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At the present time, the FDA has approved TMS for major depressive disorder recurrent and obsessive compulsive disorder (Brainsway deep TMS only). Any other use of TMS would be considered off-label or not FDA approved.
What is major depressive disorder?
Major depressive disorder has been extremely well studied and defined. The diagnostic criteria has changed very little since the 1980s. The current criteria states that in order to diagnose someone with major depressive disorder, they must have symptoms that last at least 2 weeks. Those symptoms include low or irritable mood, low energy, loss of interest or anhedonia, sleep difficulties, irritability, changes in appetite either higher or lower, feelings of worthlessness, guilt and sometimes hopelessness. The feelings of hopeless tend to be a precursor to thoughts of suicide and a sense that things aren't going to get better. These hopeless thoughts are a predictor of suicide attempts. Untreated depression or refractory depression can become deadly. Suicide is the 2nd leading cause of death for Idahoans age 15-34 and for males age 10-14. (The leading cause of death is accidents.) Idaho is consistently among the states with the highest suicide rates. In 2014 Idaho had the 9th highest suicide rate, 46% higher than the national average (1).
People who struggle with bipolar affective disorder and schizoaffective disorder also experience significant depressive episodes. Currently, TMS is not approved by the FDA for these conditions. There is research being conducted world wide to demonstrate whether or not TMS can be used in these disorders.
Major depressive disorder is considered widely as a biological condition. Some individuals may have episodes of depression following certain life crisis that appear to be more situational. There have been a plethora of biological interventions that have come onto the market to treat depression. These include various types of medication, electroconvulsive therapy, light therapy and transcranial magnetic stimulation (TMS). Among the medication options, there are multiple drug classes that are employed to reduce the symptoms of depression and often they are combined. Medications used for depression began in the 1950s with Imipramine, a tricyclic antidepressant. The number of medications used for depression has steadily increased over the years and are in extensive use today. Although antidepressants have been heavily studied, their exact mechanism of action is still not fully understood. Medications are a systemic intervention so they not only affect various parts of the brain, but also hit other receptors in the body such as the gut. This results in undesirable side effects such as weight gain, sexual difficulties (loss of desire, lack of orgasms, impotence) and many others. Antidepressants also can lose their effectiveness with each subsequent medication or with the same medication over time. The American Psychiatric Association recognizes TMS treatment as a viable alternative treatment to medications. They recognize that medication effectiveness drops off with each new antidepressant attempt. Unfortunately, the economics of treatment has favored insurance companies only allowing TMS treatment after multiple medication failures (usually 4) or refractory depression before paying for TMS. Patients who do not have insurance or want to pay out of pocket do not have this constraint. These restrictions may loosen as TMS becomes more widely accepted not only as a second line treatment but a first line approach.
Obsessive Compulsive Disorder although it's less common than Major Depressive Disorder, it is no less disabling. It occurs in approximately 2-3% of the general population. Brainsway deep TMS is currently the only FDA approved transcranial magnetic stimulation on the market. Brainsway reports approximately 55% response rate for OCD.
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TMS is showing significant promise for many other brain disorders such as bipolar depression, PTSD, Parkinson's disease, late life memory loss, various addictions and possible post stroke victims.Research is being conducted world wide to determine the range of disorders that may benefit from TMS and other brain stimulation techniques. Some patients may opt to try TMS for off label uses.