Accelerated TMS: Finding The Best TMS Therapy For You
Accelerated TMS: Finding The Best TMS Therapy For You
June 26
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Depression is a complex mental health condition that affects millions of people worldwide. While traditional antidepressant medications have been the mainstay treatment, many individuals struggle with their side effects, and in some cases, they may not feel that they work at all.
Transcranial magnetic stimulation (TMS) therapy has emerged as a promising alternative to traditional depression treatments after its approval from the Food and Drug Administration (FDA) in 2008. The approval marked a significant watershed moment in the development of TMS. In recent years, innovative physicians have condensed the protocol into a shorter time frame — from two months originally, to just one or two weeks with the latest regimes.
These week-long treatments are known as Accelerated TMS. One form of Accelerated TMS is called SAINT® (which is mainly used for treating people with depression), while an alternative form is called HOPE-TMSSM (which can be used to treat a variety of mental health conditions). Both forms, and Accelerated TMS more broadly speaking, can be tailored to the needs of individual patients.
For those exploring the possibility of receiving TMS treatment, the intricate differences between these protocols can be overwhelming. So, this article will expand upon the key differences between major TMS protocols and shed some light on an innovative solution for mental health care.
Understanding Transcranial Magnetic Stimulation (TMS) Therapy
TMS is a non-invasive brain stimulation technique that uses a powerful magnetic field to regulate brain activity.
For people with depression, anxiety, OCD, or other conditions, they may have difficulty regulating their mood because parts of their brain aren’t communicating with each other normally. Their neural pathways may be too active or not active enough. Medications alone may not be enough to help reset this activity. Targeting these brain regions with TMS helps to modulate neural activity and relieve key symptoms of mental health conditions.
The shape of the TMS magnet helps direct a powerful magnetic field directly to the affected part of the brain. Neurons (brain cells) in this affected region are stimulated. With repeated treatments, these neurons may be trained to communicate with other parts of the brain more normally again. Training may include increasing communication (i.e. activating) or decreasing communication (i.e. deactivating) depending on symptoms.
Other technologies like electroconvulsive therapy (ECT) affect the brain in similar ways. However, ECT uses direct electric current to tune the brain. This electric current essentially induces a seizure in the brain, and anesthesia is required. In contrast, TMS therapy uses magnets, and does not require anesthesia. It is much less invasive.
What to expect during traditional (conventional) TMS therapy
Traditional (Conventional) TMS involves 30 to 36 treatments scheduled Monday to Friday over seven to eight weeks. Each daily treatment session requires between 20 to 40 minutes in the office.
Each day, patients may expect to answer some safety questions and complete mood surveys prior to receiving treatment. Technicians will then position the magnet onto the head and start the stimulation. During treatment, patients may experience some discomfort near the stimulation site. Some patients also develop a slight headache and minor fatigue after treatment. This being said, TMS is a well-tolerated procedure with minimal side effects compared to medication and other legacy treatments. Patients may drive home after TMS.
As patients complete more and more daily treatments, they may start to notice their mood changing. The cumulative effect of these repeated stimulations gradually alleviates symptoms of mental health conditions by regulating the brain's neural circuits and restoring normal functioning. Every person experiences changes differently. A few improve more rapidly, others respond slower, and some do not respond at all. Acacia’s healthcare professionals will meet with patients throughout the treatment course to track progress.
While the specific treatment parameters may vary based on each individual’s condition, the entire treatment course nevertheless represents a significant time commitment. Patients must travel to the clinic every weekday for up to two months to give TMS the best possible chance of working. Missing or skipping days is not recommended unless there are extenuating circumstances.
How Accelerated TMS Differs from Conventional TMS
Accelerated TMS is an innovative variation of Conventional TMS that delivers similar therapeutic benefits in a much shorter timeframe. While Conventional TMS typically takes seven to eight weeks, Accelerated TMS can achieve similar therapeutic effects in as little as five days.
In Accelerated TMS, patients can receive up to ten TMS treatments in a day, spaced out across the morning, afternoon and evening. In between treatments, patients can work, rest, or even exercise in Acacia’s private rooms. Additional activities may be available upon request.
The condensed schedule for Accelerated TMS provides several benefits over Conventional TMS. In addition to less overall time-commitment, patients may experience faster symptom relief. Instead of waiting months, patients may experience improvement in days or a few weeks.
Plus, Accelerated TMS actually packs even more dosage. For many severe cases, more TMS may be much better. Compared to the 36 treatments in Conventional TMS, Accelerated TMS provides up to 50 treatments. Safety and efficacy are maintained by spacing treatments accordingly.
SAINT®: More Precise Targeting of Brain Depression Networks
SAINT® (Stanford Accelerated Intermittent Theta-burst) is an innovative protocol that further enhances the effectiveness of Accelerated TMS. While TMS typically focuses on stimulating the prefrontal cortex — a brain region commonly associated with depression — SAINT® targets additional areas of the brain that also play a primary role.
Specifically, SAINT® targets an area in and around the prefrontal cortex that communicates with a deeper brain region called the anterior cingulate. By accurately targeting this communication network instead of just the prefrontal cortex itself, studies have shown improved effectiveness for many patients. Interestingly, research has shown that these targets are different from person to person. As a result, SAINT® requires an additional brain scan called a functional MRI to help locate this personalized target.
In addition, SAINT® uses a more optimal and efficient stimulation pattern. Typical TMS protocols take 20-30 minutes per treatment, and breaks are required in between sessions. As a result, it would be very difficult to fit 50 treatments into five days using typical TMS protocols. Therefore, SAINT® employs a newer stimulation pattern called intermittent theta-burst stimulation (iTBS). This pattern allows for treatments that run under 10 minutes each. Condensing all treatments into one week becomes feasible. Moreover, the theta-burst pattern is more natural for the brain since it mimics theta brainwaves (around 5Hz) and is believed to be more physiologically relevant and effective in modulating neural activity.
In summary, SAINT® specifically uses brain scans to target communication networks that affect more brain regions that are involved with depression. It also uses a more efficient stimulation protocol called theta-burst. In doing so, SAINT® seeks to produce more comprehensive and lasting improvements in depressive symptoms.
HOPE-TMS: A Personalized Approach for More than Just Depression
HOPE-TMS (Holistic, Optimized, Personalized, Expedited) is another innovative protocol that also enhances the effectiveness of Accelerated TMS. Whereas SAINT® is designed to specifically target brain areas involved with depression only, HOPE-TMS specifically targets brain areas involved with more complex cases with many different diagnoses. Severe symptoms from Anxiety, PTSD, OCD, and many other conditions can also be addressed.
Like SAINT®, HOPE-TMS requires a brain scan called a functional MRI. Instead of targeting the communication network between depression centers, HOPE-TMS locates other communication networks that also regulate mood. Targeting some of these networks like the Default Mode network or Salience network) can help relieve symptoms other than depression. Again each target is personalized and will differ between individuals.
As a result, HOPE-TMS is a great clinical complement to SAINT®. SAINT® is very effective in treating patients with depression mainly. For more complex patients, they may require alternative brain targets from HOPE-TMS. 77% of complex patients respond to HOPE-TMS, an efficacy that is similar to SAINT®. However, individuals do respond differently based upon their severity and complexity.
In summary, HOPE-TMS is similar to SAINT®. Both are special forms of Accelerated TMS that require brain scans to help with precise targeting of communication networks. However, they complement each other since SAINT® is mainly focused on depression while HOPE-TMS is designed for everything else.
Choosing the Right TMS Protocol
Choosing the right TMS protocol depends on various factors, including the severity of depression, individual response, and personal preferences. A qualified healthcare professional can guide you through the available options and determine the best TMS therapy for your specific needs.
This would involve a comprehensive assessment of your medical history, in addition to an evaluation of current mental health symptoms and overall mental health condition. Based on the assessment, we can work with the individual to identify the specific goals of the TMS therapy, such as alleviating depressive symptoms, reducing anxiety, or addressing other mental health concerns.
Based on a patient’s specific needs, a personalized treatment plan can be created. For HOPE-TMS or SAINT®, this would involve fMRI brain mapping techniques to determine the most appropriate brain regions to target. This helps to facilitate an informed decision-making process that can drastically improve patient satisfaction both during and after the treatment protocol.
A Final Word from Acacia Clinics: Getting Started with Accelerated TMS
Accelerated TMS protocols are on the cutting edge of interventional psychiatry, being some of the most advanced treatment regimes for a variety of mental health conditions including depression, anxiety, obsessive-compulsive disorder (OCD), and bipolar disorder.
The most advanced treatment options, SAINT® and HOPE-TMS, provide drastic improvements to the overall effectiveness of magnetic stimulation by reducing treatment duration and targeting multiple regions of the brain with more physiologically relevant stimulation patterns.
For all intents and purposes, these protocols are considered to be the most advanced treatment regimes — building upon the progress made by earlier scientific breakthroughs and helping to alleviate symptoms of mental health disorders in more than 70% of cases.
