Transcranial Magnetic Stimulation (TMS)

What Is Transcranial Magnetic Stimulation (TMS)? 

TMS is a safe, noninvasive therapy that uses gentle magnetic pulses to stimulate targeted areas of the brain.

TMS delivers magnetic pulses that reset abnormal brain signals. It’s an effective treatment for major depression, OCD, chronic pain and other conditions, often relieving symptoms when other treatments haven’t helped. The standard plan for TMS treatment includes one treatment a day for six to nine weeks.

More than 50% of people who received TMS experienced relief from depression symptoms, even when medications and psychotherapy have provided little benefit. TMS is safe and noninvasive. The magnetic pulses do not hurt, but you may feel a tapping sensation on your skull. TMS may cause mild side effects, such as slight discomfort or fatigue, but these are usually temporary.

TMS often works best when combined with medications or psychotherapy. We work closely with your doctor, mental health provider and other healthcare professionals to integrate TMS into your care plan. We coordinate your care to help you achieve the best treatment results.

What Are the Types of TMS?

The standard TMS treatment plan includes one session every day for six to nine weeks. Other types of TMS include:

Accelerated TMS treatments

Our accelerated TMS treatment program shortens the treatment time to five days, called a “5x5” treatment plan. You have five TMS sessions per day for five consecutive days.

Most people experience relief from depression symptoms within a few days. Maximum benefits occur about two weeks after the end of the course of treatment. You meet with a psychiatrist two weeks and four weeks after treatment to determine if you might benefit from additional sessions.

This accelerated approach is safe and effective. However, insurers don’t cover accelerated TMS because the Food and Drug Administration (FDA) hasn’t reviewed it. Accelerated TMS is an off-label treatment, which means the treatment itself is approved but doctors are using it differently than the guidelines suggest. Off-label treatments are commonly used in healthcare.

At UCLA Health, we offer affordable payment options for people who want accelerated treatment. You can also participate in research to demonstrate the efficacy of accelerated TMS.

Follow-up TMS treatments

Most people who get TMS enjoy long-lasting symptom relief for months or years. But if symptoms do return, you can safely get TMS again. Talk to your doctor about follow-up TMS treatments.

Neuromodulation treatments for neuropathic pain

In addition to treating depression and mental health conditions, TMS is also proven to help with pain. Neuropathic (nerve) pain occurs because of injury to the nervous system. This pain can arise from any part of your nervous system, including peripheral nerves, spinal cord or brain.

When nerve fibers are damaged, they may send abnormal signals to pain centers throughout the body. Nerve damage (neuropathy) and changes in nerve function can cause:

• Numbness, weakness and problems with balance
• Pain from activities that should not hurt, such as putting on socks, touching a smooth or soft surface, or exposure to heat or cold
• Unpleasant sensations, such as burning, tingling or a “pins and needles” feeling

TMS targets specific areas of the brain, changing how the brain processes pain. We also use other noninvasive neuromodulation techniques to treat neuropathy: 

• Magnetic peripheral nerve stimulation (mPNS): This treatment applies safe magnetic pulses directly over the painful area. It helps retrain your nerves and reduces pain signals to the brain.
• Scrambler therapy: We use small electrical currents to send “non-pain” or “normal sensation” signals to the nerves near the painful area. This treatment essentially scrambles the pain messages sent to the spinal cord and brain, reducing the sensation of pain.

TMS has been shown to help people with mental health conditions, including: 

• Anxiety disorders
• Major depression and treatment-resistant depression
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Substance use disorder (addictions to smoking, alcohol and illicit drugs)

It also helps treat:

• Migraines
• Neuropathic pain, chronic pain and fibromyalgia
• Tinnitus
   

To ensure TMS is right for you, our team conducts a thorough evaluation. A care manager and a psychiatrist meet with you and discuss your symptoms, medical history and goals.

TMS takes place in an outpatient clinic every weekday for six to nine weeks. The length of each treatment session varies from 10 minutes to 75 minutes, depending on the condition and severity of symptoms. If necessary, we may recommend additional TMS treatments to maximize the benefits of this therapy.

Before the first treatment, your care team performs a motor threshold check so we can determine the optimal treatment intensity for you:

1. You rest one arm comfortably on a cushion while we deliver gentle electromagnetic pulses to the part of your brain that controls hand movement. 
2. Your hand twitches or moves slightly as we deliver the magnetic pulses. 
3. We adjust the treatment intensity based on your movements.

We customize each treatment session to meet your needs. In general, here’s what you can expect:

1. Health check: Your psychiatrist conducts a brief health assessment before every TMS session.
2. Getting ready: You sit in an exam chair with a headrest (similar to a dental office chair) and get earplugs to muffle the sounds of the magnetic pulses.
3. Cap placement: Your technician places a treatment cap on your head. They position the TMS magnet over the designated area of the treatment cap and recline your chair.
4. Starting treatment: Your doctor checks the device settings and starts treatment. The device delivers magnetic pulses based on your individualized treatment plan.
5. During treatment: You may hear clicking sounds or feel a tapping sensation as the device delivers magnetic pulses. You can watch TV, read or use your smartphone or laptop.
6. Questionnaire: After every fifth session, you complete a symptom evaluation questionnaire. We use your responses to adjust treatments and achieve the desired results.

TMS may cause discomfort, headaches, sleep problems or fatigue following a session. These side effects are typically mild and go away after the first few treatments. The risk of having a seizure during treatment is extremely low, but if you have a history of epilepsy, TMS may not be right for you.

After TMS, most people experience significant symptom relief, and benefits can last for years. Many people notice relief from their symptoms after just a few sessions.

Almost anyone can safely benefit from TMS. Most of our patients are adults, although we successfully use TMS to treat patients as young as 15.

TMS may not be right for you if you have epilepsy or if you have a medical device or certain types of metal in your head, including:

• Aneurysm clip
• Cochlear implant
• Deep brain stimulator (DBS)
• Shrapnel

Our psychiatrists have years of experience with TMS. We help people find relief from depression symptoms when other treatments aren’t effective. Highlights of our care include: 

• Renowned expertise: U.S. News & World Report consistently ranks UCLA Health among the best in the nation for psychiatry. You receive care at a nationally recognized program with an excellent reputation. 
• Precision TMS approach: A psychiatrist sees you at each session to ensure you receive care based on your personalized treatment plan. We may also use MRI guidance to deliver your treatments with the highest degree of precision. Our team closely monitors your symptoms with weekly rating scales and meets frequently to modify your care plan as needed. 
• High rates of success: Approximately two-thirds of our patients see significant symptom improvements from TMS, with benefits that can last for years. Many patients notice changes after just a few sessions. 
• Treatment for conditions beyond depression: We use TMS as an off-label treatment for chronic pain, tinnitus, stroke and other conditions. We’re among a select few providers who use TMS to treat multiple conditions that often occur together (such as depression and chronic pain) in a single treatment session. 
• Dedicated TMS care managers: Your dedicated TMS care manager provides compassionate guidance and support throughout your treatment. These specialists schedule appointments, answer questions, manage insurance approvals, coordinate with outside providers and connect patients to community resources.
• Convenient, comfortable locations: Our UCLA Health clinics in Calabasas, Pasadena and Westwood provide easy access to TMS treatments near where you live. A UCLA Health psychiatrist and TMS technician oversee every session wherever you receive treatment, which takes place in a dedicated treatment room equipped with Wi-Fi and TV. 
• Accelerated TMS program: You get five TMS treatments daily for five consecutive days, finishing treatment in one week versus six weeks or more. As many as 8 in 10 patients get symptom relief with this approach. 
• Affordable options: Research shows that TMS and accelerated treatments help with chronic pain, tinnitus and other conditions. Since most insurance plans only cover standard TMS for depression treatment, we work with you to figure out affordable payment options so you can get the care you need.
• Commitment to TMS research: We’re national leaders in TMS clinical trials and research. UCLA Health experts helped develop some of the most effective TMS methods. As a patient, you can participate in our efforts to make TMS even more effective through the UCLA Health TMS Clinical and Research Service.