TMS stands for transcranial magnetic stimulation. It is a relatively new way of treating major depression. In TMS, a doctor or technician uses a powerful electromagnet to stimulate a part of the brain called the dorsolateral prefrontal cortex, or DLPFC. The DLPFC is responsible for many executive functions, such as helping yourself and others, making decisions, especially when morality is involved, and working memory, which is a major factor in general intelligence. In people with major depression, the left DLPFC is typically underactive. The goal of TMS is to jumpstart this area using electrical current, thereby helping the brain function more normally. TMS is a non-invasive procedure. A doctor or technician will position the device on your head and locate the correct area for stimulation. The electromagnet delivers short pulses that most people describe as a tapping sensation. The pulses directly stimulate the neurons in the underactive region. Persuading these neurons to wake up and participate in regular cognition takes a little time. For TMS to be effective, it takes sessions lasting 40 minutes to an hour, five days a week for at least a month. After that, you might step down to two sessions a week for several more weeks. It usually takes several weeks of treatment before you notice your symptoms improve. Daily treatments for more than a month is a relatively large time commitment, but for many people, it’s worth it. A significant percentage of people with major depression don’t get enough relief from medication and psychotherapy. About 50 to 60 percent of those people who try TMS notice an improvement in their symptoms, and in about a third of those people, symptoms disappear completely. Unfortunately, the symptoms don’t always stay gone, but they typically stay in remission for at least a year, after which, many people go through another round of treatment. Before TMS was approved to treat major depression, people suffering from treatment-resistant depression would typically undergo electroconvulsive therapy, or ECT. ECT has improved considerably since Hemingway’s day, but it still has some significant drawbacks. Patients have to be sedated and after treatment they may experience side effects such as memory loss and disorientation. TMS does not require sedation and the only common side effect is a slight headache. If you complete a course of treatment with TMS and it hasn’t relieved your depressive symptoms, ECT is still an option.
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