What is transcranial magnetic stimulation (TMS)?
TMS is a painless, safe, and non-invasive procedure that uses a hand-held magnet to create a weak electrical current around brain neurons. The electrical current changes how and when neurons fire, altering the activity in brain networks. Our protocol uses biometric data to set TMS treatment parameters, customizing treatment to the physiologic state of each participant. Repeated TMS pulses are given during treatment, adjusting brain rhythms and changing the balance between different active or inactive brain networks. When used as a medical treatment, TMS is prescribed by a physician who is a neuromodulation specialist and given by licensed medical experts.
The U.S. Food and Drug Administration has approved TMS treatment protocols for depression, obsessive compulsive disorder, and migraine. However, treatment of other mood or substance use disorders is “off-label” and “investigational” — meaning we are gathering evidence to understand who may benefit the most. There are anecdotal reports of TMS reducing people’s craving, improving sleep, and decreasing substance use, so we think TMS may help Veterans suffering from mental health, brain injury, chronic pain, and substance use disorders.
How can TMS help to improve mental health and problem substance use?
TMS can stimulate neural pathways that are important for mood, craving, pain, sleep, and other brain functions. Through this stimulation, brain rhythms change, reducing symptom severity and creating an opportunity for personal change. By pairing TMS with behavioral therapy, wellness education, medication management, and other interventions, we hope to provide Veterans with a sustainable pathway to revitalize their mood and physical well-being, as well as tools to improve their ability to function meaningfully in society.
When should I notice a response?
Just like other medical treatments, response to TMS varies. Participants will receive treatment 5 days per week for 6 weeks. Some people may begin to feel symptom relief after a few days of treatment and experience remission of symptoms after 6 weeks. Responders may notice a decrease in stress, improved mood, better sleep, fewer headaches, clearer cognition, less craving, or better ability to cope. Others may notice less of a change in symptoms or require booster treatments beyond the initial 30 to stay in remission.
What happens during a treatment session?
A member of the treatment team will review your current symptoms, perform a series of painless and non-invasive biometric readings, answer any questions you have, and position you in a treatment chair. You will be asked to remove jewelry and any objects sensitive to magnets (e.g., credit cards, keys, electronics). A family member or friend may accompany you and you will be awake during treatment. Once seated, the TMS magnet will be placed gently against your scalp, and stimulation will run for approximately 30 minutes. During stimulation, you may feel a light tapping against your scalp, you may hear a series of rhythmic clicks, and you will be monitored at all times. Biometric readings will also be repeated after treatment.
What kind of biometrics will be used?
In addition to the standard vital signs obtained during doctors visits, non-invasive, painless skin sensors may be used to measure balance, skin conductance, heart rate variability, electroencephalography (EEG) brain waves, and other biomarkers of neurophysiologic state pre- and post-TMS treatment. These readings will be used to help tailor TMS treatment parameters and monitor treatment response for each participant.
What are the risks of TMS?
TMS is safe and usually very well-tolerated. All participants will undergo an initial screening assessment to identify individuals with medications or medical conditions that may increase their risk for side effects. The most common side effects are mild and include facial twitching or scalp sensations; these resolve when the magnet is turned off or repositioned. Post-treatment fatigue, lightheadedness, and headaches can occur, but are easily treated and usually resolve after a few sessions. Rare side effects include syncope, seizures, or worsening of mood symptoms, which may require change in prescription medications or cessation of treatment. No long-term adverse effects of TMS treatment are known; however, unknown long-term risks may exist. The risks of TMS during pregnancy are unknown.