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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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Too Late to Go to Rehab? Finding the Right Recovery Path as an Older Adult

Older adults face a unique set of challenges when it comes to finding treatment for addiction or mental health disorders. If you’re in this age group, you might feel self-conscious about seeking help at this point in your life, or be worried that you won’t be able to relate to your recovery peers if you do. And while it’s true that a smaller percentage of treatment centers offer special services for more senior clientele, the good news is that there are plenty of rehab programs specifically for older adults available to help people like you.

Addiction affects people of all ages and walks of life. No matter how old you are, you deserve to feel well. It’s never too late to make positive changes, take back control of your life, and be the best version of you that you can be.

Common Stressors of Older Adulthood

Globally, the age group of people 65 years and older is growing faster than all others.1 The number of people aged 80 years or over is projected to triple to 426 million in 2050. Fortunately, there’s also an increased focus on what treatment looks like for seniors. Whether you’ve struggled with the negative effects of substance use at other points in your life and are ready to find support now, or if you’re just starting to notice concerns, there are specialized rehab programs that can help.

Getting older comes with certain stressors that can have real impacts on your mental health:

Navigating Loss

As we advance in age, we inevitably experience loss in various areas of our lives. For some people, the emotional stress of these losses leads them to cope by using substances. For others, it can trigger relapse if they’ve struggled with addiction before.

Social work researchers Justine McGovern and Stephanie Sarabia point out how life changes like this can contribute to substance abuse among older adults.2 “Aging is accompanied by multiple losses: loss of work with retirement; family roles as parenting decreases and family hierarchies are upended; loss of spouse, family, and friends due to death; physical capacity; and independence with the onset of physical and cognitive limitations…These compounded losses can contribute to increased rates of depression and anxiety, which can exacerbate underlying mental health issues.”

Whether or not you have a diagnosable disorder, you may benefit from professional guidance as you navigate the transitions that happen later in life.

Physical Changes

People go through many different physical changes as they age, and these can all have significant effects on their quality of life. “Although often gradual, the aging process itself can produce changes that put older adults at risk for developing problem substance use,”3 say McGovern and Sarabia. “As the body ages, its capacity to process alcohol and other drugs becomes less efficient. Due to decreased lean muscle mass and a slower digestive system, substances remain in the body longer resulting in higher levels of intoxication.”

Interactions between prescription drugs, decreases in eyesight, and memory issues can all increase older people’s risk of substance misuse. Additionally, chronic illnesses can also increase pain and anxiety. Being able to physically access spaces—and participate in programs that are set up to accommodate physical disabilities and other needs—is especially crucial for those facing these challenges.

Emotional Changes

As we age, it’s also common to experience mental and emotional changes. Over time, elders may develop difficulties with problem-solving and spatial orientation. They might also notice feelings of depression related to having fewer social interactions, retiring from a meaningful career, or experiencing transitions in living situations. All of these can impact emotional well-being. This can also be exacerbated by sleep changes and insomnia, which can in turn increase substance use.4

Challenges related to physical, emotional, and psychological shifts, as well as potentially isolating life experiences, have very real impacts on older adults’ mental health. And this, of course, also affects patterns of substance use.

Substance Use Disorders Among Seniors

Substance use issues among seniors are widely underreported.5 That’s one reason why experts are calling for an increased focus on the needs of this age group in providing specialized, effective care.

Alcohol is the most common substance used in most countries worldwide. And according to the U.S. National Survey on Drug Use and Health, between 2015 and 2017, 14.9% of adults aged 65 years and older reported high-risk levels of drinking.6

Changes in medication over time, combined with the cognitive impacts of aging, can lead to an increased risk of accidentally using dangerous levels of opioids. Older adults had the highest mortality rates related to opioid use7 between 2006 and 2013. Also in 2017, 3% of Americans aged 50–64 years and 1.5% of those 65 years old and older reported that they had misused opioid medications in the past year.

Substance use affects seniors in specific ways. Physically, effects might include an increased risk of falls, headaches, and seizures, as well as memory loss and disorientation. Substance use can also affect mental processes, leading to sleep disturbances, anxiety, depression, and mood swings. Seniors might also experience social consequences of substance misuse, like increased family conflict and professional, financial, and legal difficulties.

It can be hard for elders to seek treatment for these specific reasons, and it can be a challenge to identify the real problem. That’s because, in many cases, substance abuse looks similar to symptoms of medical disorders that are common at an older age.8 Not everyone is at risk based on all of these factors, and your needs are unique based on what kinds of support work best for you. Luckily, rehabs offer specialized program options to help you harness your strengths and make the most of your treatment experience.

Specialized Programs May Better Address Your Needs

Research shows that intensive treatments and self-help groups geared toward the general population can be effective for older adults9 with more severe substance use issues. But because of the unique concerns described above, some people find it helpful to enroll in treatment specifically geared towards a more mature clientele. And some therapies are found to be especially effective for people of this age group:

Family Involvement

Many clients find family therapy to be a very meaningful part of their recovery journey. Because addiction affects all of our relationships, it can be highly beneficial to involve biological or chosen family members, partners, and other important loved ones in the healing process.

Hanley Center at Origins
Hanley Center at Origins in West Palm Beach, Florida has a robust program for older adults.

One rehab facility offering family-focused work is Hanley Center at Origins, located in West Palm Beach, Florida. “Quality care for the entire family must take each family’s specific challenges into account and offer a variety of age-specific solutions,” says the center’s clinical team. “These may include co-occurring mental health or medical challenges such as diabetes, cardiac issues, or cancers that are common with older adults.”

Acceptance and Commitment Therapy (ACT)

Acceptance and commitment therapy, also known as ACT, teaches clients to embrace their feelings instead of struggling against them. This may be especially useful for seniors struggling with substance abuse. ACT centers on mindfulness exercises, which help people to become more aware of their cravings, thought patterns, and feelings without judging themselves. This also encourages psychological flexibility. Committed action helps clients achieve their long-term goals by focusing on the values that will help them get better. ACT can also decrease the negative effects of chronic pain on mental health,10 says Julie Weatherell, a professor of Experimental Psychopathology at San Diego State University.

ACT’s focus on value-based living can be specifically beneficial for seniors.11 “Losing contact with one’s life values may occur following important significant life events such as retirement or new functional impairments that arise from a chronic illness,” say clinical psychologists Andrew Petkus, M.A. and Julie Wetherell, Ph.D. “[In ACT,] we address values earlier and to a greater extent than is usually done with younger people. We explicitly incorporate religion into discussions about values because this is a very important domain for many older people. We also talk about end-of-life issues in the context of values-driven behavior.”

Kolonial House in Sanur, Bali, Indonesia supports older adults and offers ACT as one of their treatment approaches.

Trauma-Informed Approaches

Trauma-informed care can be helpful in supporting elders who have experienced loss or other painful events during their lifetime and continue to feel the effects in their daily lives. In rehab, this also means taking a curious approach to understanding how addiction is related to a person’s emotional triggers and coping skills.

“Trauma-informed treatment really prepares individuals to live in recovery, which is good self-care. They also develop skills that will help them navigate in the world as they begin the process of healing from trauma, which might involve in-depth therapy and treatment to address their experiences.”

– Dr. Monika Kolodziej, Program Director of McLean Fernside
mclean fernside slide 2
A look inside McLean Fernside in Princeton, Massachusetts.

Nōmina Wellness in Courtenay, British Columbia provides eye movement desensitization and reprocessing (EMDR) and other treatments to help their senior clients manage symptoms while they develop adaptive skills to navigate traumas.

With so many options available, it’s important to keep in mind that deciding what aspects of care are important for you will be most helpful in choosing the right facility.

Continuing Care for Long-Term Success

Residential care can be life-changing, but it’s only the first step in the journey of recovery. You may have questions about what life will look like after inpatient treatment and how to set yourself up for success in the weeks and months after returning home. Most luxury rehab centers offer aftercare programs to make sure that you’re supported in maintaining the positive changes you made. A good-quality continuing care program will also make sure you have adequate resources in place, as post-treatment challenges can and do arise. This can look like stepping down to an intensive outpatient program (IOP) or partial hospitalization program (PHP), or attending support groups with peers in recovery.

Because physical distance can create a barrier to accessing in-person therapy and group programs, some rehab centers also offer online aftercare services. Web-based programs can be especially useful for people with mobility concerns. They can also help you connect with and learn from people who aren’t necessarily located near you, but nonetheless offer valuable life perspectives. These remote programs are set up to be confidential, just like in-person therapy. And, if available, continuing to work with the same therapist after leaving rehab can create a smoother transition to the life you want to live.

It’s Never Too Late to Feel Well

Older adults may face some unique hurdles in the search for addiction and mental health treatment, but that doesn’t mean effective care isn’t available to you. You can receive support that’s in line with your wants, needs, and life experiences, several rehabs offer programs designed to provide exactly that.

To learn more about these programs, see our curated list of luxury rehabs for older adults.

Frequently Asked Questions About Rehab Programs for Older Adults

Is rehab suitable for older adults?

Yes, rehab can be highly beneficial for older adults facing substance abuse or mental health concerns. Specialized rehab programs for older adults offer age-appropriate treatment, addressing their unique stressors and needs. These include navigating physical changes, such as managing prescription medication, alongside emotional changes, like navigating loss.

What types of rehab programs are available for older adults?

Rehab programs for older adults include inpatient or outpatient options, specialized programs with a focus on family involvement, trauma-informed care, tailored therapies, medical supervision, and more. An integrated program addresses the physical, mental, and social aspects of recovery.

What are the benefits of rehab for older adults?

Rehab for older adults provides a supportive and structured environment, specialized care for age-related concerns, medication management, social connection, and opportunities for building a sober support network.