The Transcranial Magnetic Stimulation Clinical Service at Massachusetts General Hospital is dedicated to caring for patients suffering from treatment resistant neuropsychiatric conditions, including major depressive disorder (MDD), obsessive compulsive disorder (OCD) and others. Our service uses transcranial magnetic stimulation and transcranial direct current stimulation to treat severe neuropsychiatric conditions, particularly for people who have not had a therapeutic response from medications or who experience side effects.
The Transcranial Magnetic Stimulation Clinical Service provides non-invasive treatment for patients with treatment-resistant neuropsychiatric conditions using two techniques: transcranial magnetic stimulation and transcranial direct current 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 3-9 minutes but can be up to 45 minutes depending on the treatment protocol. 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 uses a constant, low 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. The procedure typically lasts 30 minutes or longer depending on the treatment protocol. Patients are comfortably seated, awake, and alert. tDCS is completely non-invasive and does not require any anesthesia or sedation. Since no medications are administered, there are no cognitive or systematic after-effects, allowing patients to immediately return to regular activity.
A tDCS treatment course can vary in the number of treatment sessions according to each individual patient. Patients undergo an initial evaluation. Throughout the treatment course, patients are closely followed by a clinician who will periodically re-evaluate the patient. Each patient’s symptoms are also tracked through standardized questionnaires to monitor the effectiveness of the treatment.
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.
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.
Our staff provides non-invasive treatment for patients with treatment-resistant neuropsychiatric conditions using two techniques: transcranial magnetic stimulation and transcranial direct current stimulation.
Joan Camprodon-Gimenez, MD, PhD, MPH
Michael Kritzer-Cheren, MD, PhD
Sahand BabapoorFarrokhran, MD, PhD
Q: Is 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 session?
A: This visit typically lasts 90 minutes. You doctor will follow this protocol:
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 happens during my subsequent TMS sessions?
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 typically last 3-9 minutes but can last 30-45 minutes in certain cases.
Q: Who will administer my TMS treatment?
A: TMS 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 director of the TMS Clinical Service.
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.
Q: Is tDCS effective?
A: There are numerous studies supporting the clinical efficacy of tDCS. However, tDCS is not an FDA approved treatment for any neuropsychiatric condition. Treatments are therefore considered off-label.
Q: What happens during my tDCS treatment session?
A: Each tDCS session will take about 20-30 minutes. During treatment, your technician will:
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 director 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 or more weeks (typically 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.
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.
