Is TMS Right for You? Understanding the Eligibility and Benefits

January 18, 2025

Transcranial Magnetic Stimulation (TMS) is gaining traction as a groundbreaking treatment for mental health conditions, particularly for those who have not responded well to traditional therapies. But how do you know if TMS is right for you? Understanding the eligibility criteria and the benefits of this innovative approach can help you make an informed decision about your mental health care.

TMS therapy is a non-invasive procedure that uses magnetic fields to stimulate specific areas of the brain associated with mood regulation. By targeting the prefrontal cortex—often underactive in individuals with depression—TMS helps restore normal brain activity and alleviate symptoms. Unlike medications, which affect the entire body, TMS is localized and doesn’t involve systemic side effects, making it an appealing option for many.

 

Who Can Benefit from TMS Therapy?

Individuals with Treatment-Resistant Depression

One of the primary uses of TMS therapy is for people with major depressive disorder (MDD) who haven’t found relief through antidepressants or psychotherapy. Studies show that approximately two-thirds of patients experience significant improvement or complete remission of symptoms after TMS.

Those Seeking Non-Medication Alternatives

For individuals who cannot tolerate the side effects of medications, such as weight gain, fatigue, or sexual dysfunction, TMS offers a drug-free solution. It’s particularly beneficial for patients who prefer a non-invasive approach to treatment.

Patients with Anxiety Disorders

While TMS is most commonly associated with depression, it’s also being used to treat anxiety disorders, including generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD). By targeting overactive brain regions responsible for anxiety, TMS helps reduce symptoms and improve overall mental well-being.

Individuals with Post-Traumatic Stress Disorder (PTSD)

TMS has shown promise in alleviating symptoms of PTSD, such as intrusive thoughts, nightmares, and hypervigilance. By modulating neural circuits, TMS helps individuals process trauma more effectively and regain control over their emotions.

Patients with Neurological Conditions

Emerging research suggests that TMS may be beneficial for neurological disorders like chronic pain, migraines, and even Parkinson’s disease. Although still under study, these applications highlight the versatility of TMS therapy.

 

Eligibility Criteria for TMS Therapy

While TMS is a safe and effective treatment, not everyone is a candidate. Below are the key factors that determine eligibility:

Diagnosis of a Mental Health Condition

TMS is FDA-approved for treatment-resistant depression and OCD. For other conditions, it may be considered off-label and requires consultation with a specialist to evaluate its suitability.

Lack of Response to Traditional Treatments

TMS is often recommended for individuals who have tried at least two antidepressant medications without significant improvement or who have discontinued medications due to intolerable side effects.

No History of Seizures

Because TMS involves magnetic stimulation, individuals with a history of epilepsy or seizures may not be suitable candidates. A thorough medical evaluation is conducted to assess this risk.

No Metal Implants or Medical Devices

TMS therapy is not recommended for individuals with implanted medical devices like pacemakers, cochlear implants, or metal plates near the treatment area. Magnetic fields can interfere with these devices.

Commitment to the Treatment Schedule

TMS therapy typically involves daily sessions, five days a week, for four to six weeks. Candidates must be able to commit to this schedule to achieve the best results.

 

Benefits of TMS Therapy

Non-Invasive and Painless

TMS does not require surgery or anesthesia, and most patients describe the procedure as painless. There’s no recovery time, so individuals can resume their daily activities immediately after treatment.

Minimal Side Effects

Unlike medications, which can cause a range of side effects, TMS side effects are generally mild and short-lived. These may include scalp discomfort or mild headaches during the session.

Long-Lasting Relief

Many patients experience lasting improvement in symptoms even after completing the treatment course. Maintenance sessions can be scheduled if necessary to sustain results.

Improved Quality of Life

By alleviating symptoms of mental health conditions, TMS allows individuals to regain focus, energy, and motivation, improving their overall quality of life.

 

The Bottom Line

TMS therapy offers a ray of hope for individuals struggling with mental health conditions, particularly those who haven’t responded well to traditional treatments. With its non-invasive nature, minimal side effects, and high success rates, TMS is an effective and life-changing option for many.

If you’re considering TMS, consult a mental health professional to discuss your symptoms, medical history, and treatment goals. Together, you can determine if TMS is the right path for your recovery journey.

smoking

Smoking Addiction

BrainsWay Deep TMS is a noninvasive, FDA-cleared, outpatient brain stimulation procedure with proven clinical results to help patients to quit smoking.  Known as the addiction coil, the H4 coil was specifically designed for targeting the deep areas of the brain involved in addictions.

A large study in 14 centers examined adults who had been long-term heavy smokers, all having failed prior quit attempts using medication, therapy, or other methods. Of those that completed Deep TMS treatment, 28% achieved four consecutive weeks without smoking, most of them not smoking for at least three months after treatment.  Among all participants in the study, the average number of cigarettes smoked per week over the course of treatment was reduced by 75%.  

TMS has none of the side effects commonly found in medication to treat smoking cessation. TMS is well-tolerated with years of safety data supporting Deep TMS. Patients may initially experience minor headaches or pain at the site of treatment which typically subside after the first few sessions. There is no preparation, no anesthesia, and patients are able to resume daily activities immediately after each treatment session. Treatments are done in our office. Each treatment session lasts 25-30 minutes. They are done daily on weekdays for 3 weeks followed by a weekly session for another 3 weeks.

BrainsWay Deep TMS offers a fresh approach that may help to quit smoking using cutting-edge neuroscience. Clinically proven and well-tolerated, Deep TMS is the first non-invasive technology that is FDA-cleared to treat smoking addiction.

addiction

OCD

Deep TMS has recently be approved by the FDA for treatment of obsessive-compulsive disorder (OCD).  OCD traditionally has been treated primarily with exposure psychotherapy, and while it is also treated with medication such as fluvoxamine, OCD does not respond well to medication management.  Medication improves symtpoms greater than 30% in only 50% of patients, and half of OCD patients stop taking their medication due to side effects.  And while exposure therapy might improve OCD, as many as 80% of patients continue to have symptoms after psychotherapy, according to some studies.

BrainsWay Deep TMS is a noninvasive, FDA-cleared, outpatient brain stimulation procedure with proven clinical results for improving the symptoms of OCD.  The technology stimulates the brain using its patented H-coil, known as the H7 coil, resulting in a deep and broad penetration of the magnetic field into areas of the brain that are affected in OCD. Deep TMS is safe and well-tolerated, has a very low rate of side effects, and does not require anesthesia.  

Research has proven a higher level of improvement using Deep TMS.  Almost 68% of OCD patients were able to reduce symptoms by more than 30%, and 87% of those who responded saw sustained improvement for at least a year.

depression

Depression

Major depression was the diagnosis first approved for treatment with TMS, and it is still the most commonly treated condition. Most patients are treated with TMS after failures of medications and psychotherapy, as insurance companies will pay for TMS treatment only after medication failures.  However, TMS treats depression much better than medication, and some would argue that TMS should be the first treatment instead of the last.  

When patients have not improved with medication, they are considered to be “treatment-resistant”. And in treatment-resistant depression, TMS treatment results in significant improvement, defined as more than a 50% reduction in symptoms, in more than 80% of patients.  And more than 60% of patients achieve remission.  That is a very high and a very impressive number of people who are happy for the first time in many years after TMS treatment.

TMS treatments for depression are done in a series of 36 treatments.  Patients have a 20-minute treatment 5 days a week for six weeks followed by 6 more treatments in a tapering schedule over three more weeks. No preparation is needed, and there is no recovery time.  After each treatment, patients are able to leave and go about their day.  Except for a rare seizure, which occurs in 1 of 1000 patients, TMS has only minor side effects of mild headache or scalp soreness in the first few days. 

It is said that after successful TMS treatment, that there is a 50% chance of relapse of depression within the first year.  However, at Hagan Health we consider that statistic to be too high, and our relapse rate is lower.  While treatments are done by certified and experienced treaters, Dr. Hagan is closely involved in determining the location and strengths of settings to provide the most accurate treatment.  In addition, Dr. Hagan meets with patients every week or two before and during treatment, and periodically after treatment, in order to insure the best possible results.  Depression varies from patient to patient, and it is important to get the know the patient and the thoughts, feelings, and circumstances that might lead to relapse.  Using cognitive therapy techniques, patients are taught to be aware of triggers and to be prepared with the cognitive tools used to reduce the chances of relapsing. 

TMS for Anxious Depression

Recently TMS has been cleared by the FDA for treatment of Anxious Depression.  This condition is one in which anxious distress is a major part of the clinical picture while depression remains the predominant diagnosis.  Anxiety which is treated along with depression is also significantly improved, while TMS is not currently considered appropriate for the treatment of anxiety without depression.

Dr. Hagan Bio

So the lesson Al taught me was about my lack of happiness related to feelings of inadequacy. Even though I had become a brain surgeon, I did not have a healthy self-regard. Al explained to me that my father, in his drive to succeed and to push me to succeed, would never let me savor a victory, that whenever I achieved something important, he would ask, . “How could you have done it better?” Or “what is next?”. He was setting the bar at perfection, such that nothing less than perfection was going to be good enough. Al said, “Nobody is perfect”, and that I would be much happier deciding what degree of imperfection I was going to settle for. When one sets the bar at perfection, then every effort falls short of perfection and is therefore a relative failure, it becomes yet more evidence of one’s belief that he is fundamentally flawed and inadequate. He said that we are all always doing our best, and that is not fair for my father or for me myself to tell myself that I am not good enough. It was the single most important piece of wisdom that I would learn for the next several decades, and I have told this story many times to those who, like me, grew up to have similar issues.

After seeing Al for a year, another year or two went by. One day at church I was listening to a talk from a psychotherapist who had grown up in a family in which his mother was an alcoholic and his father was a workaholic. His story sounded so much like mine that I decided to see him professionally to “learn more about this garbage in my head”. I saw Paul for two years.

A few years later, life had become quite stressful. I was married with three small children, practicing neurosurgery full time and doing some farming on the side. It was at this time that I started seeing my third therapist, the one that I would see for most of the next 10 years. Keith was a psychiatrist, an MD like me, who did only psychotherapy. A few months after starting my therapy with Keith, I realized that I liked what he did better than what I did. The process of therapy is that of developing an increasing awareness of how one got to be the way he or she is, starting with childhood issues. Specifically, this type of therapy is called “psychodynamic psychotherapy”.

Dr_Hagan
Terry

Three years into my experience with Keith, I made the final decision that I would rather be a psychiatrist, because I came to love the process of developing insight into one’s own psychology. As I closed my neurosurgery practice and completed a residency in psychiatry, I was so grateful the entire time for the opportunity to turn myself into a psychiatrist. “Who gets to do that?!” Years later a patient was looking at the books on my bookshelf and asked, “So you were a neurosurgeon; did you like it?” I had been asked many times why I decided to give up neurosurgery to become a psychiatrist, but no one had ever asked if I liked neurosurgery. The answer had to be that no, I did not. I did not like who I was. But I have loved psychiatry from the very beginning, and I really appreciate the contribution it has had in my own personal development.

But because of my heavy early experience in psychotherapy, I also became proficient and experienced in both psychodynamic psychotherapy and in cognitive behavioral therapy (CBT). And I attended the Cincinnati Psychoanalytic Institute for a year to take my psychotherapy skills to a higher level.

During the 17 years that I have been practicing psychiatry, I have continued to grow. The most gratifying experiences I have had have been when I have settled into a psychotherapy relationship with a patient, while there have been many, others with whom I have combined psychiatry with psychodynamic therapy, practicing psychodynamic psychiatry.

Terry
Dr. Hagan Bio

During these same years, I have also been on several mission trips, which have given me perspectives that I would never have learned otherwise. The concepts of loving your neighbor, giving of your time and resources, being kind and gentle and gracious, have come to define me.

I have always been at the head of my own practice, managing my own business. I have experience with other businesses as well, such as being a successful alpaca breeder for 10 years. “They do not teach business in medical school.” In a growing psychiatry practice, running the business is something you learn from necessity.