Transcranial magnetic stimulation (TMS) is a non-invasive, medication-free therapy used to treat mental health conditions such as depression, addiction, anxiety, PTSD and obsessive-compulsive disorder (OCD).
An electromagnet delivers a magnetic pulse to stimulate a specific area of the brain, providing relief without the side effects common with medication.
The technique was developed in Sheffield in 1985.
30 years later, in 2015, health regulator NICE finally approved the use of TMS for depression on the NHS.
Smart TMS is the largest provider of TMS in the UK. The company operates from eight clinics, treating everything from depression and addiction to PTSD.
Chief executive Gerard Barnes co-founded the company with medical director Dr Leigh Neal seven years ago.
Smart TMS has treated more than 700 patients since.
Gerard explains how it works.
“In the case of both anxiety and OCD, we’re downregulating different areas of the brain.
“In depression and PTSD, we’re upregulating the same area. There is quite a lot of crossover.
“As the brain is all interconnected, stimulating one area stimulates the whole way through the brain.”
Athana Thangarajah is lead practitioner and head of clinical training and development at Smart TMS.
The clinician line manages a team of practitioners across the eight clinics.
“The treatment usually takes about 25 minutes. We normally have a chat with the client, some will keep it casual and talk about their interests or what they’ve been up to.
“Other people talk about the traumatic events or mental health issues that brought them here.”
Clinicians can also deliver complementary therapy alongside the TMS.
This could be cognitive behavioural therapy (CBT) or mindfulness meditation accompanied by music.
Patients will typically attend 30 sessions across two months, opening up to the clinician and building a rapport over time.
Much like medication and psychotherapy, response times will also vary from client to client. But, due to the frequency of the sessions, they could start to feel the benefits within a week.
Athana says that 70 per cent will see at least a 20 per cent reduction in depression symptoms.
“I’ve had people walk into that first session with suicidal thoughts. They’re coming to me, saying, ‘this is my last resort. I’m going to kill myself if this doesn’t work.’
“And then within a week or two, those thoughts started to go away.
“A lady recently came to us two months after suicidal intent. And then halfway through the treatment, she told me she was planning for her 60th birthday, two years away.
“I see those cases quite often. It shows how impactful this treatment is. We have changed that person’s life.”
It’s common for patients to go to Smart TMS having exhausted all other avenues. However, the NICE guidance makes no mention of treatment-resistance being a requirement.
Instead, patients may choose TMS because of its low side effect profile, with transient headaches the only likely negative effect.
“It’s so quick [to take effect], and for the insured claims, whether it’s depression or PTSD, getting a speedy response will surely reduce the value of the claim, making it attractive to case managers and insurance companies.”
This all begs the question: Why has the UK been slow to embrace TMS?
Gerard believes it’s down to low public awareness and a lack of education on the clinician side.
Perception may also be a barrier.
“People think there’s something new and peculiar about putting a magnet on somebody’s head.
“But there isn’t because the brain is an electrical organ. We’re just stimulating the specific area of the brain. But there is that novelty about it, and it takes a while.
“The irony of it is that TMS was invented in the UK but it’s taken us this long for NICE to approve it.
“We had a head start, which we’ve allowed to erode, sadly.”
Smart TMS is doing its bit to raise the profile of TMS treatment in the UK.
The company continues to conduct analyses for various conditions and has recently submitted three abstracts to neuroscience journals, with more in the pipeline for the months ahead.
They are also looking into new treatment areas, starting with fibromyalgia.
“There have been some promising meta-analyses and systematic reviews, which gives us confidence that TMS is significantly better than placebo and worth doing from a patient’s perspective.
“In the Spring, we’ll look to extend more into the chronic pain area.”