Which Type of TMS Therapy Is Best?

With first hand experience, drawn from her extensive background in administering over 15,000 TMS treatments across various devices, Maddison Both with American TMS Clinics provides a unique and invaluable perspective on the nuances and effectiveness of different TMS therapies, including TMS Therapy for Anxiety. Her insights delve into the personal and clinical aspects of PrTMS, the Saint protocol within Accelerated TMS, Deep TMS (dTMS), and rTMS, shedding light on the considerations patients and clinicians must weigh. Here, we expand further on each modality, emphasizing the personal experiences and observations that Madison has contributed to the field

PrTMS: Precision and Personalization at the Forefront

PrTMS stands distinguished by its use of EEG brain mapping to create a personalized and precise map of the brain. This approach allows for targeted treatment of areas showing dormancy or those in need of stimulation, potentially due to various factors like physical injury or emotional trauma. The figure-8 coil used in PrTMS, along with a strategy that doesn’t prioritize reaching the highest possible dose, underscores a tailored approach that mitigates common drawbacks such as headaches, intolerability, exhaustion, and the need for high doses or intensity. Remarkably, PrTMS offers the ability to treat on the motor strip without inducing seizures, a groundbreaking achievement in the field.

Addressing Brain Arrhythmias: Another Critical Advancement

PrTMS’s capability to pinpoint and modulate brain arrhythmias is a pivotal advancement in mental health treatment. Brain arrhythmias—abnormal patterns of neural activity—can underlie a range of psychiatric and neurological disorders. By adjusting the magnetic stimulation to normalize these patterns, PrTMS offers a highly effective treatment modality that goes beyond symptom management to address the root cause of certain conditions. The synchronization of brain activity, ensuring all regions fire in unison and at optimal speeds, is crucial for maintaining overall mental health and cognitive function.

Enhanced by Personal Experience:

• Reduced Side Effects: Madison notes a marked decrease in the common side effects associated with TMS, such as headaches, intolerance, and exhaustion. This reduction is attributed to the customized treatment intensity and the use of a figure-8 coil, which is less likely to provoke discomfort.
• Innovative Approach to Seizure Risk: Remarkably, PrTMS enables treatment on the motor strip without the significant risk of inducing seizures, a testament to its safety and a groundbreaking achievement in TMS therapy.
• Customized Dosage: PrTMS tailors the intensity of the magnetic field to what each brain specifically needs, avoiding a one-size-fits-all approach.
• EEG Brain Mapping: Before treatment begins, an EEG brain map creates a detailed picture of brain activity, guiding the customization of the treatment.
• Brain Arrhythmia Identification: By identifying irregular brain signals, PrTMS can target the treatment more effectively.
• Personalized Treatment: Each treatment plan is as unique as the individual, designed to meet their specific needs.
• Progress Tracking: Patients can see their journey to wellness mapped out through ongoing assessments, providing a visible measure of their progress.

Accelerated TMS and the Saint Protocol: Efficacy Meets Expediency

The Saint protocol within Accelerated TMS offers a condensed, yet intense, treatment regimen capable of delivering results swiftly. Madison’s experience points to the appeal of this method for those seeking quick relief from severe depressive symptoms. However, she also cautions about the potential downsides, including discomfort and the need for significant recovery time post-treatment.

Insights from Experience:

• Rapid Results vs. Discomfort: While the ability to complete treatment rapidly is a significant advantage, Madison emphasizes the trade-off in terms of increased discomfort and intolerance. The intensive nature of the treatment, often completed in one day or over a week, requires patients to be prepared for the physical and mental demands.
• Post-Treatment Considerations: The severity of headaches and exhaustion following the Saint protocol necessitates planning, such as arranging for transportation home, highlighting the importance of patient support during the treatment process.
• Looking at The Cost: Since the SAINT protocol has only gained FDA approval relatively recently, a majority of insurance companies are still in the process of determining if they will cover this treatment. This situation can complicate efforts to obtain insurance coverage for the therapy. Consequently, the out-of-pocket expenses for the SAINT protocol may be significantly burdensome for some patients.

rTMS: The Precision Challenge

Madison Both views rTMS as a valuable tool in the TMS therapy arsenal, albeit with its requirement for meticulous setup and execution. The precision with which the coil must be positioned is paramount, as any movement can diminish the effectiveness of the treatment.

From Madison’s Perspective:

• Technician Skill and Patient Cooperation: The success of rTMS heavily relies on the technician’s ability to accurately place the coil and the patient’s ability to remain still during treatment. This precision is crucial for ensuring the magnetic pulses reach the intended brain regions.
• A Delicate Balance: Madison’s comparison suggests that while rTMS is less invasive and carries a lower seizure risk than dTMS, it also requires a careful approach to maximize its 2cm depth of treatment effectively.

Deep TMS (dTMS): Depth with Drawbacks

Madison’s insights into dTMS reveal a technique that offers deeper brain stimulation but comes with its own set of challenges. The H1 coil used in dTMS allows for more profound stimulation but also increases the risk of seizures, especially in patients with substance use concerns.

Key Observations:

• Seizure Risk and Substance Use: The necessity for patients to abstain from depressants or stimulants before treatment underscores the heightened seizure risk associated with dTMS. Madison’s experience points to a careful screening process for patients considering this option.
• Balancing Depth and Discomfort: While the deeper stimulation can be beneficial, it often results in more pronounced side effects, such as headaches and exhaustion, making it crucial for clinicians to balance therapeutic goals with patient comfort.

Madison Both’s personal experiences and professional insights underscore the significance of choosing the right TMS therapy. Her comprehensive overview emphasizes the crucial aspects of personalization, patient comfort, and the delicate balance between efficacy and safety.

These considerations are vital for both patients and clinicians in making well-informed decisions that closely align with individual health needs and therapeutic goals. Madison eloquently sums up her perspective, stating, “While I believe all TMS therapies hold great value, PrTMS distinctly stands above the rest in its ability to offer a deeply personalized treatment, directly targeting and modulating the brain’s unique rhythms. This precision not only enhances efficacy but fundamentally changes the way we approach mental health treatment, making PrTMS a game-changer in the field.” – Madison Both

Given the distinct benefits and innovative approaches each form of TMS therapy presents, from the personalization of PrTMS to the intensity of Accelerated TMS and the depth of Deep TMS,

it leads us to ponder…

Considering the unique strengths and limitations of each, which therapy resonates most with you?

In the exploration of the nuances and effectiveness of different TMS therapies, including PrTMS, the Saint protocol within Accelerated TMS, Deep TMS (dTMS), and rTMS, insights from Madison Both at American TMS Clinics are invaluable. These insights are further enriched by various studies and clinical trials that highlight the advancements and efficacy of these treatment modalities:

• A study on the effectiveness of incorporating a scan or guide with TMS therapy versus without underscores the potential benefits of personalized approaches. This can be explored further in the National Library of Medicine article: “Effectiveness of incorporating a scan/guide with TMS therapy”.
• Personalized repetitive transcranial magnetic stimulation (PrTMS®) shows promise for treating post-traumatic stress disorder (PTSD) in military combat veterans, as discussed in this National Library of Medicine article: “Personalized repetitive transcranial magnetic stimulation (prtms®) for post-traumatic stress disorder (ptsd) in military combat veterans”, which specifically highlights the effectiveness of an EEG-specific scan.
• For those interested in the clinical research surrounding PrTMS and its effects on performance, information can be found on ClinicalTrials.gov: “Effects of PrTMS on Performance – Full Text View”.
• Research on the SAINT protocol offers cautious hope for those with treatment-resistant depression, especially when considering TMS Therapy for Depression. Detailed information on this breakthrough in brain stimulation can be found in a Harvard Health blog post: “Breakthrough in brain stimulation offers cautious hope for depression.”

These citations provide a foundation for understanding the scientific basis and clinical applications of various TMS therapies, supporting the insights and experiences shared by Madison Both from American TMS Clinics.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. The insights and perspectives shared by Madison Both, based on her extensive experience with TMS therapy at various TMS Clinics, are provided to enhance understanding of various TMS therapies, including PrTMS, the Saint protocol, Deep TMS (dTMS), and rTMS. The references to studies and clinical trials are intended to support the discussion and provide readers with additional context. However, they should not be seen as an endorsement of any specific treatment approach. Individuals should consult with a qualified healthcare provider to discuss their specific situation and determine the most appropriate treatment options. The information contained in this article is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

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