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Transcranial Magnetic Stimulation (TMS) Clinical Service

The Transcranial Magnetic Stimulation (TMS) Clinical Service at Massachusetts General Hospital provides non-invasive treatment for patients with major depressive disorder who are unable to find relief through antidepressant medications or psychotherapy.

Explore This Treatment Program

The Transcranial Magnetic Stimulation (TMS) Clinical Service at Massachusetts General Hospital is dedicated to caring for patients suffering from treatment resistant depression. Our service uses transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) to treat severe depression, particularly for people who have not had a therapeutic response from antidepressant medications or who experience side effects.

Our Treatment Approach

The Transcranial Magnetic Stimulation Clinical Service provides non-invasive treatment for patients with major depressive disorder using two techniques: transcranial magnetic stimulation and transcranial direct current stimulation.

Transcranial Magnetic Stimulation

Transcranial magnetic stimulation (TMS) uses magnetic impulses to stimulate neurons in targeted regions of the brain. These pulses are delivered through a magnetic coil that is placed against the front of your scalp over the prefrontal cortex (the region of the brain associated with regulating mood). The procedure typically lasts 45 minutes, during which patients are comfortably seated, awake and alert. TMS is completely non-invasive and does not require any anesthesia or sedation. Since no medications are administered, there are no cognitive or systemic after-effects, allowing patients to immediately return to regular activity.

A TMS treatment course typically consists of 30 treatment sessions over a six-week period (five sessions per week), followed by a taper phase of six additional sessions. However, treatment courses vary according to each individual patient. Patients undergo an initial evaluation to determine the appropriate therapeutic dose of the magnetic pulse and the exact area of the brain to target. Throughout the treatment course, patients are closely followed by a clinician who will periodically re-evaluate the dose level and coil placement. Each patient’s symptoms are also tracked through standardized questionnaires to monitor the effectiveness of the treatment.

Transcranial Direct Current Stimulation

Transcranial direct current stimulation (tDCS) is another form of neurostimulation that uses a constant, low direct electrical current to stimulate neurons. The electrical current is delivered through saline-soaked sponges or electrophysiological gel that is applied onto the scalp and attached to a machine that sends currents through the brain. This results in a temporary change in brain activity, which leads to longer-lasting therapeutic changes over time. Similar to TMS, tDCS is completely non-invasive and does not require any anesthesia or sedation.

tDCS has been approved by the Massachusetts General Hospital Executive Credentials Committee for off-label treatment of emotional, behavioral and cognitive difficulties, including depression or executive difficulties. Off-label treatments using tDCS are usually not covered by insurances and come with an out-of-pocket-cost. Please check with your insurance carrier to understand your out-of-pocket costs.

About Off-label Treatments

Off-label treatments are types of treatments that have not been approved by the U.S. Federal Drug Administration (FDA). While off-label treatments are clinically safe and effective, they are not typically covered by insurances.

Costs

Coverage for TMS by public and private insurers varies greatly. While Massachusetts General Hospital accepts Medicare, MassHealth and many private insurance and managed care plans, it is best to contact us or your insurance provider to determine TMS coverage. Precertification according to eligibility criteria is required in most cases.

See the Billing, Insurance & Financial Assistance page for more information on insurance providers accepted by Mass General and our financial assistance policy.


Learn More About TMS


Frequently Asked Questions

About Transcranial Magnetic Stimulation (TMS)

Q: Is transcranial magnetic stimulation (TMS) effective?

A: Yes. Numerous studies have proven TMS to be more effective than medication for treating depression in patients who have had an inadequate response to one or more antidepressants. While response and remission rates can vary, a course of TMS treatment can keep patients symptom-free for up to a year or more.

Q: What happens during my first TMS treatment?

A: This visit typically lasts 90 minutes. You doctor will follow this protocol:

  • We first need to find the best part of your brain to stimulate and the right amount of energy to give you.
  • We will place a magnetic coil on your scalp on the front of your head and adjust the dose.
  • You will hear a clicking sound and feel tapping on your scalp.

The doctor will adjust the dose so it will give just enough energy so that your right-hand twitches (motor threshold). Everyone has a different motor threshold, so we adjust the levels so that each person gets the amount that they need.

Q: What will my following TMS sessions be like?

After your first treatment, we will know how strong of a dose to use and the proper coil target. Once the coil is placed on the correct part of your scalp, the TMS machine will give a series of pulses to your head. You will be awake and alert during the treatment. Each of these follow-up visits last 30-45 minutes.

Q: How many TMS sessions will I be getting?

A: Most patients get treatment every day for five days over a six-week period, with six addition taper sessions (for a total of 36 treatment sessions). However, some patients need more than 36 treatments to get the best results. Your doctor will determine the appropriate number of sessions for you.

Q: Are there any side effects?

A: As a non-invasive procedure using magnetic pulses, TMS is mostly free from side effects, much like an MRI. The most common side effects include scalp discomfort and headaches, but these usually improve shortly after the treatment session is finished.

There is also a rare risk of seizure. However, the risk of seizure is thoroughly evaluated and discussed during your initial consultation.

Q: Does TMS hurt?

A: No. While some TMS patients sometimes report mild headaches and scalp discomfort after the first treatment, any minor discomfort usually subsides after a few sessions. Since TMS is non-convulsive and non-invasive, the only thing you might feel is a small tap on your head.

Transcranial Direct Current Stimulation (tDCS) Questions

 

Q: What happens during my Transcranial Direct Current Stimulation (tDCS) treatment session?

A: Each tDCS session will take about 20-30 minutes. During treatment, your technician will:

  • Apply two electrodes (one anode and one cathode) to your scalp
  • Administer an electric current for 20-30 minutes. You may feel a slight tingling around the electrodes during the stimulation
  • Evaluate your progress throughout the treatment to assess the progression of benefits or identify complications

Q: Who will administer my tDCS treatment?

A: tDCS is administered by trained technicians under the supervision of attending physicians from the Department of Psychiatry at Mass General. These technicians have followed an internal training and certification process under the supervision of the chief of the TMS Clinical Service.

Q: How many tDCS sessions will I be getting?

A: Most patients receive treatment five days a week, for two to six weeks (a total of 10-30 treatments). Some patients will need more than 10 treatments to get the best results. The number of sessions will be decided with your care team according to your clinical progress.

Q: Are there any negative side effects?

A: There is very little risk in tDCS. Side effects are usually mild and will only occur during the course of stimulation. These side effects may include itching under the electrode and skin irritation. Rare side effects include headache and dizziness. 

Q: Does tDCS hurt?

A: No. tDCS patients sometimes report a mild tingling or itching sensation during stimulation, but this usually fades away shortly after stimulation.

Pioneering Psychiatry Research

The integration of patient care and clinical research has been a hallmark of the Department of Psychiatry for more than 30 years. Today, the department has the largest clinical research program in the hospital, with studies at the forefront of neuroscience, molecular biology and genetics.