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Demystifying Transcranial Magnetic Stimulation (TMS)

Traditional therapy and medications aren’t always effective for treating mental health disorders. If this is the case for you, transcranial magnetic stimulation (TMS) could be a viable alternative. This non-invasive treatment works by stimulating different parts of your brain to alleviate symptoms of mental health conditions like depression and PTSD.

Your primary care physician, mental health treatment provider, or rehab treatment team can help you determine if TMS is right for you.

Health Conditions TMS Can Treat

TMS can be used to treat1 several conditions:

About 20-30% of patients with MDD continue to experience depressive symptoms2 despite therapy and medication. For those patients, looking for alternatives to traditional treatment approaches is often a logical next step. TMS shows significant potential to improve depressive symptoms among people with treatment-resistant depression and PTSD. It may take several weeks to see results, so it’s imperative for patients to consistently attend the number of sessions prescribed by their doctor.

Repetitive TMS, or rTMS, has also been shown to be successful for anxiety and bipolar disorders,3 although it’s more effective in treating depression than manic episodes. It may also speed up recovery after a stroke, and help alleviate symptoms that arise after the event. In addition, low-frequency rTMS can help control the symptoms of Tourette syndrome and OCD. High-frequency rTMS helps people quit smoking by reducing cravings. rTMS can even reduce cocaine use and cravings4 in people struggling with addiction.

What Exactly Is TMS?

TMS is a non-invasive procedure that stimulates brain tissue5 by producing a high- or low-intensity magnetic field through a copper wire. There are 3 main methods of TMS used today:

  • Single-pulse TMS (spTMS) stimulates the motor cortex while a machine measures and records electrical activity.
  • Paired-pulse TMS (ppTMS) delivers 2 pulses through the same coil, with long or short intervals in between.
  • Repetitive TMS (rTMS) is a popular variation of TMS that applies repeating pulses to a specific area of the brain. This method treats the symptoms that come from mental health disorders. Deep TMS (dTMS)6 is a newer type of rTMS that stimulates deep brain areas because their larger helmet allows for more surface area. All Points North Lodge is one rehab center that offers dTMS treatment.

Typically, spTMS and ppTMS evaluate brain functioning, while rTMS actually creates changes in the brain. If you’re treated for a mental health condition, you’ll most likely undergo rTMS. There are several different coils available for use in TMS treatment. The specialists who deliver your treatment will determine the best one for your needs.

You can either complete TMS sessions at an inpatient rehab center (Inspire Malibu, for example, offers this in partnership with a physician’s office) or at a private clinic as an outpatient. In the latter option, you’d stay at home and commute to your sessions each day.

What Happens During a TMS Session?

Before you undergo any TMS procedures,7 you’ll take a physical and mental health screening to confirm your candidacy. This includes discussions of symptoms, conditions, and any medications you take with your treatment team, who will then guide you through the process.

During your session, you’ll sit in a reclining chair with earplugs (or some sort of hearing protection) with an electromagnetic coil attached to your head. The Dawn Rehab in Thailand even lets you listen to music so you feel as comfortable as possible. During rTMS (the most common type of TMS procedure), the operating physician will turn the coil on and off repeatedly to deliver pulses to your brain. During this process, you’ll feel a tapping sensation, called “mapping.” The professional administering rTMS will slowly increase the dose of magnetic energy to determine the right amount for you.

Most people don’t find TMS painful,8 but some people may feel slight discomfort. The Dawn Rehab describes their TMS sessions:

“A TMS-trained nurse will place an electromagnetic coil against your head which will painlessly deliver brief magnetic pulses – the same as those used in MRI (Magnetic Resonance Imaging) machines – to the region of the brain involved in mood control and depression.”

After your session, you can continue your regular daily routine as usual.

How Long Are TMS Sessions?

Duration can vary from person to person, and will also depend on your diagnosis. Standard rTMS treatment for major depressive disorder,9 for example, averages around 20-30 daily sessions for around 4-6 weeks. However, research recommends a minimum of 6 weeks. One study found that 38.4% of MDD patients responded well to just 4 weeks of treatment, but then surveyed patients who didn’t respond well to the initial 4 weeks after an additional 12 weeks of biweekly sessions. 61% of those patients responded well to the longer treatment phase.

Some studies have explored another, faster form of rTMS called “accelerated rTMS” or arTMS. During rTMS, people undergo multiple sessions in one day. Some studies suggest promising outcomes from this procedure, but more research will determine if this is actually a more viable option. Theta burst stimulation (TBS) is another, newer form of rTMS that can produce quicker results.10 Some studies found that, after only 5 days, patients enrolled in TBS arTMS trials reported success rates of 90%.

Some people may continue to attend “maintenance sessions” after their first set of TMS sessions. This involves slowly reducing the number of sessions per week from 3 to 1, which is eventually reduced to 1 session every 2 weeks. However, some people stop rTMS altogether, and go back to therapy and medications after completing their sessions. Unfortunately, rTMS maintenance isn’t well studied, and needs more research before making any determinations.

Should You Try TMS Therapy? Consider the Cons

While TMS has relatively few drawbacks, they do exist. Side effects are possible, but are usually minimal. And, TMS can be expensive and time-consuming. However, it may still be worth it for you, since lifting your depression to any degree can greatly impact your quality of life. Here are some factors to consider before trying TMS:

Possible Side Effects

Although TMS is non-invasive and seldom produces side effects,11 it can cause seizures in rare cases, and doctors do not recommend it for patients with epilepsy. While the risk of a seizure is small (less than 0.01% if you don’t have epilepsy, and less than 3% if you do), it’s still a possibility. If any of the following apply to you, you may be more likely to experience seizures:

  • Pre-existing neurological conditions
  • Adolescent
  • Changes in medication
  • Active substance use

You should talk to your doctor if you have any metal or electronic implants that will be near the TMS coil. This includes cochlear implants. These may cause problems with the therapy, and can be dangerous.

You may feel some slight discomfort in your scalp or neck during the procedure or pain afterward. You might also become more sensitive to sounds or experience ringing in your ears—which is why treatment providers should always provide ear protection. Some people report feeling fatigued afterward. However, it’s unlikely that you’ll encounter any of these side effects, and if you do, they will most likely be mild and short-lived.

Cost

rTMS is expensive,12 ranging from $200-300 USD per visit in a private clinic. If you complete the full course recommended by your doctor, you may end up paying $5,000-10,000 USD. Of course, this can differ depending on the duration and number of sessions you attend. Check with rehabs you’re considering to see if TMS is included in the cost of your program, or how much additional costs are.

Could TMS Provide the Relief You’ve Been Looking For?

Being unresponsive to treatment is incredibly frustrating when you’re living with depression or other mental health issues. But the good news is, you still have options. Alternative treatments like TMS just might do the trick for you, and the simple act of being open to trying something new can empower you to move forward in your recovery journey.

To learn more about residential treatment programs that offer this and other alternative therapies, browse our collection of luxury rehabs and connect with centers directly.

Frequently Asked Questions About Transcranial Magnetic Stimulation for Addiction Treatment

How does Transcranial Magnetic Stimulation (TMS) work for addiction treatment?

Transcranial Magnetic Stimulation (TMS) is a non-invasive procedure that uses magnetic fields to stimulate specific areas of the brain. It works by delivering targeted magnetic pulses to activate or inhibit brain cells, which can help regulate mood and alleviate symptoms of mental health conditions.

Is Transcranial Magnetic Stimulation safe for treating depression and anxiety?

Yes, Transcranial Magnetic Stimulation is considered a safe procedure for treating conditions like depression and anxiety. It has been extensively studied and approved by regulatory authorities. Common side effects may include mild headache or scalp discomfort during or after the session, but these are generally well-tolerated.

What are the potential benefits and risks of Transcranial Magnetic Stimulation?

Transcranial Magnetic Stimulation offers several potential benefits, including its non-invasiveness, minimal side effects, and efficacy in treating certain mental health conditions. However, it may not be suitable for everyone, and some individuals may experience rare side effects such as seizures. It’s essential to consult with a qualified healthcare provider to determine if TMS is a suitable treatment option.

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Finding Treatment for Bipolar Disorder

Bipolar disorder is a serious diagnosis. Without proper treatment, it can be extremely destabilizing—both for the person who has the condition, and for those around them. If you have this diagnosis, it’s vital to get the care you need. For some clients, inpatient rehab is a helpful place to start.

About 2.8% of the population has been diagnosed with bipolar disorder1 (once called manic-depressive disorder). And 83% of those cases are classified as severe. However, these numbers do not account for cases that go undiagnosed. It’s also frequently misdiagnosed as schizophrenia or borderline personality disorder (BPD). Without a proper understanding of your condition, it’s unlikely for clients to get appropriate treatment for their mental health.

If you think this diagnosis may fit your experience, it’s important to learn more about it. Make sure you talk to a mental health professional before you pursue a particular plan of care.

Understanding Bipolar Disorder

This condition is characterized by “intense emotional states that typically occur during distinct periods of days to weeks, called mood episodes,”2 according to the American Psychiatric Association. “These mood episodes are categorized as manic/hypomanic (abnormally happy or irritable mood) or depressive (sad mood). People with bipolar disorder generally have periods of neutral mood as well.”

While its exact etiology is unknown, experts believe this condition can be caused by a combination of factors. You may have a genetic predisposition to bipolar disorder,3 even if previous generations of your family were never diagnosed. It may also be related to a neurochemical imbalance. Some experts believe it can be caused or exacerbated by adverse life experiences.

The term “bipolar” may lead casual observers to believe that the associated mood swings are simple. That’s far from the truth. Mania4 isn’t just happiness; it can include sleeplessness, anxiety, irritability, and disproportionate anger. It can also cause impulsivity, which may lead to excessive spending, promiscuity, or substance misuse. Similarly, depressive episodes aren’t simply bouts of sadness. Symptoms mimic those of major depression, and may include fatigue, oversleeping, trouble concentrating, over- or undereating, and suicidal ideation, in addition to sadness.

Clients with bipolar disorder are also prone to a third emotional state, called hypomania. Hypomania is often characterized as a less severe version of classic mania. Clients still present with energy, impulsivity, and other signs of mania; however, their symptoms are less overwhelming. And unlike mania, “hypomania5 does not cause a major deficit in social or occupational functioning.” By definition, it lasts for at least four days, whereas mania lasts for at least a week.

Based on the frequency and severity of the client’s mania, hypomania, and depression, bipolar disorder may be classified in one of three ways.

Bipolar Disorder I

According to experts at Creative Care Calabasas, “bipolar I is the most severe form of the mental health condition.” To qualify for this diagnosis, clients must experience mania for at least one week. Their behavior “must represent a change from the person’s usual behavior and be clear to friends and family. Symptoms must be severe enough to cause dysfunction in work, family, or social activities and responsibilities.” Clients with this type of bipolar disorder also experience depressive episodes that may last for weeks at a time. In severe cases, hospitalization can be necessary.

Bipolar Disorder II

Bipolar II is more often associated with depressive episodes. Clients with this condition experience similar swings, but their mania is both less severe and less frequent. Some experience depressive episodes interspersed with hypomanic episodes, without ever showing symptoms of mania.

Cyclothymic Disorder

Clients with cyclothymic disorder also cycle between depression and hypomania. This condition includes less severe symptoms than other forms of bipolar. It can also take much longer to get an accurate diagnosis. Clients must experience mood swings for at least two years, without ever meeting the exact criteria for bipolar I or bipolar II.

Living With Bipolar Disorder

It’s important to remember that bipolar disorder is a medical diagnosis, and not a reflection of a person’s character. Like any other diagnosis—from diabetes to depression—it can have a huge impact on the rest of your life. Conversely, the events of your life may make your symptoms more or less severe. Clients may have difficulty navigating regular activities as a result of this condition.

Important Life Events

Trauma is linked to the development of many psychiatric conditions, including depression, anxiety, and a number of mood disorders. Bipolar is no exception. Experts agree that “​​childhood trauma6 in all its subcomponents appears to be highly associated” with this condition.

And after developing bipolar disorder, various life events may bring on severe mood swings. Both traumatic events and extremely positive experiences may be risk factors.7 Research has found that “bipolar patients are highly sensitive to reward, and excessive goal pursuit after goal-attainment events may be one pathway to mania. Negative life events predict depressive symptoms, as do levels of familial expressed emotion.”

Career

When even positive events can trigger your symptoms, it may be difficult to maintain an upward trajectory. For that reason, bipolar disorder interferes with some clients’ ability to work.

One study found that “Occupational disability is one of the most problematic impairments for individuals with bipolar disorder due to high rates of unemployment and work impairments. Current evidence indicates that social stressors at work8—such as social isolation, conflict with others, and stigmas—are common experiences for employed individuals with bipolar disorder.”

These social stressors can make or break a clients’ success in the workplace. And for people with bipolar, even more than for other clients, social support is hugely impactful throughout the healing process.

Community Building

Strong relationships are uniquely important for people with this condition. Data suggests that social support9 may be directly linked to the severity and frequency of clients’ symptoms.

Some rehab programs have a unique focus on the social aspect of healing. Gould Farm, for instance, is a therapeutic community that treats clients with bipolar disorder. Residents receive clinical care from a team of healthcare providers, and also participate in community efforts. This treatment model is designed to help clients “learn new skills, and others re-discover their strengths, building confidence and self-esteem.”

According to experts, “empathy and understanding from another person can make it easier to cope with bipolar disorder.10 Social interaction can also provide opportunities to challenge negative ruminative thoughts and prevent the onset of a major mood episode.” A loss of social support, on the other hand, can trigger either mania or depression.

When your diagnosis has such a great impact on so many aspects of life, it can be hard to disentangle your symptoms from your healthy emotional reactions. And remember, not all healthy reactions are positive. For example, it’s perfectly healthy to experience anxiety if you have to switch jobs. Clients with bipolar disorder may struggle to stay present with that anxiety, instead of tipping into a manic episode. This difficulty can lead to unhealthy coping mechanisms, such as substance misuse.

Bipolar and Substance Use Disorders

There is a high prevalence of substance use disorders among people with bipolar disorder.11 This may be an attempt to self-medicate by regulating unstable moods, and/or response to symptomatic impulsivity.12

Also, experts believe there may be “a shared neurobiology between bipolar disorder and addictions.”13 If this is true, it would mean that people with a diagnosis of bipolar are neurologically predisposed to substance use disorders. Much more research is needed on this subject, however.

Because bipolar disorder may be related to neurochemical imbalances,14 substance use of any kind may have a direct impact on your symptoms. That’s true of both substance misuse and appropriate use of prescription medications. For this reason, it’s absolutely vital for clients to receive care from clinicians who have experience with this diagnosis.

If you have both bipolar disorder and a substance use disorder, you may benefit from rehab for co-occurring disorders. These programs address each client as a whole person, rather than treating each symptom individually. And, they may have a higher success rate. According to the experts at Skyland Trail, “research indicates that people who address multiple psychiatric diagnoses simultaneously experience better long-term outcomes than those who try to address each diagnosis separately.”

Healing From Bipolar Disorder

Bipolar disorder is a chronic condition. Once you receive this diagnosis, it will probably continue to apply for the rest of your life. That being said, bipolar can absolutely go into remission, and some clients go for long periods of time between manic, hypomanic, or depressive episodes. With appropriate care and management, you can significantly improve your quality of life.

While there are a number of ways to treat bipolar disorder, most clients benefit from a combination of therapy and medication.15 During treatment, you’ll work closely with your providers to decide which options are best for you. Certain modalities have been found to be extremely effective.

Psychotherapy

Talk therapy is a powerful way to begin healing from almost any mental health diagnosis. With this approach, you’ll develop a one-on-one relationship with a provider. Therapy sessions will take place more often during inpatient treatment—sometimes even daily. Outside of rehab, it’s quite common for clients to meet with their therapists once a week. However, your specific clinician may suggest you see each other either more or less often.

This modality allows clients to work through difficult feelings in a safe context. Therapy can work as a release valve, in which you can express extreme feelings without jeopardizing other relationships. It’s your therapist’s job to hold space for you, no matter what you think or how you feel. You can safely and ethically set aside any concern that they’ll judge you negatively for having mood swings.

Research has demonstrated that therapy is extremely important for people with this condition. Experts write that “psychotherapy, when added to medication for the treatment of bipolar disorder, consistently shows advantages over medication alone as a treatment for bipolar disorder.16 There are many different types of psychotherapy. If you attend an inpatient program, the team at your facility will help you choose which modality best suits your needs.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) teaches clients how to change their own thought patterns using practical, repeatable strategies. For example, you might learn to recognize when your own thoughts are distorted or divorced from reality. In those moments, CBT skills can help you ground yourself in the present moment, and respond from a calmer place.

Data suggests that this type of therapy is especially helpful for clients with certain conditions. Specifically, it “has a positive impact on patients with bipolar disorder17 in terms of reducing depression levels, improving mania severity, decreasing relapse rates and increasing psychosocial functioning.”

Psychiatry and Medication

Medication can be hugely beneficial for people with this diagnosis. Specifically, psychiatrists often prescribe lithium, lamotrigine, or antidepressants such as Prozac. Because bipolar disorder is thought to be a neurochemical imbalance, these treatments may be necessary even if talk therapy proves helpful.

However, it’s also important to consider the relationship between bipolar and substance use disorders. Even with a prescription in hand, some clients may be tempted to fall back into unhealthy patterns. In order to avoid this, it’s absolutely vital that you stay in close communication with your mental health team about your medication use. For some clients, having access to a prescription of any kind may be a trigger. If that’s the case for you, be sure to ask your therapist about substance-free alternatives.

Finding Balance With Bipolar Disorder

With extreme emotions, introspection can be difficult. Some clients with bipolar disorder struggle to find clarity, or even to ask for help. If these symptoms resonate with your experience, know that you have the right to reach out. It’s important to get the care you need.

Because bipolar disorder touches on so many aspects of life, it can be difficult to imagine what healing would look like. Remember that, no matter how severe your symptoms may be, no emotion lasts forever. You can and will feel differently. And, with the right support, you can even feel consistently better. It is absolutely possible for clients with bipolar to live rich and meaningful lives.

To learn more about inpatient treatment for this condition, you can browse our list of luxury rehabs specializing in bipolar disorder.

Frequently Asked Questions About Rehab for Bipolar Disorder

What are the common treatment options for bipolar disorder?

Treatment for bipolar disorder often includes a combination of medication, psychotherapy, and lifestyle adjustments. Medications like mood stabilizers are commonly prescribed, and therapies such as cognitive-behavioral therapy (CBT) and family therapy help with managing symptoms and improving overall well-being. Some people start treatment at an inpatient rehab.

How long does rehab for bipolar disorder typically last?

The duration of treatment for bipolar disorder varies depending on individual needs and response to interventions. It typically involves long-term management to stabilize mood and prevent relapse. Treatment may span several months to years, with regular follow-up appointments and adjustments to the treatment plan as necessary.

Can therapy alone be effective in treating bipolar disorder?

While therapy alone may not be sufficient for managing bipolar disorder, it plays a crucial role in the overall treatment plan. Therapy, such as cognitive behavioral therapy, helps individuals develop coping skills, improve self-awareness, and enhance relationships. Combined with medication and other interventions, therapy contributes to a comprehensive approach for bipolar disorder treatment.