Dr. Mhd Khaled Bowarshi, M.D. | Depression Psychiatrist

Some patients may require maintenance TMS therapy after their initial or repeated treatment course. It can keep patients from relapsing again into depression after their initial treatment. Maintenance TMS therapy could be once a week for a while then once every two weeks.

TMS can be repeated again if depression returns. Generally, we would want to see a response by a decrease of depression rating scale score of 50% to consider a second treatment course. The chances of response with the second TMS therapy course of treatment is very good (78% to 84%).

About two out of three patients will maintain their response or remission 6-12 months after TMS. About one third could see a return of depressive symptoms.

The first session for the motor threshold determination and brain mapping is performed by a psychiatrist trained in TMS Therapy. The following sessions are performed by a medical assistant directly trained and supervised by the psychiatrist.

During your first session, you will be seated on a comfortable chair in a very relaxing room. The doctor will perform your brain mapping and motor threshold determination. This will specify the exact location to deliver the magnetic pulse. Also, it will specify the exact dosage (intensity of the magnetic pulse) for your treatments. To do this, the doctor will be giving one pulse at a time at the motor cortex until the spot that moves the patients thumb is identified. A few more pulses will be delivered at different intensities until the best magnetic pulse intensity is identified. This is referred to as the Motor Threshold. The next step will be determining the treatment target which is measured as 5.5 cm anterior to the spot identified in the previous step. Once thats done, you will be receiving your first TMS for the duration based on your protocol. You will notice that your first TMS session is going to be longer than the following sessions. This is because of the time needed for the mapping.

It is advised that you stay awake during treatment sessions. Researchers are currently looking into the combination of cognitive behavioral therapy with TMS to augment the antidepressant effect. You are more than welcome to invite your therapist to come join you during your sessions. Also, there has been a boom in therapy apps on smartphones that could be helpful to invest your time in. Lastly, you will have access to a 65 4K TV so you can watch your favorite channel, YouTube or Netflix. We recommend that you watch, read or listen to things that bring joy, happiness, and peace. Please avoid watching the news, action movies, thriller movies, or scary scenes.

During your first session, you will be seated on a comfortable chair in a very relaxing room. The TMS psychiatrist will perform your brain mapping and motor threshold determination. Mapping will specify the exact location to deliver the magnetic pulse. Also, mapping will specify the exact dosage (intensity) of the treatment required. Once thats done, you will be receiving your first TMS.

TMS therapy is performed in outpatient settings. There is no sedation required. There are no restrictions required before or after the treatment sessions. Patients can drive themselves after the TMS treatment session.

A depressed brain is hypoactive in certain areas. TMS stimulates these certain areas of the brain. This will cause a cascade of brain circuits activation that results in certain brain circuits that used to be sleepy to wake up. Obviously, the science behind it is more complicated. This novel mechanism of action is referred to as neuroplasticity. A magnetic coil is placed in contact with the patients forehead. The magnet painlessly delivers a magnetic pulse that stimulates nerve cells in the region of your brain involved in mood control and depression. More specifically, this area of the brain is called the Dorsolateral Prefrontal Cortex or DL-PFC. It's thought that the left DL-PFC is hypoactive in depressed patients and activating this regain of the brain can result in the improvement of depressive symptoms and even complete recovery in many cases.

TMS or Transcranial Magnetic Stimulation is a new treatment for depression that uses pulsating magnates to stimulate parts of the brain believed to be responsible for depression. The activation of the brain cells requires the repetition of this magnetic pulse. Hence it is sometimes called repetitive Transcranial Magnetic Stimulation or rTMS. Transcranial Magnetic Stimulation is a non-invasive outpatient treatment for depression. In TMS we use a magnetic pulse to stimulate areas of the brain connected to depression circuits.