TMS is a treatment option for some

Dear Dr. Roach: After reading your recent column regarding psilocybin for depression, I looked online and found information on transcranial magnetic stimulation. I had three rounds of electroconvulsive therapy. Can you give me your input on TMS as a treatment for depression? I am bipolar but have suffered debilitating depression for many months. Changes in medication either haven’t helped or have caused uncomfortable side effects. — P.S.

Depression, whether by itself (unipolar) or as part of bipolar disease, can be challenging to treat when the usual treatments fail. In addition to novel medication treatments such as psilocybin and ketamine, there are therapies designed to stimulate the brain.

Electroconvulsive therapy is one of these, and it is often tried in people who have a poor response to both medication and psychotherapy. I think it reasonable to consider another treatment that has increasingly become accepted, transcranial magnetic stimulation.

TMS has been used mostly for people with “ordinary” depression, but it has been studied for people with depression as part of bipolar disease — and is about as effective as it is in unipolar depression. Some experts recommend TMS in people with bipolar disease.

It is known that strong magnetic fields can depolarize neurons in certain areas of the brain, but the exact mechanism as to how this can treat depression is not understood. n bipolar disease, the treatments are often given weekly. Most studies looked at TMS in addition to medication. No factors to help predict who might respond were identified. The major side effect was seizure at time of stimulation, with less than 1% of people having this.

I think that TMS is an option to consider for a person who has had poor response to other treatments, certainly in people with unipolar depression.