While the Columbia Ketamine Center does not provide Transcranial Magnetic Stimulation (TMS), it may be a good option to consider for people with depression who have not responded to other treatments. Here is a brief overview of TMS and how it differs from intravenous (IV) Ketamine. References are also provided for those interested in more detailed information. This is by no means a comprehensive description of the procedure.
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1. What is TMS?
TMS stands for Transcranial Magnetic Stimulation. It uses a magnetic coil placed on the patient’s scalp. The magnet creates an electric current to stimulate the targeted areas of the brain.
2. How effective is TMS for the treatment of depression?
The manufacturers of the devices received approval from the FDA for the treatment of depression in 2008 based on a large study of 301 patients with treatment-resistant depression. In this study, 14% of those who received active TMS had a meaningful response vs. 5% of those who received placebo TMS. Another similar study of 190 patients performed by the National Institutes of Health provided the same results. Other studies have shown that up to 40% of patients have a positive response to TMS(2). Ketamine on the other has been shown to have a 70%-80% response rate(3).
3. How long does it take to start seeing improvement?
Individuals who respond to TMS typically start to see symptom improvement within two weeks(4), whereas with ketamine improvement is seen within one to two days(5).
4. What does an initial course of treatment entail?
A typical initial course of TMS treatment consists of 5 sessions per week for 4-6 weeks. Depending on the particular device, treatment sessions last anywhere from 5 to 30 minutes. Most providers recommend patients try up to 6 weeks of treatment before deciding whether or not it is beneficial. At the Columbia Ketamine Center, we recommend six intravenous ketamine sessions over a two-week period. If the patient does not experience meaningful improvement after six intravenous ketamine sessions, we refund the cost for two of the infusions.
5. Are continuing treatments needed to maintain the benefit?
In one study, after an initial course of TMS treatments, the average time to relapse is four to five months(6). The time to relapse with Ketamine is eighteen to twenty days(7,8). In order to increase the duration of benefit, the Columbia Ketamine Center prescribes a low dose of at-home Ketamine as long as there are no contraindications. This allows the majority of our patients to go for at least one month before needing another infusion.
The chart below provides a comparison between Intravenous Ketamine and TMS.
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Intravenous Ketamine VS. Transcranial Magnetic Stimulation
| IV Ketamine | TMS | |
|---|---|---|
| Success rate | 80% | 40% |
| Onset of benefit | 2-3 days | 20-30 days |
| Initial Course of Treatment | 6 days | 30-45 days |
| Need Driver | Yes | No |
| Covered by Insurance | No | Sometimes |
| Maintenance required | Yes | Yes |
| Significant Health Risks | No | No |
References
- O’Reardon et. al. Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial Biol Psychiatry. 2007 Dec 1;62(11):1208-16.
- Berlim,M; Clinically Meaningful Efficacy and Acceptability of Low-Frequency Repetitive Transcranial Magnetic Stimulation (rTMS) for Treating Primary Major Depression: A Meta-Analysis of Randomized, Double-Blind and Sham-Controlled Trials Neuropsychopharmacology volume 38, pages 543–551 (2013)
- Diazgranados, N, et al. A Randomized Add-on Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Bipolar Depression Arch Gen Psychiatry. 2010 August ; 67(8): 793–802.
- Klein, E; Therapeutic efficacy of right prefrontal slow repetitive transcranial magnetic stimulation in major depression: a double-blind controlled study. Psychiatry. 1999 Apr;56(4):315-20
- Zarate, N et.al.;A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Psychiatry 2006 Aug;63(8):856-64
- René Benadhira, Fanny Thomas, Noomane Bouaziz , A randomized, sham-controlled study of maintenance rTMS for treatment-resistant depression (TRD); Psychiatry Res., 2017 Dec;258:226-233.
- James W Murrough 1, Andrew M Perez, Sarah Pillemer, et.al.; Rapid and longer-term antidepressant effects of repeated ketamine infusions in treatment-resistant major depression. Biol Psychiatry 2013 Aug 15;74(4):250-6.
- C Sophia Albott, Kelvin O Lim, Miriam K Forbes,; Efficacy, Safety, and Durability of Repeated Ketamine Infusions for Comorbid Posttraumatic Stress Disorder and Treatment-Resistant Depression; J Clin Psychiatry; 2018 May/Jun;79(3):17m11634.
- Mark S George, Rema Raman David M Benedek, et.al.;A two-site pilot randomized 3 day trial of high dose left prefrontal repetitive transcranial magnetic stimulation (rTMS) for suicidal inpatients; Brain Stimul; 2014 May-Jun;7(3):421-31.
- Yi Zhao, Zongling He, Wei Luo,et.al.; Effect of intermittent theta burst stimulation on suicidal ideation and depressive symptoms in adolescent depression with suicide attempt: A randomized sham-controlled study. J Affect Disord; 2023 Mar 15;325:618-626.
