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The Types of TMS Therapy – And Which One Is Best for You

“Not only are bloggers suckers for the remarkable, so are the people who read blogs .” – Seth Godin

Introduction

If you’ve recently learned about Transcranial Magnetic Stimulation (TMS), you probably have many questions. This cutting-edge mental health treatment could change your life if you’ve struggled with PTSD or mood disorder. But it’s also confusing. You’re probably having trouble understanding what differentiates one type of TMS from another. To clear things up, let’s talk about the types of TMS therapy – and which one is best for you.

Who Is TMS For?

KarmaTMS delivers personalized TMS treatment to patients with depression, trauma, and mood related disorders. We’re passionate about helping you feel better – whether you’re a Mom grappling with postpartum depression or a veteran still battling PTSD. We want you to understand your options so you can make the best decisions for your own care.

Many people seek TMS after several rounds of medication, therapy, or other treatments. You may be feeling discouraged after seeing little improvement from these methods. We encourage you to keep hope. We’ve seen incredible outcomes in our patients after TMS therapy.

Single-Pulse TMS is the slowest type of TMS stimulation. This system channels magnetic impulses into your brain once every two or three seconds.

This brain-rewiring technology helps patients write new neural pathways and new thought patterns as a result. What if you could break out of your thought habits to build newer, positive ones? TMS works by channeling magnetic stimulations into specific parts of the brain. This leads to neural growth in these brain regions, giving you a jump-start to building new thought patterns. Learn more about how TMS works on our blog.

You’ve probably tried Googling TMS, but have only gotten more confused by the results. We’re here to help bring you clarity about the topic. You need to understand your options before making a decision. So let’s get into the main types of Transcranial Magnetic Stimulation Therapy.

Single-Pulse TMS

Single-Pulse TMS isn’t typically used for treatment. Instead, it’s a way to help researchers understand more about the brain and its connections. When one area is stimulated, the area it’s connected to may change blood flow. Single-Pulse TMS has helped researchers map areas of the brain that are associated with cognition, including attention and memory.

If you’re looking for TMS treatment for psychiatric symptoms, it likely won’t be single-pulse TMS. Other types of TMS deliver their magnetic pulses more often. Here’s more about these types of TMS.

Paired-Pulse TMS (ppTMS)

Just like it sounds, Paired-Pulse TMS delivers magnetic pulses in pairs. Two separate impulses can help excite or slow down neuron activity on the same side of the brain. In other cases, one impulse can inhibit activity on that side while another excites it on the other.

Paired-Pulse TMS is sometimes called Dual-Site TMS because it lets scientists use two impulses at two different sites. The interaction of these two impulses gives scientists more information about how our brains work, so Paired-Pulse TMS is also used to study brain activity. Scholars have shown specific brain areas associated with inhibition and other decisions through paired-pulse TMS research.

Like Single-Site TMS, you likely won’t be receiving Paired-Pulse TMS if you’re getting psychiatric treatment. Let’s talk about the TMS method we use when treating patients with PTSD, mood disorders, and depression.

Repetitive TMS (rTMS)

Repetitive TMS is used most commonly in TMS therapy, and it’s what we use in our office. It’s when magnetic impulses are repeatedly applied to the brain, stimulating a specific region repeatedly. These rapidly changing pulses of magnetism create an electric field, which leads to excitement in the neurons of your cortex.

rTMS was approved by the FDA as a depression treatment in 2008. It’s been successfully used to treat treatment-resistant depression, posttraumatic stress disorder, obsessive-compulsive disorder, and Tourette’s. Chronic pain, generalized anxiety, bipolar, and movement disorders have also shown good responses to rTMS therapy.

If you’ve been searching for TMS treatment, you may have noticed a growing market for home rTMS devices. These claim to have all the benefits of in-office TMS while letting you stay home and perform therapy on yourself. But if you look closely, some of these devices aren’t using TMS.

One of the most popular devices, Fisher Wallace’s at-home brain stimulation device, uses a different method called tDCS. This is Transcranial Direct Current Stimulation, and while it has some similarities, it’s not TMS. Most devices that really do offer TMS from home are limited to a lower magnetic impulse, which is less potent than what we administer to patients in our office.

Some early studies have shown that real at-home TMS devices could be helpful for people with depression. But we still don’t know enough to recommend it to our patients. TMS is relatively safe, but it does come with some risks.6 In our office, patients have the expert supervision of one of our providers to give peace of mind in the rare instance that something goes wrong.

Deep TMS

As the name suggests, Deep TMS applies magnetic impulses to deeper areas of the brain. dTMS machines go deeper by using a different type of coil inside the TMS machine. rTMS uses a figure-8 coil or paddle, while dTMS uses an H-1 coil.

Both dTMS and rTMS are non-invasive treatment methods for treatment-resistant psychiatric conditions. The different coils in dTMS machines allow penetration into areas that are thought to coincide with reward systems. These areas may be beneficial when targeting Major Depressive Disorder (MDD).

We don’t yet have research comparing outcomes between rTMS and dTMS. For now, rTMS has the most significant amount of evidence behind it. But another type of TMS has shown better results because it lets us deliver therapy with more precision. Let’s talk about qEEG-Guided rTMS.

qEEG-Guided rTMS

qEEG-Guided rTMS is a more precise way of applying transcranial magnetic stimulation. It’s not a different way of delivering impulses but a more detailed way of looking at the brain during therapy.

qEEG stands for Qualitative Electroencephalogram Test. qEEGs help us see electrical activity in the form of brain waves. Standard EEG also looks at these waves, but qEEG applies another layer of mathematical analysis.

This more sophisticated wave-measuring system lets us see brain waves, analyze how often they happen, and how complex they are. We can look at how brain networks connect and analyze networks as a system instead of individual waves acting alone.

We use qEEG TMS to deliver more precise impulses during rTMS therapy. By doing a qEEG analysis of your brain connectivity, we can make informed decisions about the areas we target. We can take your goals and symptoms into account to give you a more personalized TMS regimen. And we can provide you with the best possible chance of feeling better after your treatment.

What Type of TMS Is Right for Me?

If you’re looking for help with treatment-resistant PTSD or mood disorders, rTMS is the best type of TMS for you. And if you’re looking for more personalized treatment, qEEG-guided TMS lets your provider target specific areas of your brain according to your symptoms and goals.

qEEG-Guided rTMS With Karma TMS

If you try to find qEEG-Guided TMS therapy, you might have trouble. Not many practices are doing TMS therapy the way we do. We deliver precise, compassionate care through TMS therapy personalized to you and your unique needs.

KarmaTMS specializes in treating reproductive mood disorders in women, including post-partum depression and Premenstrual Dysphoric Disorder. We’re experienced in helping people who identify as LGBTQ and who are struggling with trauma. We also treat veterans and civilians with PTSD and people who have general mood disorders.

We see patients daily who have been let down by medications and therapy. If you’re struggling to find treatment options, TMS treatment may be able to help you improve your life. To learn more about your TMS options, contact our team. We’re currently taking patients 18 and up. You can schedule an appointment on our website.

Resources

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2) Klomjai, W., Katz, R., & Lackmy-Vallée, A. (2015). Basic principles of transcranial magnetic stimulation (TMS) and repetitive TMS (rtms). Annals of Physical and Rehabilitation Medicine, 58(4), 208–213. https://doi.org/10.1016/j.rehab.2015.05.005

3) Bashir, S., Al-Hussain, F., Hamza, A., Shareefi, G. F., Abualait, T., & Yoo, W.-K. (2020). Role of single low pulse intensity of transcranial magnetic stimulation over the frontal cortex for cognitive function. Frontiers in Human Neuroscience, 14. https://doi.org/10.3389/fnhum.2020.00205

4) Campen, A. D., Neubert, F.-X., den Wildenberg, W. P., Ridderinkhof, K. R., & Mars, R. B. (2013). Paired-pulse transcranial magnetic stimulation reveals probability-dependent changes in functional connectivity between right inferior frontal cortex and primary motor cortex during go/no-go performance. Frontiers in Human Neuroscience, 7. https://doi.org/10.3389/fnhum.2013.00736

5) Mann SK, Malhi NK. Repetitive Transcranial Magnetic Stimulation. [Updated 2022 Mar 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK568715/

6) Lee S, Jang KI, Yoon S, Chae JH. The Efficacy of Miniaturized Repetitive Transcranial Magnetic Stimulation in Patients with Depression. Clin Psychopharmacol Neurosci. 2019 Aug 31;17(3):409-414. doi: 10.9758/cpn.2019.17.3.409. PMID: 31352707; PMCID: PMC6705096.

7) Levkovitz Y, Isserles M, Padberg F, Lisanby SH, Bystritsky A, Xia G, Tendler A, Daskalakis ZJ, Winston JL, Dannon P, Hafez HM, Reti IM, Morales OG, Schlaepfer TE, Hollander E, Berman JA, Husain MM, Sofer U, Stein A, Adler S, Deutsch L, Deutsch F, Roth Y, George MS, Zangen A. Efficacy and safety of deep transcranial magnetic stimulation for major depression: a prospective multicenter randomized controlled trial. World Psychiatry. 2015 Feb;14(1):64-73. doi: 10.1002/wps.20199. PMID: 25655160; PMCID: PMC4329899.

8) Livint Popa L, Dragos H, Pantelemon C, Verisezan Rosu O, Strilciuc S. The Role of Quantitative EEG in the Diagnosis of Neuropsychiatric Disorders. J Med Life. 2020 Jan-Mar;13(1):8-15. doi: 10.25122/jml-2019-0085. PMID: 32341694; PMCID: PMC7175442.