Andy Behrman: What is TMS like? How does it feel to the patient?
Dr. Kira Stein: The magnetic pulses feel like a repetitive tapping sensation and sound very much like a loud old typewriter. Brain cells themselves have no ability to feel sensation, so activating them is essentially a painless process.
The tapping sensation is not caused by anything knocking on your head, but rather is produced by the magnetic field's stimulation of a thin layer of superficial muscle underneath the skin of your scalp. This is a rather a strange experience that takes getting used to; but after a few treatments, patients usually accommodate. In fact, they tend to acclimate to the procedures so rapidly that they can often comfortably watch television or read a book during TMS.
Very rarely, patients experience TMS as painful, but if they do, discomfort can be alleviated by using simple over-the-counter analgesics or by changing the angle or intensity of the stimulation.
Marcia Purse: What is a typical TMS session like, from start to finish?
KS: On their first day of TMS, the patient is greeted by me and my staff and we take some time to make sure all questions are answered and that they remove all metal jewelry and watches and have no metal implants or other contraindications to magnetic therapy.
Then, while the patient is comfortably resting in our TMS chair, I carefully administer magnetic "test" pulses along their scalp in order to determine the weakest magnetic field strength needed to cause a brain cell to activate, as well as to determine the scalp location that most closely overlies the part of the brain we want to stimulate.
This enables us to individualize the treatment strength and location, and is pretty much a painless and passive procedure for patients and takes approximately an hour. Once this is accomplished, patients immediately start their first TMS treatment.
The usual TMS treatment for depression feels like a repetitive tapping sensation on your scalp for 4 seconds, with a 26 second pause, followed by tapping for 4 seconds and so forth. This process continues for close to forty minutes.
Before each treatment you are provided with earplugs to reduce irritation from the noise of the TMS machine, which sounds like a very loud old typewriter. While initially the tapping sensation can be experienced as annoying or irritating, the discomfort is usually temporary and can be alleviated with simple over-the-counter pain medications given before the TMS session, and by our staff making simple adjustments.
Patients tend to acclimate to the procedures quite rapidly, to the point that most end up watching DVDs, listening to music, talking with staff, or participating in meditation. Sometimes, TMS becomes so relaxing and routine that I need to gently tap patients' shoulders to prevent them from falling asleep.
MP: Can a person drive immediately after a TMS session ends?
KS: Yes. Patients can drive immediately after TMS as there is no associated impairment in cognition, memory, or decision-making.
AB: How can you specifically tailor TMS to the needs of each patient?
KS: The location, quantity, intensity and pattern of magnetic pulses can be changed from the standard FDA-approved protocol, depending on patient response, in order to individualize treatment. As with all medical treatments, the risks of a TMS protocol need to be weighed against the potential benefits on a case-by-case basis.
AB: What are the typical side effects of TMS?
KS: The most common side effects of TMS are transient scalp/facial irritation and headache.
AB: Is seizure a potential complication of TMS?
KS: The seizure risk of TMS is low (0.003% per treatment or 0.1% per TMS patient).
Andy Behrman is the author of Electroboy: A Memoir of Mania.
NOTE: Dr. Stein's interview responses are for general information purposes only and are not intended to be professional medical, psychological, or legal advice for any specific situation or individual. This information is intended for individuals and their families to use in consultation with a qualified healthcare professional. Dr. Stein does not warrant or make any representations, and disclaims any and all liability, concerning any treatment or action by any individual who has made decisions based on information from this interview.