What is Transcranial Magnetic Stimulation and How Does it Work? | Practical Demonstration of TMS
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- čas přidán 29. 06. 2022
- Dr Sanil Rege, Consultant Psychiatrist discusses the mechanisms of action of Transcranial Magnetic Stimulation (TMS) and its indications.
#transcranialmagneticstimulation #depression #tms
Transcranial Magnetic Stimulation is an evidence-based treatment for depression and treatment-resistant depression. It also has indications for other conditions such as PTSD, OCD, Migraine and Tinnitus.
TMS involves placing a small coil near the scalp that when engaged generates a magnetic field that induces an electrical field in the brain’s outer cortex in regions that are close to the coil.
TMS is a safe and effective computerised medical device that delivers non-invasive and focal magnetic stimulation to the DLPFC over a brief duration of time.
The pulsing magnetic fields induce electrical currents in these brain regions and over the course of 4 to 6 weeks can significantly increase a patient’s chances of achieving remission from depression.
TMS is seen as being a safe procedure however the possibility of a seizure during TMS therapy is a small yet significant safety concern. In a study of 325 patients with an accumulative 10,000 treatment sessions, no seizures were observed.
The most common adverse events with rTMS are headaches and scalp discomfort. Switching is possible in patients with bipolar disorder.
Local and international experience has demonstrated that rTMS can safely be provided as an outpatient therapy with no restrictions required of the patient after attendance for treatment.
![Dr Rustin Berlow TMS demonstrations [CloudTMS TMS Course - Marina Del Rey 10/2018]](/img/n.gif)
I have went through 2 rounds before in the last 3 yrs. I strongly believe in it! I am just starting my 3rd time. It’s a big commitment but so worth it!!
...gone through...
@@paulgilmartin5675 rly? tht's wht u got out of my comment? smh
What kind of changes and improvements have you noticed? I'm about to start treatment.
@@paulgilmartin5675 Thank you grammar police.
@@f0ibl3d When I first went through I expected nothing so it ended up being a good thing. My focus got better, and my overall mood improved. idk how the place u r going to is run but with mine you do a check every time which was nice to get anything out of your head n not wait til your next therapy appt. Overall I just seemed like a i woke up. kinda hard to explain but anger and irritability went way down, saw the world differently.
Interesting video, I like how you demonstrated yourself :) thanks for sharing this!
I have read this good for tinnitus. Looks interesting 🙏🏽
I have used electronic stimulation (tens device) on my knees. Instead of having knee replacement. I stimulated the knees for an hour a day. After 2 years, I am still walking with no surgery.
I've used a tDCS device and it has helped me. It seems a very similar type of therapy to TMS.
This seems like a great treatment. Very basic very efficient through and through more pros than cons. However I've seen countless reviews on this and seems like people who get a benefit from it, the benefit it very shortly experienced and who is to know what future side effects can come
It is not a panacea, and yes for some maintenance treatment is needed. Not everyone responds to this treatment.
Is it totally safe? And what happens if a normal person takes it?
Does it have any long term effects or consequences or is it 100% safe?
Hi doc.
My therapist has recommended this treatment for me as I have a combination of OCD, Depression, Anxiety, and c-PTSD
I also have been diagnosed with DID
is there any research into how this effects individuals with DID? I am very nervous about going through with TMS as I know the research of DID is generally limited and will probably be even more limited with a Niche like TMS, but I figured I could ask.
TMS is usually used to target specific aspects with most evidence in the conditions you mentioned. However As you state research in DID is limited. A discussion with your doctor carrying out a risk benefit analysis would be appropriate. Wish you well
wow useful info 👍❣️
Does of help with Existential crisis/depression?
I just finished 5th session. Not as bad as I thought it would be. I hope it works.
Did it work?
Yea did it work? Why five sessions? Is it expensive?
I am on my second round of treatment. I did not notice much effect during the 35 sessions, but the months afterwards had many reduction of symptoms. I had about 1 decent year before it was time to undergo again to keep depression at bay. It was pain-free but as other said, a big time commitment to your lifes schedule for the regimen..
Great video! How do you feel the TMS remission rates compare to esketamine or racemic ketamine for treatment resistant depression?
Excellent question. With esketamine there is a third trial looking at this question ; we should know more about relapse rates. With TMS - studies have shown up to 80 percent relapse rates ( Cohen) - many requiring Maintainence treatment. High relapse rates are also a feature of ketamine. But these relapse rates are more likely a reflection of the nature of depression as these treatments are used in severe Rx resistant depression. Clinical practice shows that the severe end of the spectrum depression is characterised by a relapsing reporting pattern of illness.
@@PsychiatrySimplified Do you know if the PBS is reconsidering the 35 + 15 lifetime limit on TMS? Hopefully treatment will be available where I am next year and a limited income means once the pbs funding runs out, there won't be any more treatments for many on social security.
I've heard NDIS may cover it for some but unsure of that.
And are they doing thetaburst in Australia or the saint protocol? Saint looks like it can be done in a week which is much more affordable potentially for people who live rural.
Great video as always!
Thank you for your feedback
Do you feel it at all? Like If there is any sensations my anxiety probably won’t let me sit in the chair for treatment. I would just panic.
I know someone who has gone through this - unfortunately a complete personality change has taken place and very angry, some cognitive disability noted ie forgetfulness. He is an older gentleman.
That is unusual unless it has precipitated a hypomanic / manic state which it can do including lower levels of irritability and mood swings
Can u plz tell me what is this tdcs my doctor has advised me to take this tdcs session for my ocd problem
Hi doctor
Patient is diagnosed with bipolar depression.Should we go for ect or tms.
I was tested with one for a provoked reaction test for ms, it was like a mule kicking you
Interesting.
Can it help with progressive supranuclear palsy ( psp)
It depends on what Sx are being treated. If it is cognition or depressive Sx. It can help with the latter with some mild potential benefit on cognition. The doctor will be able to outline the benefits and if it’s indicated.
I read an article the low frequency tms can help autonomic dysfunction and high frequency can help cfs. If you have both cfs and pots , how can you determine what may work for you? Could the tms doctor do that based on symptoms? I really need help.
I am also very interested in this. Meds have been unsuccessful and I have cfs c ptsd and innattentive adhd what are the chances this will be better? I'm sure over the hellride medications have put me through I think I would love to try this but what if it's not in my area?
Have you been treated for ADHD? Individuals with ADHD have an increased risk of CFS.
@@PsychiatrySimplified
I have had ritilin 10mg 3x per day led to palpitations shaking and rage attack by 8pm...vyvanse heart palpitations no response at all...then moved to mirtazapine plus quetiapine to go to sleep but it left me utterly zombified by drowsiness that I couldn't do my job as a mother...that's it it the last straw for me it took me over a week to get over that one dose and I'm not going back again. It was supposed to be supporting sleep and returning to 1x dose of ritilin again since at the very least the ritilin gave me the energy I don't have...I have tried to tell drs for years it's cfs but they don't listen still I have no doubt of the innattentive add, the anxiety and rumination, stuck in freeze mode and cptsd but it's the post exertional malaise and the physical pain symptoms along with that fatigue that stand out worse debilitating my enjoyment to walk and play with my kids... guarana and ginseng is the only thing that gives me mild improvement of stamina without side effects I don't have it every day because I fear it won't work after a while so I only use it when I know I'm going to have to survive a busy time over a couple of days. I also regularly take 2x paracetamol and 2x ibuprofen for sacroilliitis and joint/muscular pain...I can't complete home cleaning duties without it and if I have then something else is always sacrificed because of executive functioning but always because of PEM for 48hrs each time.
@@dearjuan covered the overlap in this video PSYCHIATRIST Explains Clinical Evaluation in CHRONIC FATIGUE SYNDROME & ME. Solving the CFS Puzzle
czcams.com/video/kaTCExuc1Ps/video.html
Hi doc!!!
My mother has leg pains all the time bt donno wt is paining i mean is it bone, muscle or nerves but she always say it feels like burning sensation and she couldn't even keep her leg touched to even bed while sleeping...can u please recommend rtms for brain modulation as a treatment..
Has this been evaluated? This could be part of a neuropathic presentation or restless legs syndrome. Other causes also need to be ruled out. Has a neurolgist opinion been sought? RTMS is indicated for depreasion mainmy - it is unlikely to address rls or neuropathic pain if present .
I've had a migraine everyday now for 8 months that won't go away from ibuprofen over use from 2 hips replacement s will a tms home kit help , I'm seeing a neurologist but it's not working. ???? Help please I need suggestions
Sir, does TMS help to patients after Traumatic brain injury who are in MCS condition?
I want to know the same. I’ve only seen one thing online saying that it does.
Is TMS considered equally to more traditional forms of treatment like CBT and pharmaceutical anti-depressant drugs, or is TMS a "last resort" treatment? Thank you
TMS can be first line treatment from evidence based point of view. It has good tolerability as well.
It can be but, insurance will usually not approve you to do TMS first. They will want you to go the "traditional route" ssris,snris, CBT/talk then if those are ineffective,TMS could be approved.
Does this help with birdsrline personality disorder
Good afternoon doctor, i recently had some blood tests done which showed high levels of progesterone (about twice the normal level) and ACTH, i have already set an appointment with an endocrinologist, but do you think this could have caused my very high nervousness resistant to antidepressants ? Thank you very much !!
Not necessarily. Antidepressants can help regulate HPA Axis. As in all cases of deprresion medical causes should be ruled out.
Where are you located
Australia, VIC
Does it work in auditory and visual hallucinations? Please reply 😢 patient is very aggressive and taking clozapine. Please reply and suggest me better options if possible. Thank you
I can’t provide advice here as treatment is based on an individualised approach . There is some evidence for auditory hallucinations.
Can just use Brainsway and they have a cap so no marker on head.
Plz sir tell me why tms blood test in children's y doctors prescribed
Sorry do not understand the question?
Hi :) when do you think your next video will be out?🙏
Hopefully a few weeks. Things have been very busy with clinical and teaching work.
@@PsychiatrySimplified great!
Dear sir, Average How many sessions required for Major depression and anxiety?
For depression 20-30 sessions. It is not evidence based for anxiety as a routine Rx but used when comorbid with depression. Usually the same amount. Ps not advice as number of sessions may vary from individual to individual.
Can TMS help with cluster headaches?
It can depend on the formulation. It is not routine treatment, however. Here is some evidence - www.brainstimjrnl.com/article/S1935-861X(18)30422-4/fulltext
Does it help with positive schizophrenia Dr?
“In conclusion, evidence for an effect of TMS on positive symptoms was mixed. Since most of the studies were performed in patients with auditory verbal hallucinations, further research of TMS for other positive symptoms including thought disorder and delusions is warranted.” pubmed.ncbi.nlm.nih.gov/31505508/
Doctor, can you answer my question? My son does not speak and walks little, knowing that he has pure oxygen at birth. And he has a lack of concentration, is it possible to treat him with this device? Note that the doctor told me that it is useful for him in order to stimulate his brain
TMS is indicated for Rx resistant depression although is used for many other conditions , anxiety, OCD, PTSD , migraine etc. re individual answers it’s difficult to answer as so many aspects need to be taken into account. Your doctor is in the best position to answer this question. Overall TMS when used appropriately can improved mood, cognition & activity dimensions.
@@PsychiatrySimplified Thank you, Doctor. I really needed this answer. I wish you success
@@alialabadهل عالجت ابنك
Is this effective than hyponotherapy ,CBT ,NLP and ERP?
Depends on what is being treated.
Does this treat insomnia as well ? Plz reply as i am looking to opt for this treatment
Insomnia is not a single entity . There is no indication for TMS for insomnia generically. Insomnia has multiple causes / factors . It’s best to get an evaluation and then speak to a medical professional about your question . Wish you well
You can see this video to see the evaluation - How to Evaluate and Treat SLEEP PROBLEMS and INSOMNIA? - A Quick Guide | Psychiatrist Explains
czcams.com/video/Rrdx11rDa9o/video.html
@@PsychiatrySimplified My insomnia was way worse back then .Like i could only sleep 2 hrs a day.After that i consulted with a neurologist and he prescribed me tryptomer which is an antidepressant.After taking it my sleep has improved a lot.If my insomnia was due to neurotransmitter imbalance then ,can TMS cure my insomnia since TMS is said to restore the chemical balance back in the brain?Plzz replyyyy
@@chirayupardikar3050 that’s a very simplistic explanation for TMS. TMS is mainly indicated for Major depression. It can help sleep if depression is present as it can treat depression. There are some studies showing benefits but it’s not a routine treatment for insomnia due to other treatments present including CBT-I sleep hygiene etc
@@PsychiatrySimplified well lets just hope it works
What about tms used not just for depression? But used on the right side to calm the anxiety centers? My neuro said it can heal POTS and cfs and has healed people from it
TMS can be used for other indications as well and there is some evidence for this: however a general statement like TMS heals CFS or POTS is unlikely to be true in moderate to severe cases as these conditions are heterogenous and the experiences between individuals differ. They can help when used to target the appropriate symptoms and other aspects are also addressed. While for CFS there is some evidence for POTS - this evidence is not so strong. Your doctor should be able to discuss the rationale for the treatment. Ps not medical advice
@@PsychiatrySimplified I’m not sure I follow your last sentence about thoughts and CFS which one has more evidence. My brain mapping showed extreme over activity in the amygdala and surrounding areas of the limbic system. I have CFS severe anxiety with it connected directly to my crashing and then pots as a result of the crash. So how do you know what you’re targeting? That’s very vague and what I never understand. He’s trying to calm down those parts of my brain that are over active in the limbic system. So are you saying that this cannot help to heal me? What other aspect Are there to look at for for the causes for pots and cfs? Everything else is normal the only thing that has ever shown off is that my cortisol and norepinephrine levels are lower in my body. But taking hydrocortisone made me feel horrendous. My body is clearly in a trauma state and needs to get out of it. So what else can anyone even do it that point? I don’t tolerate any medication either I crash from anything I take.
@@PsychiatrySimplified Like I’m not sure what you mean when you say that and other aspects are addressed? What other aspects could you give some examples? I mean you crash you have anxiety and then you have pots that’s typically how it goes.
@@PsychiatrySimplifiedi gave severe emotional instability I cannot handle anything at all. Those are my symptoms of CFS and pots And if I try to move my body much my heart rate spikes up a ton and I guess of your pressure in my head. But the worst part is my nervous system issue feeling no safety anywhere and then crashing into it feels like I’m stuck in a hole. That area of the brain is the only part that was overactive on my brain mapping eeg. I do have a question though does calming down this area of the brain help regulate the HPA axis and help stress hormones return to normal level for example cortisol returning back to up to a healthy level and norepinephrine if they were low?
@@elizabethread6878 simplistically - the amygdala activity can be reduced - directly via targeting amygdala itself ( medications ) or by ‘strengthening the PFC - frontal cortex) . In some patients with the amygdala activity the PFC part may not be able to calm the amygdala. TMS aims to do the latter PFC - DLPFC - so it depends on the severity. It does not mean it can’t work - just that if it doesn’t work one has to recognise why ? Also some symptoms may improve ; others many not . It depends on the overall picture . The reason I mentioned ‘ heal CFS ‘ is because CFS presents differently in different individuals .
My mom has dementia, and her dementia rapidly progress after she got Covid recently . She becomes keep repeating the same words and has restlessness body movement
We just sent her to a rehab center in China, and the nurse there start to use TMS to treat her. As my mom is not a depression patient, I am wondering whether TMS will help her
It’s difficult to say as TMS is a treatment for depression not dementia related aspects. Hope she gets help.
My Nephew is only 4 years old. I visit a Dr for him. his doctors suggested me to take this treatment for him. I have a confusion about it for kids Isn't it harmful. Or if i take this treatment is it careate any future major problem for his Brain?
It is not FDA or TGA Approved for
Does magnetic stimulation treat auditory hallucinations?
There is some evidence for this.
Hi,what about ocd patient is it cure thus method. What's the cost
There is some evidence for TMS in OCD - not mainstream but can be trialled for resistant OCD if deemed appropriate . Ps not medical advice. The cost differs from country to country.
So does it help anxiety if it downplays the amygdala?
Yes it can / however one of the potential side effects can be activation in some ( describe increase anxiety) - hence important to ensure agitation is addressed. See potential side effects. czcams.com/video/2ON6KM8AHK8/video.html
@@PsychiatrySimplified thank you. So controlling the agitation as in medication?
it cured my ocd completely❤
I wish I had known about this back in 1997 when I was a child when my
Dpdr started.I probably wouldn’t have been brain damaged from all these meds these docs pushed on me the past 14 years.
Sir, is human long term memory capacity unlimited?
Not sure I understand the question. One can store memories here but decay can happen -
So storage may be substantial but doesn't mean all with be recalled.
can tms repair brain dysfunction because of depression ?
TMS is evidence based in treating depression. But there are a number of response indicators. It does not work in all cases.
I am 51 years male .my paralysis is 4 years old .i am bed no cure many medicine i use this rtms cure my paralysis please told me
Where’s the video of GAD Doctor ??
How to Diagnose and Treat Generalized Anxiety Disorder? - Insights from Dr Sanil Rege (Psychiatrist)
czcams.com/video/QqLqzKNzxuM/video.html
Hi Dr i did 30session (5per day) after 2month i did 20other session always (5perday) for 17min a session is that a lot please answer me?
Very difficult to answer as it depends on what Sx are being treated. Your doctor is in the best position to answer this. You can read more here for general info: psychscenehub.com/psychinsights/transcranial-magnetic-stimulation-depression-case-study/
I had a severe depression I did it in outside country do you think it can damage my brain cause always with headache
How are you now@@nabilanaybie535
@@nabilanaybie535has it improved?
I tried,,it hurts and my right eye was twiching
Can we remove bilateral amygdala for sever anxiety disorder??? Kindly reply 🙏
Any invasive neurosurgery is not appropriate for anxiety treatment, especially the removal of the amygdala - bilateral amygdala lesions lead to a syndrome called Kluver-Bucy syndrome. Klüver-Bucy syndrome is a rare behavioural impairment that causes individuals to put objects in their mouths and engage in inappropriate sexual behaviour. Other symptoms may include visual agnosia (inability to visually recognize objects), loss of normal fear and anger responses, memory loss, distractibility, seizures, and dementia. Amygdala is necessary as it mediates other functions. Multiple other treatments can help. Wish you well.
@@PsychiatrySimplified hi, thanks for your reply. Could you please tell me which surgery is perform for sever anxiety. Kindly reply 🙏
My sister 36 years, is suffering from schizophrenia, taking skizoril 50mg daily at night, will this TMS is good for her,
@rajkumartappeta Don't take my word for it but I think I read somewhere that this type of treatment can actually be bad for someone with Schizophrenia
Does this treat insomonia
We've answered a similar question before in the comments. Insomnia is not a single entity. There is no indication for TMS for insomnia generically. Insomnia has multiple causes/factors. Getting an evaluation and then speaking to a medical professional about your question is best. Wish you well. TMS is indicated for depression, and if depression is linked to insomnia - improvement in depression may help the insomnia.
You can see this video to see the evaluation - How to Evaluate and Treat SLEEP PROBLEMS and INSOMNIA? - A Quick Guide | Psychiatrist Explains
czcams.com/video/Rrdx11rDa9o/video.html
Hi Jazmin 🥰
Does rtms damage or kill neurons? Or in general cause any harm to the brain? Please clarify. Thank you
There is no evidence of TMS ‘killing neurons’
I do not understand how magnets can affect brain depression or OCD?? Like medicine makes sense your changing chemistry but how does a magnet actually do anything?
It’s is a magnetic field that leads to stimulation of the cortex. psychscenehub.com/psychinsights/transcranial-magnetic-stimulation-for-depression/
Do it work for ocd overlapped with agoraphobia?
There is evidence for OCD- the electrode placement is different.
And for agoraphobia?
Sir I am medical graduate myself I am MBBS from Pakistan here health facilties are limited I have found one center here with tms .just wanted to know do it works for agoraphobia?
@@ahmedzeeshan-pc2kb for agoraphobia CBT is the most appropriate treatment. TmS can be considered for anxiety but the evidence is not as strong as for depression
TMS work for anxiety
It can yes ; but is not main stream for it. Note in some it can worsen it if mixed features present.
My doctor suggested this but I am concerned about the stories I hear of it making anxiety and depression worse.
This is very commonly used nowadays for depression. Treatment can be stopped and evaluated if any anxiety occurs. Generally treatment is uneventful. It is a non invasive option in the treatment of depression. Ps not advice.
Excuse me doctor it helpful for generalized anxiety disorder ?
@@mehdiaitsiali868 sorry I thought I answered this. it is not independently evidence based for GAD routinely but can help. It can help when comorbid with depression. I've covered GAD in another video on this channel
What stories? I never heard of those stories
I hope my experience helps answer some people's questions. Everyone is different but this is what I encountered.
I have finished my second session for rTMS with 30 sessions to go. I have Crohn's and Fibromyalgia coupled with chronic fatigue, chronic pain, brain fog etc.
This treatment is life changing for myself. I have energy, I have motivation, and I can get out of bed with ease now. The biggest change in which I have heard other patients experience, is the brain fog being cleared out. It's literally gone! I haven't felt like this in over 10 years.
My first calibration treatment was painful. My second was not painful, but more like a woodpecker tapping which was totally fine for my newly improved Brain.
Any questions, fire away.
Thank you so much for sharing. Yes TMS is an evidence based treatment for CFS & works better for the Sx group you mentioned due to the DLPFC stimulation. As you say everyone is different and response depends on severity, Sx being targeted etc. Thanks again for sharing
If possible a further update would be helpful. 🙏🏼
@@PsychiatrySimplified Not a problem at all and thank you for the video!
That's great info, as I only just started I'm still learning about how it is affecting my brain. The DLPFC is a part of the brain that's involved in executive function, so it makes sense that stimulating this area could help to improve fatigue, motivation, and brain fog.
Can it dampen trauma
It can activate PFC which in turn modulate amygdala over activation ( which can occur in trauma) . This is a simplistic explanation ofcourse - psychscenehub.com/psychinsights/transcranial-magnetic-stimulation-for-depression/
Sir, is it stronger than ECT?
No it isn’t. It uses a magnetic field . It is non invasive and no anaesthesia is needed
Hi is this for autism too?
Not routine or significantly evidence based but in comorbid depression can be indicated if deemed appropriate by the psychiatrist . scholar.google.com.au/scholar?q=tms+autism&hl=en&as_sdt=0&as_vis=1&oi=scholart#d=gs_qabs&t=1670110983495&u=%23p%3DPFpDOcqc_6IJ
I did get TBS done (theta burst stimulation) but my depression got worse because of it I think. Is that possible ?????? Pls help
Yes not all patients respond . There are predictors of response to TMS. If mixed features are present as part of depression this group can worsen. Not uncommon in clinical practice.
@@PsychiatrySimplified what does mixed mean ? Do you mean bipolar ?
@@PsychiatrySimplified what does mixed mean ?????? Pls answer
Dr. Michael Persinger found he could create alien abduction experiences using similar technology.
Does this help tinnitus ?
There is some evidence it can but it depends on the overall diagnostic assessment of tinnitus. Medical causes should be ruled out .
The are some reports of it causing tinnitus. The literature is unclear so far.
Does this treats autism in children as well ??
Does it help autistic children.
It is not routine treatment. There are some studies in literature showing benefits. For an individual however the child and adolescent psychiatrist is in the best position to speak to about options.
@@PsychiatrySimplified Thank you for your prompt reply doctor. 👍👍
How severe is the autism?
Can you treat someone with a blank mind and no personality
I think psychedelics are better for treatment resistant depression
And how do you know this? I'm curious?
@@PsychiatrySimplified just look at any result of the trials that have been going on
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ᴘʀᴏᴍᴏsᴍ
Drs. SWEAR there are no side effects, but there are! Some are long lasting and include severe anxiety, tinnitus, blown retinas among some things. Beware.
Go to God for depression remember right hand or forehead this is the mark of the beast