Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive brain stimulation technique used to treat various psychiatric and neurological conditions. It involves applying recurring magnetic pulses to brain regions, typically the left dorsolateral prefrontal cortex (L-DLPFC), to modulate cortical excitability.

How TMS Works

TMS uses magnetic pulses, leading to neuronal depolarization and modulation of brain activity. The treatment can be classified into two main types:

1. High-frequency rTMS (>1 Hz): Increases cortical excitability
2. Low-frequency rTMS (≤1 Hz): Decreases cortical excitability

Evidence for rTMS in Adult Depression
Several studies have demonstrated the efficacy of rTMS in treating depression, particularly in cases resistant to conventional treatments:

1. Efficacy in Clinical Trials: Multiple randomized controlled trials have shown that daily left prefrontal TMS over several weeks is effective in treating depressive symptoms, with remission rates of 30-40%
2. Real-World Effectiveness: Observational studies in clinical settings have reported similar efficacy rates, with 40-50% of patients responding to treatment and 37% achieving remission
3. Comparison to Sham Treatment: Meta-analyses have consistently found rTMS to be superior to sham treatment, with odds ratios for response and remission ranging from 3 to 5
4. Durability of Effects: The antidepressant effects of rTMS appear to be as durable as those achieved with other antidepressant interventions, with many patients maintaining improvement for months to years after treatment
5. Treatment-Resistant Depression: rTMS has shown promise in treating patients with treatment-resistant depression, who have failed to respond to multiple antidepressant medications
   

TMS can be used in Children and Teens

Safety and Side Effects
TMS is generally considered safe and well-tolerated. Some people experience mild side effects like scalp discomfort at the site of stimulation and headache.

FDA-Approved Conditions for TMS:

• Major Depressive Disorder (MDD) - TMS was first approved by the FDA for treating Major Depressive Disorder in 2008.
• Obsessive-Compulsive Disorder (OCD) - In 2018, the FDA permitted marketing of TMS for the treatment of Obsessive-Compulsive Disorder.
• Depression with Comorbid Anxiety
• Smoking Cessation
• Migraines
• Adolescent Depression - In 2024, the FDA cleared TMS for adolescent patients aged 15 and up with Major Depressive Disorder.

Other Applications

While depression is the most well-studied application, TMS has also shown promise in treating other conditions:

• Obsessive-Compulsive Disorder (OCD)
• Post-Traumatic Stress Disorder (PTSD)
• Migraine
• Smoking cessation
• Post Concussion
• ADHD

Research and clinical treatments are ongoing in the US treating additional psychiatric and neurological disorders.

Transcranial Magnetic Stimulation (TMS) has been approved for several conditions in Europe. Approved Conditions for TMS in Europe:

Major Depressive Disorder (MDD), Depression with Comorbid Anxiety, Obsessive Compulsive Disorder.

Additional Approved Conditions
In Europe, TMS has received CE certification for the following conditions:

• Alzheimer's disease
• Autism
• Bipolar Disorder
• Chronic Pain
• Parkinson's disease
• Post-traumatic Stress Disorder (PTSD)
• Schizophrenia (negative symptoms)
• Smoking cessation
• Stroke
• Multiple Sclerosis
  

Brain Health Hawaii’s extensive experience, derived from treating thousands of patients and administering hundreds of thousands of treatments, has positioned us as a leader in transcranial magnetic stimulation (TMS) therapy for depression. Our expertise spans both advanced TMS dosing protocols and conventional left dorsolateral prefrontal cortex (L-DLPFC) TMS, providing a robust hands-on observational medicine foundation for optimizing treatment outcomes. This vast clinical experience has honed our ability to make small yet clinically significant adjustments to conventional L-DLPFC TMS protocols, tailored to individual patient response and needs based on comprehensive assessments and close monitoring of responses to stimulation promoting enhanced efficacy and tolerability. This adaptability, grounded in years of hands-on practice and data-driven insights, allows us to maximize therapeutic benefits for each person's unique brain profile and response to treatment.