Transcranial Magnetic Stimulation (TMS) Therapy

Background

Starting a TMS Therapy Treatment Program

On November 30, 2023, our TMS treatment began for Mr. Mark. His PHQ9 depression scale score was 22 out of 27, indicating severe depression. Similarly, his GAD7 anxiety survey score was 17 out of 21, also classified as severe.

During the initial TMS sessions, we established Mr. Mark's motor threshold (MT) at 45% and targeted stimulation at his left dorsolateral pre-frontal cortex, located near the forehead. We introduced the iTBS modality, a brief yet potent TMS treatment compared to the standard 10 Hz. Mr. Mark underwent two iTBS sessions at the start of his treatment, each lasting less than 7 minutes.

By his 11th session, Mr. Mark's depression persisted as his PHQ9 score had only slightly decreased from 22 to 20. To address this, we incorporated standard TMS at 10 Hz frequency with an increased pulse count of 4000, surpassing the usual 3000 pulses.

TMS Optimization – Going Beyond FDA Guidelines To Match Patient Needs

To provide context, the FDA advises a regimen of 3000 pulses per session at a 10 Hz frequency for treating resistant depression with TMS. However, by the 11th day, Mr. Mark was receiving 4000 pulses plus two iTBS treatments, equivalent to a typical 3000-pulse session each. Consequently, he was receiving a total of 10,000 pulses daily during our post-day 11 meetings. This level of customization is achievable at our clinic due to frequent patient consultations throughout the TMS protocol, allowing for adjustments, calculated risks, and surpassing FDA recommendations. This tailored approach sets us apart from TMS providers operating on a franchise model nationwide, where treatments are uniform, and Success with TMS is limited to those aligning closely with the standard patient profile.

Mr. Mark's Progress with TMS Therapy

Mr. Mark's mood started showing improvements in a significant way at about session 17, approximately 4-5 weeks after starting treatment. He persevered and kept coming in for more TMS sessions. It has been reported in the scientific literature that some patients who undergo TMS only notice relief after all 36 sessions have been completed, a delayed effect, if you will. Therefore, it’s imperative that patients push through to achieve real Success with TMS.