Transcranial magnetic stimulation (TMS) is a treatment that is used to improve symptoms of depression in people who have not responded to other treatments. The use of TMS therapy for addiction is experimental. More research is needed, but early results are promising, suggesting that transcranial magnetic stimulation (TMS) treatments may help to treat comorbid depression and reduce cravings. Please continue reading to learn more about TMS treatment and how it can help people in recovery from drug and alcohol addiction.
What is Transcranial Magnetic Stimulation (TMS) Therapy?
Transcranial magnetic stimulation (TMS) is an FDA-approved non-invasive procedure for treatment-resistant depression. It involves applying magnetic fields to the brain from outside the skull (without making any cuts in the skin). The magnetic fields stimulate nerve cells and improve symptoms of depression in people who have not responded to other standard depression treatments.
How Does TMS Work?
TMS treatment involves placing a magnetic coil on the scalp. This coil delivers magnetic pulses to specific areas of the brain. The therapy works by stimulating and activating nerve cells in parts of the brain that regulate mood. Experts believe that in people with depression, regions of the brain that control mood have slowed activity.
The exact mechanism by which TMS helps with depression is not fully understood. However, researchers believe TMS improves mood and relieves depression symptoms through cerebral neuromodulation including:
- Increasing the excitability of neurons (increasing activity in parts of the brain responsible for mood regulation).
- Increasing the frequency of neuronal discharge (how often the nerve cells send signals).
- Increasing blood flow in the region of the brain that regulates mood.
- Increasing the release of neurotransmitters such as dopamine.
- Acting on deeper structures through the formation of new brain circuits and connections.
What is rTMS and deep TMS?
The term rTMS refers to repetitive transcranial magnetic stimulation. It is called rTMS because a series of treatments is usually necessary to see results.
Repetitive TMS uses a figure-of-eight magnetic coil. Deep TMS refers to a treatment that uses a different coil called an H-coil that can stimulates wider and deeper areas of the brain.
What is TMS Therapy Used For?
The FDA has approved transcranial magnetic stimulation (TMS) therapy for:
- Major depressive disorder
- Obsessive-compulsive disorder (OCD)
- Migraine headaches
- Smoking cessation
Research is ongoing for other potential uses of TMS, for example, in the treatment of seizure disorders (epilepsy).
Use of TMS in Treating Addiction
The use of TMS in treating addiction is experimental. In other words, TMS is not an FDA-approved treatment for substance use disorders. However, some studies have found that it can be useful for people in recovery.
How is TMS Applied in Addiction Treatment
TMS can help in treating comorbid depression in people with alcohol and drug use disorders. Dual diagnosis and treatment of mental health conditions such as depression alongside addiction treatment is vital for successful and sustained recovery.
Transcranial magnetic stimulation may help in managing mood changes caused by withdrawal from drugs and alcohol. Detoxification from substances is one of the most challenging phases of recovery. Getting TMS during detox can potentially help to elevate mood and promote motivation to stay in addiction treatment.
Is TMS Effective in Treating Addiction Symptoms?
Studies in people receiving treatment for cocaine addiction have shown that TMS therapy can lead to fewer cravings. Reduced cravings can help in preventing relapse in recovering cocaine addicts. TMS could therefore have potential as an effective treatment modality for cocaine addiction. Unlike alcohol and opioid drugs, there are currently no medication-assisted treatment protocols for cocaine abuse.
Success Rate of TMS Therapy for Addiction
Small studies on the use of TMS therapy for addiction symptoms have shown promising results.
One 2016 study enrolled 32 participants who were randomized to rTMS or pharmacological treatment. People in the rTMS group received 8 sessions of TMS over a period of 4 weeks. At the end of the study period, there were 11 people without relapses (negative urine drug test results) in the rTMS group compared to only 3 in the pharmacological group. Drug cravings were also less in the rTMS group. However, there was no difference in reported depression symptoms.
In 2019, researchers applied 24 TMS sessions (with 20 sessions in the first two weeks and two weekly sessions in the remaining two weeks) to people in recovery from drug abuse. Approximately 56% of the 16 participants who completed the study had a negative urine drug test with significantly reduced drug cravings, less severe withdrawal symptoms, and less anxiety and depression.
Another 2019 study used a rTMS treatment protocol of three sessions per day with a 1-hour interval between sessions. The therapy was given for 10 days over a 2-week period. The 9 participants who completed the study reported a 78% reduction in the amount of money spent on cocaine and the number of days the drug was consumed. Additionally, cocaine cravings were reduced by 26%-37% along with a reduction in anxiety and depression.
A 2020 study used an intensified rTMS treatment protocol with 10 sessions in the first 5 days and then two weekly sessions for 11-12 weeks. There was a significant reduction in the number of days cocaine was consumed in the treatment group. Additionally, cocaine cravings were reduced, sleep quality was improved, and depression and anxiety symptoms were reduced. The average time to relapse was 91 days in the rTMS group compared to 51 days in the group that did not receive transcranial magnetic stimulation treatments.
TMS Therapy for Co-Occurring Conditions
Mental health conditions such as anxiety and depression often co-occur with substance use disorders. TMS is an effective treatment for major depressive disorder and obsessive-compulsive disorder. However, there isn’t much research on the efficacy of TMS for anxiety treatment. The little research that has been done suggests that TMS therapy may be effective for generalized anxiety disorder and post-traumatic stress disorder.
Pros and Cons of TMS Therapy
Pros
- Non-invasive treatment
- Outpatient procedure
- Safe and FDA approved
- Generally well tolerated (serious side effects are rare)
- Effective based on available research
- Useful for people who haven’t responded to other depression treatments
- Can be used alongside other treatments such as medications and psychotherapy
Cons
- Side effects such as mild headache and facial twitching
- Skin reaction at the site of coil placement
- May not be covered by insurance
- Requires 30-60 minutes per session and multiple sessions per week for several weeks
What to Expect During TMS Treatment
What Happens During Transcranial Magnetic Stimulation Treatment?
Transcranial magnetic stimulation is a non-invasive treatment. Meaning, it does not involve making any cuts in the skin or the insertion of any instruments inside your body.
During a TMS procedure, a healthcare provider will hold an electromagnetic coil against your forehead to target a specific area of your brain called the prefrontal cortex. The coil will deliver magnetic pulses through your skull to your brain tissue by creating small electrical currents. These currents will stimulate nerve cells in your brain and make them more active.
Is TMS Therapy Painful?
No, TMS therapy is not painful. You may feel a mild tapping or knocking sensation on your head during the treatment.
If you feel any discomfort during the treatment, be sure to tell your provider. They can adjust the level of the stimulation to ensure you are comfortable.
Your provider may recommend taking an over-the-counter painkiller such as Tylenol to prevent post-treatment headache.
Note: TMS can trigger severe headache in some people who get frequent headaches or migraines. Tell your provider if this happens. They will likely stop the treatment.
How Long Does TMS Treatment Last?
A TMS session typically lasts for 30-60 minutes.
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+18442884672 How Many Sessions are Required for Treating Addiction with TMS?
There are no standardized TMS protocols for addiction treatment. Your healthcare providers will develop a customized TMS treatment plan for you based on your symptoms and their severity. A typical protocol may involve five TMS sessions per week for 4-6 weeks.
How Long Does TMS Take to Show Results?
Most people see an improvement in their mood and depression symptoms within 2-6 weeks of starting TMS therapy. You may notice an improvement after the third or fourth session. Younger individuals in their 20s and 30s get faster results from TMS compared to older adults in their 40s and beyond.
How Long Do the Effects of TMS Treatment Last?
TMS results were found to last for at least one year in people who participated in clinical studies. Some patients even reported TMS results lasted several years.
Should I Continue Taking My Antidepressant Medication While Undergoing TMS Treatment?
Most healthcare providers recommend continuing antidepressant drug treatment while undergoing TMS therapy. After completing a series of rTMS treatments, you can discuss slowly tapering off your antidepressant medication with your provider to see if you still need it. Never stop your antidepressants without the guidance and supervision of a healthcare provider. Abruptly stopping antidepressants can cause serious adverse effects.
Can I Drive Myself To and From TMS Sessions?
Yes, you can drive yourself to and from the treatment center. TMS therapy does not involve the use of any sedating drugs. Your ability to focus and concentrate will not be affected post-treatment.
What is the Downtime After TMS Therapy?
There is no downtime after TMS treatments. You can return to your normal daily routine immediately, including going to work, exercising, and socializing.
Eligibility and Considerations of TMS Therapy
Is TMS therapy approved by the FDA?
TMS therapy is FDA approved for treatment-resistant major depressive disorder, obsessive-compulsive disorder, migraine headaches, and smoking cessation.
Who Should Get TMS Therapy?
People who have not responded to standard treatments can consider TMS therapy.
Who is a Good Candidate for TMS Therapy?
You should consider TMS treatments if:
- Your depression symptoms have not improved on medications.
- You are not satisfied with the results you got from medication management for depression or OCD.
- You cannot tolerate the side effects of antidepressant drugs.
- You have other health conditions that do not allow you to take antidepressant medications.
- Your depression symptoms are severe and interfere with your day-to-day functioning.
Who Can’t Get TMS Therapy?
Your healthcare provider may recommend against getting TMS therapy if:
- You are pregnant or are planning a pregnancy soon.
- You have metal implants such as bullet fragments, magnetic implants, or implanted medical devices such as stents, aneurysm clips, deep brain stimulators, electrodes, cochlear implants, or other devices inside your body. The strong magnetic fields used during TMS therapy can interfere with the functioning of these devices or cause them to migrate from their position.
- You have brain damage such as from a traumatic brain injury, stroke, or tumor.
Is TMS Therapy Covered by Insurance?
Most insurance companies only cover medically necessary FDA-approved treatments. Therefore, TMS therapy may be covered by your health insurance plan if your healthcare provider certifies it as medically necessary for the treatment of depression, OCD, migraines, or smoking cessation. Be sure to check with your benefits administrator because coverage can vary among insurance providers.
TMS Controversies and Concerns
What is the Controversy with TMS?
The U.S. Food and Drug Administration (FDA) has approved TMS therapy for depression, OCD, migraine headaches, and smoking cessation. However, there is much less data about the effectiveness of TMS treatments for other psychiatric conditions. Therefore, the use of TMS for treating many conditions is still controversial.
Some of the issues and problems with TMS include a lack of standard protocols including appropriate coil location, best device parameters (intensity, frequency, dose, and dosing schedule), and choice of candidates.
In general, TMS therapy is an exciting and promising treatment but continues to be controversial for conditions other than depression.
What Are TMS Side Effects?
Common side effects of TMS treatment include:
- A mild, dull headache
- Scalp discomfort or pain
- Redness at the site of magnetic coil placement
- Numbness and tingling
- Muscle spasms or twitching of facial muscles
- Slight dizziness
Less common adverse effects include seizures, mania episodes in people with bipolar disorder, and hearing loss if the ears are not protected during TMS treatment.
How Long Does a TMS Dip Last?
Some patients experience an emotional dip during rTMS treatments. This typically occurs at about week 3 and can be associated with a return to pre-treatment levels of depression. The TMS dip usually lasts 2-5 days but can last up to two weeks in some individuals.
People with a history of past trauma are more likely to experience a TMS dip. This is believed to be due to resurgence of repressed feelings due to stimulation of the prefrontal cortex area of the brain.
If you experience a TMS dip, be sure to tell your provider so they can monitor you more closely. On a more positive note, once the dip subsides, TMS results usually gain momentum. Therefore, a TMS dip can be a sign that the treatment is working.
Does TMS Actually Work?
Multiple clinical trials have shown that transcranial magnetic stimulation (TMS) therapy can help people with treatment resistant depression obtain long-lasting relief from their symptoms. However, results can vary from person to person.
Does Brain Stimulation Work Better Than Medication?
Medications (antidepressant drugs) are proven to be effective in treating symptoms of depression. Brain stimulation with TMS or electroconvulsive therapy (ECT) is less commonly done and therefore there is less data on the effectiveness of these treatments for depression.
The use of TMS for other mental health conditions, including addiction, remains experimental.
Moreover, various factors like proper patient selection, magnetic coil strength and placement, pulse frequency and intensity, and dosing frequency can affect how successful TMS is in treating depression.
Integrating TMS into Comprehensive Addiction Treatment
If you have a substance use disorder (drug or alcohol addiction) and a coexisting mental health condition such as depression, there may be a role for transcranial magnetic stimulation in your recovery. TMS therapy is not a standalone treatment, however. It can only work when used in combination with other evidence-based treatments such as medically supervised detoxification, counseling and therapy, medication-assisted treatment, and relapse prevention.
TMS Therapy in Washington
At Discover Recovery Addiction Treatment Center in Washington State, we offer a range of holistic addiction treatment protocols that are individualized to address your specific needs. Get in touch with us today if you are interested in non-drug treatments for addiction, depression, and other mental health conditions. We can help you decide whether transcranial magnetic stimulation (TMS) therapy is right for you.
