How TMS Works in Depression and OCD

Evidence-based and Considerations for therapists looking to integrate TMS into their clinical setting.

TMS (Transcranial Magnetic Stimulation) also referred to as rTMS (repetitive Transcranial Magnetic Stimulation) is a safe treatment option in Psychiatry and Psyhology, proven to have high response and remission rates. With very minimal side-effects, TMS is a suitable option for patients who do not wish to take or who have not responded to medications. TMS is delievered as a short-term progam, with studies showing 66% positive response, and 55% complete remission after 6 months. An average of 20 sesssions are typically needed, with sessions held at least 2 times weekly.
Magnetic Coil is placed on the front of the head which exogenously stimulates two areas involved in Depression, the DLPFC and the Anterior Cingulate Cortex
Therapist or Clinician stays in the room to conduct Psychotherapy. In Psychotherapy we activate the frontal cortex and the ACC endogenously
When combining TMS and Psychotherapy, these Depression pathways are dually activated and reinforced. This has been scientifically proven to increase the patient’s chances to achieve complete remission of Depression symptoms (Donse et al. 2017)

See how a TMS program works in Clinical Practice

Where is TMS therapy subsidized?

The Netherlands

TMS / rTMS therapy is

United States

TMS / rTMS therapy is

Key studies which demonstrate the effects of TMS (rTMS) as a treatment for Depression or OCD

Donse, Padberg, Sack, Rush & Arns (2017). Simultaneous rTMS and Psychotherapy in Major Depressive Disorder: Clinical Outcomes and Predictors from a Large Naturalistic Study. Brain Stimulation.

This study shows that combining rTMS with Psychotherapy is more effective than either therapy alone. In this study of 196 patients, 66% of patients with Treatment Resistant Depression, responded after an average of 21 sessions. Furthermore, lasting effects are notice after 6 months in 65% of this group. This suggests that the combined approach, TMS combined with Psychotherapy, improves the likelihood of a patient achieving complete remission.

Spronk, Arns & Fitzgerald (2010). repetitive Transcranial Magnetic Stimulation in Depression: Protocols, Mechanisms and New Developments.

A general book chapter providing a preliminary overview of TMS / rTMS as a treatment method for Depression

Arns, Drinkenburg, Fitzgerald & Kenemans (2012). Neurophysiological Predictors of Non-Response to rTMS in Depression.

This manuscript highlights some of the EEG predictors that are currently being further investigated, replicated and extended which can thereby facilitate a prediction of treatment outcomes of rTMS using baseline brain imaging data.

Donse, Sack, Fitzgerald & Arns (2017). Sleep Disturbances in Obsessive Compulsive Disorder. Association with Non-Response to repetitive Transcranial Magnetic Stimulation (rTMS). Journal of Anxiety Disorders.

The following study shows the first results of rTMS used in the treatment of OCD where 55% of patients responded to treatment. Furthermore, sleep onset problems were found as a reliable predictor for non-response to rTMS.

Arns et al. (2016). EEG Alpha Asymmetry as a Gender-Specific Predictor of Outcome to Acute Treatment with Different Antidepressant Medications in the Randomized iSPOT-D Study. Clinical Neurophysiology.

This publication demonstrates results from a large multicentre study to illustrate the potential of using EEG to predict treatment outcomes, which will become one of the major innovations in Psychiatry in the years to come.

Iseger et al. (2017) Neuro-Cardiac-Guided TMS (NCG-TMS): Probing DLPFC-SGACC-VAGYS Nerve Connectivity Using Heart Rate. First Results. Brain Stimulation.

First proof-of-concept study demonstrating a possible new way to localize the DLPFC using heart rate for rTMS treatment (Neuro-Cardiac-Guided TMS, NCG-TMS)