How Effective is dTMS (Deep Transcranial Magnetic Stimulation) for Treatment Resistant Major Depression? (TMS series Part 2 of 3)

Treatment resistant depression is one of the most crippling and emotionally devastating conditions known to man. Many good medications have been developed to treat Major Depression over the years, but sometimes the disease can be too severe and the medicine does not work. Some intensive treatments, such as ECT, are very effective but have severe side effects. This leaves many patients seeking a better solution. This dire need for a better solution led to the

FDA approval of TMS in 2008. Deep TMS was approved by the FDA in 2013, taking a really good thing and making it even better.

Q: What is Deep TMS?
Deep TMS, also known as dTMS, refers to a more effective and deeply penetrating form of TMS now possible using the newer generation of TMS technology. The Brainsway Corporation has engineered the H1, H7, and H4 dTMS coils that were approved by the FDA for Treatment Resistant Depression and other indications. These H coils produce a magnetic pulse that stimulates a larger area than a traditional figure 8 coil used in regular TMS. The stimulation also penetrates deeper, reaching 3-5 cm into the cortex. The benefits of this have to do with both a more complete stimulation of the target area as well as some stimulation of the neighboring areas of the brain that interconnect with the target area. The risk of dramatically losing efficacy from deviating even just 1mm from the target area is greatly diminished using a Brainsway device, as compared to a traditional figure 8 coil, due to the larger and deeper area of stimulation. This all helps yield higher rates of both response and remission for Treatment Resistant Depression.

Q: How does Deep TMS compare with conventional TMS?
Conventional TMS is performed with what is called a “Figure-8” coil that delivers a focused magnetic pulse that reaches 0.7 cm beneath the skull surface. TMS machines using this coil are manufactured by Neuronetics, Magstim and Magventure. A TMS session using a traditional “Figure-8” coil takes approximately 40 minutes.

Deep TMS is performed using a Brainsway dTMS machine using the H-1, H-4, and H-7 coils. The magnetic pulses produced by the H-1, H-4, and H-7 coils are focused but cover a much broader area that a “Figure-8” coil. The H-1 pulse reaches 3 cm below the surface of the skull while the H-7 can go as deep as 5 cm.

Q: What is the duration of a Deep TMS procedure and how long is a treatment course?
dTMS session using either H coil takes approximately 9-12 minutes in most cases, depending on the dose necessary. Advanced protocols that involve treating more than one location of the brain have become increasingly popular. The highly advanced dual combination of the H-1 protocol followed immediately by the H-7 protocol takes 18-24 minutes on average. A typical treatment course is comprised
of Deep TMS being administered 5 days a week for the first 6 weeks and then twice a week for 3 weeks for a total of at least 36 sessions. Some cases may require additional sessions to achieve an optimal response.

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