical history. It may be a requirement to try at least four antidepressants before receiving TMS coverage.
If you’re paying with insurance, you’ll pay anywhere between $10 and $70 per session, depending on your plan’s copay or coinsurance rate. If a total of 36 sessions are required to complete the treatment course, then the overall cost will be at least $360-$2,520 (this doesn’t exclude consultation costs).
Does Medicaid Cover TMS Therapy?
If antidepressants and psychotherapy don’t work for you, then you will be glad to know that it’s possible Medicaid can cover the majority of TMS therapy costs. Coverage may vary depending on your specific Medicaid plan. But, if patients meet all requirements, Medicaid can pay for up to 80 percent of the treatment cost.