A New Approach to Treating Depression with TMS

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For those struggling with depression, finding the right treatment can be a long and frustrating journey. Andrew Guido knows this firsthand. After working for a company that promoted transcranial magnetic stimulation (TMS), he decided to try the treatment himself — an experience that changed his life.

In an interview with The Educated Patient, Andrew shares his journey with NeuroStar TMS, the moment he realized it was working and how it helped him regain the joy in everyday life. Ope Akinnusi, M.D., an expert in TMS, also weighs in on how TMS works and who might be a good candidate for this nondrug therapy.

You initially started working for a company that promoted TMS before deciding to try the treatment yourself. What made you take that step?

Andrew Guido: I had never heard of TMS or NeuroStar until I started working at the company as an employee. I’ve struggled with mental health issues for over a decade and have tried a few antidepressants, but the results from medication were inconsistent. I slowly became more curious about TMS and started looking into the clinical research. NeuroStar has the largest research database of any TMS device, and the numbers were really adding up.

What finally made me take that step was hearing from the patients I work with and seeing the life-changing results they had. Witnessing the treatment process and talking to patients about their experience was incredibly powerful — they were all just regular people, like me, who were getting their lives back. That’s when I gained the confidence to take the plunge myself, and I’m so glad I did.

Can you describe what the treatment sessions were like for you?

AG: We tell our patients that the treatment feels like a light tapping on your head — that’s exactly what I experienced.

Before treatment began, the provider used a mapping process to determine the exact right placement for the magnetic coil to deliver treatment for me. When treatment started, the tapping sensation on my head was mild and not at all uncomfortable or painful. Each session lasted about 20 minutes, and during that time I would talk to my provider, listen to music or even watch television. That made the time pass quickly and made me feel more at ease.

I was also pleasantly surprised by how accommodating my care team was regarding my schedule. It can be intimidating to think about completing 36 treatment sessions over just a few weeks, but staff always found times that worked for me so I could stay compliant.

How long did it take before you started noticing a difference in your mood and daily life?

It wasn’t an immediate, dramatic change, but more of a gradual, subtle shift that I noticed near the end of my treatment cycle. I was prepared for this type of gradual change because my providers had given me a lot of background from what to expect.

Midway through my 36 treatment sessions I felt like I had a bit more energy and could engage in activities that had previously drained me without being as tired. It wasn’t until a few weeks after my last treatment that I really had an aha moment.

I remember just being alone one day, playing with my cats on the floor, and suddenly realizing how much easier and more enjoyable that simple task felt. The little joys in life that I had been missing started to come back, and I could feel this sense of agency and motivation that had been lacking before.

The TMS process was like an “inchworm” for me — treatments provided me with slow and steady progress that eventually led to a significant shift in my overall well-being. I now find myself wanting to do things I know will help my mental health, like journaling and exercise. It’s now easier for me to do tasks like that, which in turn also improve my well-being.

Depression can make even small daily tasks feel impossible. Looking back, how has your ability to engage in life changed since finishing treatment?

AG: You’re absolutely right. When I was in the depths of my depression, even the simplest daily tasks felt like challenges. I became an expert at just functioning. I’d go through the motions of my daily life, maintaining a facade of calm and collected, but inside I was feeling disengaged. TMS treatment has shifted my ability to engage with life in a meaningful way. It’s like I’ve been given a new lease on living, rather than just existing.

The little things that used to feel like such a struggle — playing with my cats, reading a book, trying out a new recipe — have become sources of genuine joy and fulfillment. I find myself actively seeking out these types of activities, rather than passively letting the day go by.

I’ve also rediscovered my desire to connect with the people I care about. Before, I would have made excuses to avoid social gatherings or trips to see family and friends. Now, I’m the one proactively reaching out, making plans and genuinely looking forward to those interactions. The thought of attending a wedding or taking a weekend getaway doesn’t fill me with dread, but rather a sense of excitement. I’ve also moved to a new city and been promoted at work.

I’m actively making choices that align with my values and bring me fulfillment. It’s empowering to know that I have the capacity to try new things, take calculated risks and not be discouraged by potential failures.

For patients who may not be familiar, can you explain how NeuroStar TMS works and how it differs from traditional depression treatments?

Ope Akinnusi, M.D.: The latest National Institutes of Health (NIH) data show there are about 21 million U.S. adults who experience major depression disorder (MDD) annually. Most first-line treatments for depression focus on counseling and antidepressant medication, but research shows 67% of patients are not happy with their current treatment. Medication side effects, like weight gain or lethargy, likely play a role in that.

NeuroStar Advanced Therapy is a nondrug and noninvasive TMS treatment for MDD. It delivers short, focused magnetic pulses to revitalize underactive areas of the brain involved in regulating mood.

In other words, there are specific areas in your brain that control mood. When synapses in those mood-regulating areas are underactive, connections are broken and depression can result. NeuroStar TMS essentially revitalizes those dormant synapses, “waking up” the brain to function as it was meant to.

Are there any side effects of TMS, and how do they compare with common side effects of antidepressant medications?

OA: Unlike traditional medications, NeuroStar TMS doesn’t go through the digestive system, so there aren’t the common side effects associated with medications. The most common side effects of NeuroStar TMS are mild to moderate pain or discomfort at or near the treatment site during treatment. This sensation is usually temporary and typically subsides after the first week of treatment. The most serious side effect is a rare risk of seizure, which is less than 0.1% per patient, and not unlike the same risk with most antidepressants.

A standard treatment course includes 36 treatment sessions, with each session lasting approximately 19 minutes. During the session, the patient sits in a comfortable treatment chair, and they’ll feel a tapping sensation on their head. Many patients start to see improvement within 2 to 3 weeks of treatment. That can include changes in mood, fewer days of depression and an increased desire to engage with other people more often.

Who is the best candidate for TMS therapy? Are there any patients for whom this treatment might not be suitable?

OA: NeuroStar TMS is U.S. Food and Drug Administration (FDA) cleared for use as first-line add-on (adjunct) treatment for MDD in adolescent patients aged 15 to 21. It’s the the first TMS treatment FDA-cleared for this age group. It’s also approved for adults with major depressive disorder who have failed a medication trial in the current episode, as an add-on treatment for obsessive-compulsive disorder (OCD) and for anxiety symptoms that accompany major depression.

What would you say to someone who has tried multiple antidepressants without success and is hesitant to try a new treatment like TMS?

OA: I have seen firsthand the positive impact NeuroStar TMS can have on patients who are not seeing sufficient results with their existing medication or talk therapy. The data also don’t lie. NeuroStar has very robust clinical support, and patients should consider three important points:

• Data published in the Transcranial Magnetic Stimulation journal found TMS treatment had a broad antidepressant effect improving all symptoms including mood, energy, appetite, self-view and sleep disturbances, rather than targeting a few.
• Real-world data indicate that over three-quarters (78%) of adolescents achieved clinically meaningful improvement in their depression severity.
• By clinician rating, in real-world data, 83% of adult patients achieve meaningful improvement with TMS therapy and 62% reach full remission from depression.