monthlong course of treatment, “I had what I thought were
miraculous improvements,” Gray says. “I went to sleep on a
Tuesday night depressed, and woke up Wednesday morning not
To celebrate, she went jewelry shopping. If that sounds
trivial, think again: “I had not been interested in my appearance
for so long,” she says.
The following year, in 2008, the Food and Drug
Administration (FDA) approved TMS as a treatment for people
with major depression who have failed to respond to at least
one antidepressant. Initially, the agency approved just one TMS
device, called NeuroStar, made by the company Neuronetics.
In 2013, the FDA approved a second device, manufactured by
In the years since FDA sanctioned the therapy, TMS
treatment centers have been popping up across the country.
Slowly, insurance companies have begun to cover the non-invasive, though costly, treatments. But plenty of questions
about TMS still linger, including how best to deliver it, which
patients make the best candidates and even what, exactly, the
device is doing in the brain.
Despite that, the therapy is gaining support from patients
and mental health providers alike. “I think it’s a promising
treatment,” says William McDonald, MD, a psychiatrist at
Emory University School of Medicine who was involved in the
clinical trials that led to the approval of the NeuroStar device.
“I’m a skeptic. But if I had significant depression and I had
failed one or two antidepressants, I’d have to consider TMS.”
Changing neural networks
TMS is typically administered by a physician or a nurse. The
procedure involves a non-invasive machine placed against
the scalp. The device sends short but intense magnetic pulses
into the brain, where they generate an electric current. The
pulses are centered over the left prefrontal cortex, an area that
often shows abnormal electrical activity in depressed patients.
A typical course of TMS therapy involves 20 to 30 sessions,
generally given in three to five treatments per week for four to
six weeks. The full course of therapy with the pricey machines
can cost $6,000 to $12,000. During the treatments, patients
remain awake and alert, seated in a chair while a physician or a
nurse places the device against the scalp.
TMS has become a promising treatment alternative
for the estimated 30 percent to 50 percent of people with
depression who don’t respond sufficiently to antidepressant
medications. One option commonly offered to such patients
is electroconvulsive therapy (ECT), a procedure in which
electrical currents are sent through the brain to trigger a short
seizure. ECT has been available in the United States for more
than 70 years. Administered several times per week over three to
four weeks, ECT can be effective at alleviating major depressive
However, ECT has some significant drawbacks. It can cause
confusion and memory loss. Plus, it must be administered
under anesthesia, which comes with risks of its own and adds
preparation and recovery time to each session.
Gray had tried ECT, but her doctor discontinued the
While TMS shows promise, it’s certainly no miracle cure.
treatment after she experienced serious memory loss. “I have
no recollection of that entire two-plus weeks,” she says. “I live
alone, and it was scary.”
TMS, by contrast, is administered while patients are awake.
“You sit in a chair, it takes about 30 minutes, and then you can
get up and drive yourself home,” says McDonald. Side effects
are minimal; headache and muscle soreness are the most
Some of the patients who responded positively to TMS
have experienced remissions lasting months or even years,
but follow-up booster sessions every few weeks or months
may help prevent a relapse.