PENN TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT PROGRAM

The Transcranial Magnetic Stimulation (TMS) Treatment Program at The University of Pennsylvania offers a non-invasive, outpatient-based form of brain stimulation therapy for neuropsychiatric disorders.

The TMS program at the University of Pennsylvania is one of the leading TMS providers in the U.S. with more than 10,000 TMS sessions administered over the last 10 years. Our TMS center is directed by experts on mood / anxiety disorders and interventional psychiatry to ensure adequacy of treatment and to maximize the chances of treatment response. The treatment is administered within The University of Pennsylvania medical campus following safety standards to minimize the risk of complications.

The University of Pennsylvania TMS service was involved with the largest study of TMS as a treatment for major depression. That large, multicenter study showed that TMS is a well-tolerated and effective treatment option for patients with depression and was pivotal for its subsequent FDA approval. Data on the effectiveness and safety of TMS provided at our clinical center after FDA approval has been published in academic peer-reviewed journals.

ABOUT TMS AT PENN

TMS uses focused pulsed magnetic fields to non-invasively stimulate brain regions and circuits. TMS has proven effective as a treatment for depression and obsessive-compulsive disorder (OCD) and it is approved by the U.S. Food and Drug Administration (FDA).

TMS is a relatively safe procedure that lacks side effects seen with some psychopharmacologic agents such as weight gain, sedation, and sexual dysfunction, and with other interventional psychiatry techniques such as transient cognitive effects, transient dissociative symptoms, and the need for surgery. TMS sessions are usually well tolerated. Scalp discomfort and mild / transient headache are the most common side effects, both usually limited to the first week of treatment.

Initial Assessment

Patients are initially seen by a psychiatrist with expertise in mood / anxiety disorders and interventional psychiatry. The initial assessment includes a diagnostic and treatment evaluation focusing on determining the appropriateness of TMS as the next step in your treatment, as well as its risks, benefits, and other available treatments for your condition. Patients are carefully screened for the presence of conditions (seizure disorder or epilepsy) or underlying risk factors (implantable devices or presence of metal within the head) that might make the administration of TMS clinically unsafe. If TMS is deemed to be safe and appropriate for your case, you will be scheduled to commence a course of TMS treatment. Scheduling is contingent upon insurance approval / coverage.

Treatment with TMS

Sessions are administered on an outpatient basis and last from 15 to 60 minutes depending on the dose and protocol being use. You will be fully conscious and aware throughout the procedure and no post-session recovery period is needed. A symptom provocation protocol (i.e., exposure to triggering thoughts or images) may be used when treating obsessive-compulsive disorder. You will be able to resume your normal activities like work or driving immediately after your TMS session.

TMS is administered daily from Monday to Friday. An adequate initial course of TMS requires 20 to 30 sessions depending on the diagnosis and its severity.

Patients are reassessed for clinical progress and need for dose optimization by an experienced psychiatrist every 2 - 3 weeks (10 - 15 sessions) of treatment. Additionally, patients are assessed for side effects and other changing conditions before each TMS session.

If you do benefit from TMS, we will discuss with you how this improvement can be best sustained, including the possibility of intermittent maintenance TMS sessions with a frequency that can range from 1 per week to 1 per month or longer. If no clinical benefit is achieved after an adequate trial of TMS, we will discuss other treatment options and suggest appropriate referrals or courses of action.

Resources for Patients

NEJM - Depression- Advanced Treatments for Treatment-Resistant Depression

In an interactive perspective recently published by The New England Journal of Medicine, Dr.Cristancho, Dr.Sanacora, and Dr.Nikayin discussed the evolution and current status of some interventional psychiatry treatment modalities including Transcranial Magnetic Stimulation (TMS), Esketamine / Ketamine, Electroconvulsive Therapy (ECT), and Psilocybin. Dr.Cristancho, MD, is an Associate Professor at The University of Pennsylvania and Chief of Penn Interventional Psychiatry where TMS, Esketamine, ECT, Deep brain stimulation (DBS), and Vagus nerve stimulation (VNS) are used to treat complex mood disorders and obsessive-compulsive disorder.