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= Transcranial Magnetic Stimulation (TMS) Treatment for Depression =

Transcranial Magnetic Stimulation (TMS) is a neurostimulation that changes a magnetic field with electric currents. This is a non-invasive procedure of electromagnetic induction process that modifies the cortical physiology. During the process an electric stimulator is connected to an electromagnetic coil, which is connected to the scalp. The stimulator produces the change in electric current of the magnetic coil that elicits a magnetic field which encourages the electrical conductor to create an electric charge inside the brain.

Major Depressive Disorder
Transcranial Magnetic Stimulation (TMS) can be used to treat psychiatric disorders, such as depression and major depression. Transcranial Magnetic Stimulation is used as an alternative treatment to Pharmacological interventions and psychological therapy. It was discovered that electrical currents could transform into magnetic fields. During the procedure, the coil is placed above the head, enabling a magnetic field to access the brain to induce an electric field in the cerebral cortex area.

Treating Major Depressive Disorder (MDD) can be difficult. Individuals are given medication and psychotherapy to reduce symptoms, however, both interventions are usually ineffective and result in treatment-resistant depression (TRD). Diagnosing depression must include at least five symptoms for the duration of two weeks according to the fifth edition of Diagnostic and Statistical Manual (DSM-5). Major Depressive Disorder (MDD) symptoms are characterised by diminished interest and persistent depressed mood. Other symptoms are changes in daily routine, such as eating, sleeping and the inability to concentrate with feelings and thoughts, for example, worthlessness. Transcranial Magnetic Stimulation (TMS) presents effectiveness in treating patients with treatment-resistant depression (TRD).

Process of TMS
Treating a patient with treatment-resistant depression consists of repetitive TMS. When the electromagnetic coil is placed on top of the scalp, the magnetic field enables the depolarization of the cortical neurons. The stimulation of the neurons can be monitored with high frequency (10-20 Hz) or low frequency (1 Hz). The magnetic field in this process is similar to the Magnetic Resonance Imaging (MRI). Patients that are treated for treatment-resistant depression are given five sessions a day of TMS, this can pursue for a number of weeks (usually three to six weeks). Applying TMS to treatment-resistant depression (TRD) requires high frequency stimulation to the dorsolateral prefrontal cortex to reduce depressive symptoms, whilst a low frequency stimulation will relieve symptoms conversely.

Studies suggest that patients with major depressive disorder (MDD) show dysregulation and impairment in the frontal regions of the brain. The dorsolateral prefrontal cortex (DLPFC), orbitofrontal cortex (OFC), and the anterior cingulate cortex (ACC) are the regions of the brain that are mostly associated with major depressive disorder (MDD). According to previous studies, the anterior cingulate cortex (ACC) participates in cognitive process and mood regulation. An fMRI study stated that the anterior cingulate cortex (ACC) displays an increase of functional correlation between the dorsolateral prefrontal cortex (DLPFC) and the amygdala within patients of major depressive disorders. The results suggest that the increased function between the ACC, DLPFC, and the Amygdala participates in attention and emotion dysregulation in major depressive disorder patients.

Clinical Trials
A series of randomised clinical trials state that daily treatments of Transcranial Magnetic Stimulation of the left side of the prefrontal cortex region in patients had shown effectiveness in treating depressive mood symptoms. Following the results, the figures show that remission rates were 30% of cases. Many randomised and controlled trials have investigated the efficacy of Transcranial Magnetic Stimulation. In one specific study, twelve patients that were diagnosed with depression were given daily TMS treatment to the left prefrontal cortex. They found that the results were similar to pharmacological treatment. The study found that repetitive TMS treatment to the left prefrontal cortex had signs of antidepressant activity in the region.

Another study measured the results of slow and repetitive Transcranial Magnetic Stimulation in patients diagnosed with major depressive disorder. A total of seventy patients were randomly placed into two groups. One group received active TMS treatment, and the other group were given placebo treatment. As predicted, the group that received active TMS displayed significant improvement in depressive mood and scores in comparison to the group that received placebo treatment.

Depression is scored using the Montgomery-Asberg Depression Rating Scale (MASDR). The patients that were part of previous studies were scored before and after TMS treatment. Most studies suggested that patients displayed significant improvement in the MASDR scores subsequent to TMS treatment. The average weeks of TMS treatment that displayed efficacy were four weeks.

The National Institute for Health and Care Excellence (NICE) supports the Transcranial Magnetic Stimulation treatment and declares the treatment is safe and effective. The National Health Service (NHS) of England, Wales, Scotland and Northern Ireland also support TMS treatment. Transcranial Magnetic Stimulation is the alternative treatment to ineffective interventions such as medication and psychotherapy.

Possible Side-Effects
Although TMS is an effective treatment for patients with depression, studies suggest that one in twenty people will experience an adverse effect to the treatment. Some patients felt discomfort during the treatment, however it was reported that the discomfort was less noticeable after a few treatment sessions. Other side-effects were headaches and feeling dizzy or faint mid treatment.

Obsessive Compulsive Disorder
Some studies propose that Transcranial Magnetic Stimulation is an effective treatment for other disorders. One effective study is based on obsessive compulsive disorder (OCD). The study concluded that repetitive TMS to the right lateral prefrontal cortex reduced urges and symptoms of OCD. This indicates that the right lateral prefrontal cortex is the region of obsessive compulsive disorder is most active.

Post-Traumatic Stress Disorder
Another disorder is considered to be effectively treated by TMS is post-traumatic stress disorder (PTSD). Patients were given sessions of low TMS to the left frontal cortex. It seemed that core symptoms of PTSD improved, for example lower anxiety levels in some patients. Another disorder that is effectively treated by TMS is post traumatic stress disorder (PTSD). Patients were given sessions of low TMS to the left frontal cortex. Each patient was measured using the Clinical Global Impression Scale before the study. It seemed that core symptoms of PTSD improved, for example less anxiety in some patients. Other patients declared improvements in other symptoms such as avoidance, hostility and insomnia. Despite having effective results, another study states that high frequency TMS had greater results in treating PTSD in comparison to the repetitive low frequency.