TMS (Transcranial Magnetic Stimulation): What It Is

OverviewWhat is transcranial magnetic stimulation (TMS)?

Transcranial magnetic stimulation (TMS) is a noninvasive treatment that involves using a magnetic coil to influence your brains natural electrical activity. This treatment, first developed in 1985, now sees widespread use for a variety of mental health and brain-related conditions.

Transcranial magnetic stimulation relies on two basic principles of physics: electricity and magnetism. These two principles can also work cooperatively, and TMS relies on their ability to work together.

The space surrounding a magnet is magnetically active, and a magnets influence in that space is known as the magnetic field. You cant see it, but that space still shows the effects of the magnet at its center. When you bring a magnet near something that conducts electricity, the interaction between the conductive item and the magnetic field generates electricity.

So, why does all that matter? It matters because your brain is electrically active. The brain cells in your brain and nerves (known as neurons) use tiny amounts of electricity to send and relay information throughout your brain and body. Bringing a magnet close to your brain can influence your brains electrical activity. Thats why TMS targets specific parts of your brain, especially those related to your emotions, internal decision-making, feelings of pleasure, etc.

However, doing TMS requires a magnet that switches on and off. Doing that is possible by using electricity to control when the magnet is on or off. It also requires a magnet thats much stronger than the average magnet on your refrigerator or that you keep around your home.

There are different ways to perform TMS. They have to do with the magnets strength or various ways to apply the magnetic field.

TMS is often a treatment that can help when other treatment options are unsuccessful. Its also an important option because its noninvasive. That means it doesnt require surgery, and the entire treatment happens through your skin.

TMS can also offer an alternative to treatments like electroconvulsive therapy (ECT), if ECT isnt an option or isnt effective.

The conditions TMS has full approval to treat may vary from country to country. TMS has approval from the U.S. Food and Drug Administration (FDA) to treat four conditions:

In addition to the approved conditions, research is ongoing to see if it can treat other conditions. These include, but arent limited to:

Theres limited available data on how many people undergo TMS per year. However, TMS is widely available, with accredited and certified providers in dozens of countries worldwide.

Before you undergo TMS, a healthcare provider will probably refer you to a specialist with training and experience in using this treatment. The specialist will also talk to you before treatment to make sure you meet the criteria for having TMS or if there are any conditions or circumstances that mean you shouldnt receive it.

Reasons that you shouldnt undergo TMS can include:

If your provider determines that TMS is a good and safe option for you, theyll talk with you about the treatment schedule they recommend. TMS takes multiple treatments typically three to five per week spread out over several weeks. For FDA-approved protocols for depression, a typical TMS course happens every weekday over six weeks for a total of 30 treatments. However, some newer treatment courses can greatly reduce the course of treatment down to a single week.

Because theres some variability in treatment courses, your provider is the best person to explain the recommended course of treatment sessions. They can provide the most accurate information specific to your case.

TMS is a noninvasive procedure. The only thing you might need to do right before the procedure is to take off glasses with metal frames or remove any metallic jewelry items. Removing all metallic jewelry is a safety precaution in case they contain any magnetic metals you dont know about.

The magnetic coil for TMS is inside a nonmagnetic case or housing. Some devices use a magnet inside a helmet that you wear. Others have the magnet attached to an extension arm (much like the type of arm that allows a healthcare provider to position an overhead light during a medical procedure). Your provider will have you sit in a specially designed chair underneath or beside the magnet.

Once youre seated comfortably, your provider will give you earplugs (or another type of hearing protection). Thats because the sound of the magnet is loud enough to damage your hearing (using hearing protection is also standard with MRI scans for this same reason).

After you have hearing protection in place, your provider will position the magnet on your head. That either involves putting on the magnet-containing helmet (with a chin strap, so it stays in place) or positioning the extension arm with the magnet at its end, so the outer case of the magnet is against your face. The specific placement depends on the condition you have.

Before starting the treatment, your provider will give single-pulse stimulations on your scalp. This helps to find the right location and setting for your treatments. Once the magnet is in position, theyll start the treatment. Early on, youll feel a tapping-like sensation from the magnet as your provider slowly increases the strength of the magnetic pulses.

As the pulse strength increases, youll notice a twitch or movement in your hands, especially in your thumbs. This is normal, and your provider will watch for it because it helps them know when the pulse strength is high enough.

After finding and setting the right pulse strength, your provider will have the magnet deliver pulses with a specific timing or pattern. Youll hear clicking sounds during the treatments as the magnet turns on and off. This is also normal. There may be pauses between a series of pulses. Thats because the electricity that powers the magnet also makes the magnet heat up, and those pauses give the magnet time to cool.

Depending on the type of TMS youre receiving, including the pattern of magnetic field pulses, the treatment sessions can last anywhere from a few minutes to half an hour. Your provider is the best person to tell you how long a session will take.

The sessions that follow the first TMS treatment are usually very similar to or the same as the first session. Your provider may make some adjustments to the treatment, depending on changes in your symptoms since the first treatment or side effects that you experienced.

Once a treatment session is over, you can return to your usual routine or schedule for the day. If you have lingering side effects, such as twitching or unusual sensations in your head or face, your provider may ask you to wait a few minutes before leaving. Most of the symptoms that follow a treatment session are mild and only last a few minutes (more about these under the Risks and Benefits section).

TMS has several advantages that make it a useful treatment.

TMS has relatively few side effects, risks and complications. The most likely serious side effect of TMS is having a seizure. However, these are also extremely rare. The risk of having a seizure from a TMS session is 0.01%, or less than 1 in 10,000.

The most likely complications, most of which are mild and usually dont last more than several minutes after a session, include:

Most people can return to their usual activities and routine immediately after a TMS session. Some people may need a few minutes to let side effects pass, but this isnt common.

You should see your healthcare provider as recommended for your visits. A key factor in whether TMS works is attending all the sessions as recommended. Missing sessions makes this treatment less effective. You should also contact your healthcare provider if you notice any side effects that are moderate or severe or that linger or dont get better even a few after a session.

People with conditions like major depressive disorder and obsessive-compulsive disorder have a higher risk of dying by suicide. You should get emergency care if you have disturbing thoughts about harming yourself, including thoughts of suicide or harming others. If you have thoughts like this, you can call any of the following:

Experts have performed dozens of research studies on TMS. None of those studies has linked TMS to harmful changes in the brain. There are very isolated cases where people have reported significant side effects. However, such cases are extraordinarily rare, and there are only a handful of such cases where experts concluded that TMS probably or definitely was the cause.

A note from Cleveland Clinic

Transcranial magnetic stimulation (TMS) is a treatment technique that involves using a magnetic field to influence the electrical activity of your brain. This treatment can help with depression, obsessive-compulsive disorder, smoking cessation and migraines.

While it isnt a first-line treatment, TMS does offer hope to people who havent seen improvements from other more-common treatments. In the case of severe or treatment-resistant depression, TMS is a treatment with life-saving potential. Experts are also researching whether it can help many other brain-related conditions, opening up the possibilities of even more uses for the treatment.

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TMS (Transcranial Magnetic Stimulation): What It Is