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If you are reading this page, it is fair to assume you are looking for an alternative depression treatment for yourself or a loved one. Thank you for researching Transcranial Magnetic Stimulation and we hope this page and website helps to educate and guide your decision process as you look for answers. Before we dive into TMS therapy, however, let’s talk a bit about Major Depression. What do we mean when we say Major Depression? 

The human brain is a little like the universe, we are learning more and more about how it works, but much still remains uncharted territory. We know that emotions and mental well-being are rooted in the brain and involve billions of electrical connections in key circuits that all interconnect to function appropriately. We have started to map out the key structures within the brain and associated neural connections between them that regulate mood and emotions. But we still don’t know exactly how these all interconnect or how to make sure they work in synchrony. We are learning more each day, however.

Everyone at some point in their lives, regardless of location, lifestyle, age, gender, race, socioeconomic status, or other circumstance has traversed normal feelings of happiness and love. We also unfortunately all know frustration and sadness as well. Sadness is very different from depression, however, as it is only periodic and a normal response to some definitive cause - such as ending a relationship, saying goodbye to a loved one that passes, or even just tearing up watching a sad movie.

When sadness is persistent, however, and causes dysfunctional symptoms, Major Depression may be diagnosed. In this situation, depression often presents despite no major life event or stressor. Or if stressors are present, they serve as the catalyst for persistently low mood. A combination of bad luck through genetics and certain events at key times, can lead to depressed brain functioning. A very different picture is painted for the aforementioned connections in the brain. In depression, anxiety, and other mental health conditions, these connections work the opposite of intended and become stuck in negative feedback loops.

Read more: TMS therapy for anxiety →

Common Symptoms of Depression

In Major Depressive Disorder, these symptoms persist and the assistance of a mental health professional is needed. If safety concerns are present, resources such as the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or their web chat at suicidepreventionlifeline.org/chat are available.  Additional crisis services are available through a mental health crisis walk-in center or the ER. 

Treatments for Depression

Depression can range from mild to severe. Sometimes removal of a specific stressor or lifestyle change such as a healthy diet, exercise, or stopping alcohol or drug abuse can improve depression. When severe, however, willpower and changes in the environment will not pull someone from the black cloud that is severe depression.

Mild to Moderate Major Depressive Disorder may respond well to counseling such as Cognitive Behavioural Therapy - CBT.  This can sometimes help manage more severe depression as well, but often only helps along with additional treatment.  In this situation, antidepressant medications are utilized. 

How Do Medications for Depression Work?

As noted, research into the pathophysiology of depression has shown changes occurring amongst different areas of the brain. We have also seen changes in brain chemistry, or neurotransmitters, that correlate to symptoms of depression. From a high level, we can see deficiencies in neurotransmitters such as serotonin and dopamine. Antidepressants seek to rebalance these deficiencies by indirectly boosting the amount of these neurotransmitters circulating in the brain.

Unfortunately for many, however, antidepressants are not always effective short or long term. Treatment resistance and recurrence is common in up to 30% or more of patients with Major Depression.¹ With this knowledge, we must therefore presume that deficiencies in neurotransmitters are not the sole cause of Major Depression, nor do they fix the problem long term. With limited treatment options, however, patients and clinicians turn to medication after medication and combination of medications seeking relief. With each medication trial, however, we see diminishing returns and increased propensity for side effects.²

Read more: TMS vs medications →

What Can We Do When Medications Fail?

Which finally brings us to TMS. The good news is that this novel treatment has shown great results, and carries no systemic side effects as seen with medication, nor other barriers to treatment or side effects seen with ECT.  It is extremely safe and well-tolerated, can be conducted in an outpatient clinic, and shows better short and long term response and remission rates compared to multiple additional medication trials.³

Read more: TMS therapy success rate  /  TMS vs medications →

How Can TMS Help?

Transcranial Magnetic Stimulation, or TMS, is a relatively new approach to treating depression. It was FDA approved in 2008 and has recently been granted approval for other indications such as OCD and smoking cessation. Additional studies are underway for other often co-occurring mental health conditions such as Generalized Anxiety and PTSD and for other mood disorders such as Bipolar Depression. There are numerous other psychiatric and neurologic conditions that have also shown promise with TMS treatment.

Read more: TMS therapy for OCD →

As described above, we know that different pathways in the brain become dysfunctional in Major Depression. Medications tackle things from a broad approach by influencing neurotransmitter function throughout the brain - and unfortunately throughout the entire body as well. ECT is a bit more targeted as it causes a seizure in the brain, but this diffuse electrical discharge causes numerous effects throughout the brain and a convulsion. But what if we could be more targeted in our approach? 

This is where TMS comes into play. By using a pulsating magnetic field at a targeted location known to be operating ineffectively in Major Depression, we are able to cause electrical discharge or potentiation of surrounding neurons. These in turn communicate with one another and influence connected brain circuits. Depending on treatment location and treatment protocol, this can awaken dormant depressed circuits or suppress hyperactive anxious pathways. With TMS, we are in effect re-calibrating broken neural pathways caused by depression and returning them to a healthier state conducive to mental well-being. And the latest TMS technology (iTBS - Theta Burst) imitates the brain's own natural process of electrical communication.

Read more: Theta Burst Stimulation →

Another way to perceive this, is that TMS gives the brain a guided ‘workout’. The magnetic pulses simulate brain patterns and the repetitive nature of treatment serves to build brain ‘muscle’.

TMS Therapy Process

Your TMS Consultation

What is a Treatment Like?

As noted above, once you have completed your initial consultation and been determined a good fit for treatment, you will be prescribed the appropriate course of TMS therapy. 

An initial ‘mapping’ session will take place where Dr. Clinch determines the best treatment stimulation intensity and location to cause electrical firing in your brain. You wear soft earplugs as a safety precaution as the stimulation emits a mild to moderate tapping noise. The first treatment takes place following the ‘mapping’.

You will be seated in a comfortable reclining chair and positioned so that your head remains in the same position throughout the treatment. The magnetic coil is then positioned at the treatment site, resting gently on your scalp. The treatment begins with repetitive stimulations at the treatment site with brief intervals that are stimulation free to allow for the neurons to fire and connect, return to baseline, and then fire and connect again.  This is necessary to cause excitation of the surrounding hypoactive nerve cells. Repeated or constant stimulation actually can alternatively cause reduction or depression in activity. This approach can be utilized in certain situations where brain activity is hyperactive, such as anxiety.

The magnetic pulsations feel like a sharp tapping just surrounding the treatment site. The pulsations only directly influence neuronal activity two to three centimeters into the surrounding tissue. You hence only feel a pulsation in this diameter. Typically, this is well tolerated and we usually start with a lower target intensity and then gradually work up over the first week to avoid any discomfort. A mild headache or slight sensitivity at the treatment site are the most common side effects and these are usually mild and resolve after the first few sessions. Some patients have even fallen asleep during treatment as the pulsations can lull people to sleep. This is not a goal for treatment as we want the brain in a resting, but wakeful state, but it gives an idea as to how easy the treatment can be.

The treatment can take as little as three minutes with the newest Theta Burst stimulation or up to 19 minutes with the standard 10 Hz protocol. Treatment time may vary between this or be a bit more based on additional treatment sites and parameters.  Once the initial mapping is complete and your unique parameters are entered into the system and our confidential electronic medical record, you may be able to get in and out of the office in 30 minutes or less.

Before, during, and after treatment there is no need for medications to tolerate the procedure. You may use an over-the-counter analgesic, but most find this unnecessary. You can drive to and from appointments without assistance. You may return to work and other daily activities following treatment. 

Each treatment is reviewed by Dr. Clinch and your TMS therapist and progress is recorded securely in our electronic medical record. Treatment is reviewed throughout care and adjusted as needed. Remapping or changes to treatment protocol can be administered as necessary. 

Read more: First visit expectations →

Why TMS?

Many people who suffer from depression and anxiety manage their condition very well through medication, therapy, and lifestyle modifications.  Unfortunately, a large number of patients still struggle to find relief, however, and TMS has demonstrated excellent results with those individuals. 

It also serves as a powerful alternative to antidepressants that frequently cause challenging side effects. In light of this, TMS is growing as an alternative and in many cases preferred next step for treatment. As a result, all insurance providers now cover TMS for Treatment-Resistant Depression and indications are growing. Inspire TMS Denver accepts all insurers and works with patients throughout treatment to ensure they understand costs. Self-pay is also an option when insurance doesn’t cover treatment.

Transcranial Magnetic Stimulation-TMS, is the only neuromodulation treatment that offers relief for Treatment Resistant Major Depression that is rapid and allows patients to return to their day immediately after therapy sessions. It is,

TMS Therapy For Depression at Inspire TMS Denver

We hope the information on this page and associated pages is helpful in determining if Transcranial Magnetic Stimulation might be the next best treatment option for you or a family member. TMS is a great and underutilized treatment option that is safe, well-tolerated, and highly successful at relieving depression and other mental health symptoms. Our team at Inspire TMS Denver will review all treatment options to ensure you are getting the best chance for success if you elect to pursue TMS therapy.  More questions about TMS Therapy for Depression or other information on this page? Please contact us to see about a free phone consultation.