\”What distinguishes qEEG TMS from standard TMS therapy is that it allows us to tailor treatment, and to measure neurological outcomes of TMS in real time.\”
Introduction
Struggling with mental health takes a toll on your whole life. Depression can leach the color out of your days, and make you scared for the future when you could be excited. Anxiety can make the brightest days fraught with fear and racing thoughts. Finding the right treatment can not only improve your mental health but your whole life.
Anxiety and depressive disorders are very common and difficult to treat. Many patients find that psychotherapy or talk therapy alone doesn’t meet their needs, and their medications lose effectiveness after months or years. Treating the mental health epidemic means we need to think beyond the standard treatment options, to give patients the best outcomes that medicine can offer.
Karma Doctors wants you to have options when it comes to your mental health. That’s why we offer not only psychotherapy and medication management, but cutting-edge qEEG TMS as well. But many of our patients have never heard of TMS therapy before, or they don’t understand what it does. Let’s take a deep dive into qEEG TMS therapy.
What is qEEG TMS?
QEEG TMS stands for Quantitative Electroencephalography Transcranial Magnetic Stimulation. But what do all of these fancy medical words mean? Let’s break them down:
EEG stands for Electroencephalogram. This brain study measures existing electrical impulses in the cortex of the brain. In this outer brain layer, neurons “light up” as we think, act, and sense the world around us. EEGs allow doctors to see brain activity in real time.
qEEG stands for Qualitative EEG. in qEEG, the electrical impulses in the brain are put through complex algorithms. This allows us to measure signal frequencies, complexity, connectivity, and associations between networks. Basically, qEEG allows us to extract even more information from a standard EEG.
qEEG studies give us unique insights into the brain and its pathways. They’ve shown to help diagnose neuropsychiatric conditions, including seizure disorder, strokes, and traumatic brain injuries.
TMS stands for Transcranial Magnetic Stimulation. In TMS, coils are placed on specific areas of the scalp, where they transmit small magnetic impulses into the brain. These impulses travel into our neurons, creating excitability that travels between brain cells.
Research has shown that TMS is effective for patients with:
- Treatment-resistant depression
- Post-traumatic stress disorder
- Obsessive compulsive disorder
- Anxiety disorder
- …And more.
qEEG TMS uses guided brain imaging to target specific areas of the brain, and to treat a range of psychiatric disorders. What distinguishes qEEG TMS from standard TMS therapy is that it allows us to tailor treatment, and to measure neurological outcomes of TMS in real time.
qEEG TMS is more precise than standard TMS therapy. The information we gain through qEEG studies allows us to deliver TMS therapy that is customized, and guided by the patient’s unique brain waves. But how do the magnetic impulses used in qEEG TMS actually help people with their mental health?
How Does qEEG TMS Work?
To understand how TMS works, we first have to think about how depression and other mental health diagnoses work.
Our brains are creatures of habit. It’s much easier for us to think the same way we did yesterday than to think in a new way. Your thoughts are like water, and your brain is like a riverbed. As you think the same thing frequently, the riverbed becomes a canyon. And it becomes harder and harder for the water to go anywhere new. As we wear down canyons in our brains, our thoughts are more likely to flow the same way they have before.
Thought habits are mostly helpful. They’re a way for our brains to conserve energy, because they let us go on autopilot. If you’ve been living in a house for a while, you don’t really have to think about where to put the dishes when you unload the dishwasher. It wouldn’t be very efficient to come up with a new way to put away the dishes every time.
But for someone with depression, these thought patterns are not helpful. Their brain’s autopilot catapults them to fear. The canyon that their river carves through is dark, murky, and hopeless. It can feel impossible to carve new thought pathways, because they’ve been using the old ones for so long.
TMS therapy creates new pathways, and new riverbeds in our brains. This makes it easier for us to think in new ways rather than continuing down old thought patterns. TMS helps our brains begin new thought habits, so that we can stray from the old canyons in our brain that aren’t serving us anymore.
The targeted magnetic impulses in TMS therapy is thought to help our brains adapt more quickly than we can on our own. TMS creates new pathways by inducing excitability in the cortex of the brain, where thoughts occur. This cortical excitability causes new neural pathways to form.
TMS therapy doesn’t just work at the site of magnetic stimulation. Impulses travel down nerve cells, creating synaptic activity in targeted zones of the brain. These impulses changes patterns of activity in these zones, re-writing neuronal pathways in separate areas of the brain. But does all of this stimulation hurt?
Interested in learning more about how depression affects the brain? Check out our blog.
What Does qEEG TMS Feel Like?
Transcranial Magnetic Stimulation may sound invasive, but it’s really not. The currents used in TMS therapy are relatively weak. They’re never meant to cause a “jolt”. Some patients report a slightly uncomfortable feeling during their initial sessions, noting reduction over the first few sessions.
During your TMS treatment, you’ll sit in a reclining chair, wear ear protection – either in the form of ear plugs or headphones. An electromagnetic coil will be placed against your head, and will switch on and off repeatedly during your session. This causes a clicking or tapping sound, as well as a tapping sensation on your head.
At the beginning of your session, your doctor will need to determine how much magnetic energy you need. This is determined by increasing the amount of energy in each impulse until your hands twitch. This sensation won’t hurt, but it can definitely feel strange to watch your hands move without your input! This amount of magnetic energy is called your motor threshold.
TMS has several advantages over other mental health treatments. Patients don’t go under anesthesia for their sessions, so you can drive yourself to and from your appointments. It’s even possible to go back to work after TMS, so some patients can get a treatment done during their lunch break.
TMS Sessions are typically about 40 minutes, spaced out over weeks or months. TMS doesn’t interfere with most medications, so you shouldn’t have to worry about weaning off your SSRIs before starting TMS. But definitely consider talking to your doctor beforehand, just to be safe.
TMS comes with few side effects, especially when compared to SSRIs. Take a look at these common side effects:
- Headaches
- Pain at the coil sites
- Neck pain
- Tooth pain
- Muscle twitching during treatment
- Lightheadedness
Who Can qEEG TMS Help?
TMS was FDA approved to treat depression in 2008. In 2013, access was expanded to include migraine headaches, and in 2018 it was expanded again for patients with Obsessive Compulsive Disorder. Today, it’s used off-label for patients with PTSD, bipolar disorder, substance addiction, fibromyalgia, and more.
TMS is especially helpful for people who have tried other treatment methods without success. It’s shown to be safe and effective for people with treatment-resistant depression (TRD). These patients have tried three or more antidepressants without relief. TRD is especially frustrating for patients and clinicians, because many people feel hopeless after trying several treatment methods.
TMS can be helpful for people who can’t (or don’t want to) be on psychotropic medicines because it doesn’t come with the side-effects and contraindications of medication therapy. Mothers with postpartum depression, as well as women with perimenopausal depression, have experienced breakthroughs after TMS therapy.
TMS therapy has also shown to be effective for post-traumatic stress disorder (PTSD). Both civilians and veterans with PTSD struggle to get effective treatment, and medications are often unhelpful. TMS has shown to be helpful for people with PTSD and trauma-related disorders, and could provide relief for people who are struggling with PTSD-related anxiety and flashbacks.
People struggling with substance addiction may also find relief from TMS therapy. These patients often struggle with relapse, as well as co-morbid mental health diagnoses. In trials, TMS therapy has shown to be effective for helping people recover from substance addiction.
TMS has proven to be helpful for people with a range of mental health diagnoses. And new evidence keeps coming out about different indications for TMS. We hope that these continuing breakthroughs will help patients live better lives.
Is TMS Therapy for You?
KarmaDocs prescribes TMS therapy to treat patients with reproductive psychiatric problems, addiction, PTSD, and depression. qEEG TMS is a cutting-edge treatment modality that could help so many people live happier, healthier lives. We’ve helped our patients improve their symptoms with TMS, as well as medication management and talk therapy. If you or someone you love is interested in TMS, book a consult with us today. Our experienced psychiatric team will create a custom treatment plan that addresses your unique needs and goals.
Resources
1) 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.
2) 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/
3) Hill AT, Rogasch NC, Fitzgerald PB, Hoy KE. TMS-EEG: A window into the neurophysiological effects of transcranial electrical stimulation in non-motor brain regions. Neurosci Biobehav Rev. 2016 May;64:175-84. doi: 10.1016/j.neubiorev.2016.03.006. Epub 2016 Mar 6. PMID: 26959337.
4) Siebner HR, Hartwigsen G, Kassuba T, Rothwell JC. How does transcranial magnetic stimulation modify neuronal activity in the brain? Implications for studies of cognition. Cortex. 2009 Oct;45(9):1035-42. doi: 10.1016/j.cortex.2009.02.007. Epub 2009 Mar 3. PMID: 19371866; PMCID: PMC2997692.
5) Mayo Foundation for Medical Education and Research. (2018, November 27). Transcranial magnetic stimulation. Mayo Clinic. Retrieved July 8, 2022, from https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625
6) Commissioner, O. of the. (n.d.). FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder. U.S. Food and Drug Administration. Retrieved July 7, 2022, from https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-
7 )Wexler A, Nagappan A, Kopyto D, Santarnecchi E, Pascual-Leone A. Off-Label Promotion of Transcranial Magnetic Stimulation on Provider Websites. Brain Stimul. 2021 May-Jun;14(3):723-724. doi: 10.1016/j.brs.2021.04.013. Epub 2021 Apr 23. PMID: 33901705; PMCID: PMC8318387
8) Conelea CA, Philip NS, Yip AG, Barnes JL, Niedzwiecki MJ, Greenberg BD, Tyrka AR, Carpenter LL. Transcranial magnetic stimulation for treatment-resistant depression: Naturalistic treatment outcomes for younger versus older patients. J Affect Disord. 2017 Aug 1;217:42-47. doi: 10.1016/j.jad.2017.03.063. Epub 2017 Mar 29. PMID: 28388464; PMCID: PMC5460629
9) a10)Garcia KS, Flynn P, Pierce KJ, Caudle M. Repetitive transcranial magnetic stimulation treats postpartum depression. Brain Stimul. 2010 Jan;3(1):36-41. doi: 10.1016/j.brs.2009.06.001. Epub 2009 Jul 8. PMID: 20633429.
10) Huang, C.-C., Wei, I.-H., Chou, Y.-H., & Su, T.-P. (2008). Effect of age, gender, menopausal status, and ovarian hormonal level on RTMS in treatment-resistant depression. Psychoneuroendocrinology, 33(6), 821–831. https://doi.org/10.1016/j.psyneuen.2008.03.006
11) Namgung E, Kim M, Yoon S. Repetitive transcranial magnetic stimulation in trauma-related conditions. Neuropsychiatr Dis Treat. 2019 Mar 19;15:701-712. doi: 10.2147/NDT.S189498. PMID: 30936700; PMCID: PMC6430993.
12) Steele, V. R. (2020). Transcranial magnetic stimulation as an interventional tool for addiction. Frontiers in Neuroscience, 14. https://doi.org/10.3389/fnins.2020.592343