Transcranial Magnetic Stimulation (TMS)

The doctors in Star Trek have an assortment of devices that can heal your ailments in seconds with beams of light or energy. In Star Trek Next Generation they use this little flashlight thing that heals minor cuts and abrasions with a beam of light. They have other devices that can accelerate healing in a similar way. It seems like crazy future technology, something that none of us will live long enough to see. But what if I told you that doctors are using a device like that right now? Transcranial Magnetic Stimulation (TMS) uses high-powered magnets to beam energy directly into your brain. Proponents say the magnetic fields—and the electric currents they induce—can treat depression. 

I’ve been told that I need to breathe more, so this is going to be in a slightly different format. I usually write out the entire podcast, article style, before I sit down in front of the mic. The results are fairly polished, but maybe a bit robotic. Plus, it takes forever to make a podcast like that.

Instead I’m going to try to freestyle this one, go directly off my notes. Warning: It might be awful. I’m not great at improv, and it usually takes some time for me to compose my thoughts. So buckle up, here we go. Improv TMS.

Here’s a quick overview: TMS uses magnetic fields to induce electrical currents in your brain. Those currents supposedly excite neurons, forcing them to establish new connections or change for the better in some way. At least that’s what researchers think, they’re not really sure at all how it could work. It’s just a theory, one that’s based on electro convulsive therapy. Back in the day it was commonly called electroshock therapy, and it got a bad name after the way it was portrayed in the movies. One Flew over the CooCoo’s nest, to be precise. But electro convulsive therapy or ECT is actually super effective for treating patients with severe depression. In fact, it’s the best single treatment we have for major depression. According to a study published in the Journal Clinical Psychology, 75 percent of 217 severely depressed patients went into remission after ECT. Anecdotally, a therapist friend of mine saw a nearly catatonic patient almost completely recover after a round of ECT. It works really, really well.

They think TMS works kinda like ECT, but on a smaller scale. It was developed in the 1980s by a physicist named Anthony T. Barker at University of Sheffield in England. He was searching for an alternative to using electrodes to stimulate the brain. Before TMS, you could only stimulate neurons in the brain using powerful and painful electrodes. These electrodes were used to research brain functions—like poking around in the brain with electricity. Dr. Barker wanted to do that kind of poking around without using painful electrodes. 

He knew that magnetic fields induce currents in wires, and that electric currents running through wires produce magnetic fields. In fact, this is how every standard electric motor works—an electric current runs through coils of wires, creating strong magnetic fields that make the motor turn. This is Faraday’s principle of electromagnetic induction. Dr. Barker theorized that a powerful magnetic field could induce a current in the brain, similar to electrodes. He built his device, which is kind of like a power supply attached to a loop of wire. A power supply sends pulses of electrical current through the wire loop, which is held next to your head. The loop creates a magnetic field that induces a current in a specific part of your brain. This has a similar effect as an electrode, but without the zap.

TMS is supposed to produce similar effects to ECT, but without those troublesome convulsions. Here’s how it works: Patients visit the TMS clinic every day for about six weeks. They receive 30 minutes of TMS in each sitting, at various frequencies—I’ll get more into that later. After six weeks, the TMS treatment is considered finished.

So does it work? Do magnetic fields work just as well as straight-up electrical current applied via electrodes? Short answer: Probably not. Long answer: Get ready for some statistics.

Psychiatrist Jennifer Couturier from the Department of Psychiatry at the University of Western Ontario in London did a meta-analysis of six TMS studies in the 2000s. Her analysis was published in the journal Psychiatry Neuroscience. She found that two of the studies reported significant improvement in mood vs a sham group. But when she combined the data with the other four studies, she found that there was no difference from the sham treatment in major depression.

José Luis Rodriguez‐Martin from the Instituto de Salud Carlos III in Spain did a similar review of 16 TMS trials that was published in the The Cochrane Database of Systematic Reviews. He concluded that there is no strong evidence or benefit from using transcranial magnetic stimulation to treat depression.

Links to both articles are in the show notes on my website.

All those studies are pretty old, though, so maybe they just didn’t have the technique nailed down? Drs. Stephanie Fox-Rawlings and Diana Zuckerman from the nonprofit National Center for Health Research tell a similar story. They did an extensive metastudy, and ton of research into the FDA approval process for TMS machines. They found a huge variation in the treatment methods used. Remember how you can vary the frequencies and intensity on a TMS machine? There’s no standard treatment regimen for TMS—every clinic has its own program. The machine manufacturers have recommended regimens and there is a lot of published data from many clinics, but still–no standards. 

As we learned in the last podcast, the human brain is insanely complex. In fact, the human brain is probably incapable of comprehending its own complexity. It contains billions of neurons that communicate using hundreds of neurotransmitters. And everyone’s brain is unique. It seems insane to think that there’d be a single TMS regimen that works for everyone, or even a handful. If TMS works at all, every person would need their own customized treatment plan. It’s possible, but it means every treatment program is an experiment with just one subject. If you’re familiar with the scientific method and experimental procedures, you know that’s a nightmare, scientifically. 

Still, in scientific paper after paper, I see researchers starting with the premise “TMS is an effective treatment for depression and post-traumatic stress disorder.” I’m not sure why, given the lack of hard evidence. I mean, once you get past the search results from TMS clinics and TMS machine manufacturers, you’re dumped into a sea of inconclusive studies*. Another article from the National Institutes of Health reviewed more than a dozen TMS studies (for depression) and found very little evidence that it works. Link in the show notes. 

*Note: Harvard has one of the top search results for TMS and states that it’s 50 to 60 percent effective, but offers no evidence to back up this claim.

So why is TMS a thing? Why would Kaiser Health, one of the largest healthcare providers in the nation, offer TMS treatment plans if they don’t work? After several different antidepressants, I was offered TMS treatment at Kaiser. Everyone I spoke to seemed to believe it worked, even though they admitted that only half of their patients saw some benefits. I think it all comes down to money. There’s a lot of money to be made through the sale of TMS machines and treatments. Many TMS machine manufacturers devote pages of marketing materials to the business of TMS. They outline the cost and number of treatments a clinic would need to perform to pay for their machines and start turning a profit. TMS seems more like a way to make money than a way to make people happy. Of course TMS clinic owners are probably very happy. Treatments usually cost between $400 and $500 a pop. And private medical insurance may pay even more per treatment. Patients typically do up to 10 sessions for a total of about $15,000. And remember, most clinics recommend repeat treatments, sometimes up to 10 treatments twice a year. A single TMS patient could generate about $30k per year for a clinic. Not too shabby.

Is TMS just another snake oil, a way to treat empty pocketbooks rather than actual health problems? I don’t know. There appears to be little evidence that it works, or does anything at all. Yet anecdotally most psychologists and psychiatrists I speak to seem to think it works. Could they all have been duped by the TMS industry? It’s possible. Doctors have prescribed much more harmful treatments to make a buck. If waving a magnet over someone’s head has a chance to make them feel better, why not try it? What’s the harm? I can’t answer that. It’s ultimately up to decide if sham treatments that sometimes work are morally acceptable. Part of me thinks, “Sure, why not? If it helps, do it.” But the other part thinks that believing in miraculous medical treatments is dangerous. If you believe an electromagnet can cure your depression, what else will you believe? Holistic medicine? Gweneth Paltrow’s health advice? Your friendly local cult leader? How much credit card debt will you accrue for TMS treatment? Would you skip other proven treatments? 

Next time I want to take a deep dive into a wonderful discovery about octopuses. Apparently cephalopods can alter their own DNA. Wuuuut. I’m beginning to believe the people who say they’re from another planet.

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You can read my science fiction and watch videos I’ve made at my website: dustindriver.com

Thanks for listening, and stay mental.

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