Transcranial Magnetic Stimulation (TMS)

Are you not responding to antidepressants?

Transcranial Magnetic Stimulation (TMS) might be the solution for you

TMS is a non-invasive treatment for stimulating neurons in the brain using a magnetic stimulator to relieve symptoms of treatment-resistant depression (TRD). TMS is an option when other depression treatments haven't worked and:

  • Improves the symptoms of depression in most people
  • Doesn't impair cognitive function
  • Is free from common antidepressant drug side effects
  • May be used with or without antidepressants (determined by physician)
  • May cause some side effects, such as scalp discomfort at the treatment site, headache, nausea, fatigue, and twitching of facial muscles
  • Enables you to resume daily activities right after treatment

We offer two types of TMS at Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire:

We look at your medical history and daily needs to find the best treatment for you.

Conventional TMS

Conventional TMS is a well-tolerated, non-invasive neurostimulation procedure that:

  • Uses magnetic fields
  • Is offered in short, once-daily sessions over 6-7 weeks
  • Has remission rates that range from 20% to 30%, whereas response rates range from 50% to 70%

Conventional TMS treatment schedule

Step 1: Assessment

Your first TMS treatment depends on your specific needs and diagnosis. Generally, we determine how much stimulation is needed during the first session. This session can last about 30 minutes to an hour.

Step 2: Treatment series after the first treatment

All other sessions last approximately 5 minutes. You typically receive treatments 5 days per week, Monday through Friday, for 6 to 7 weeks, for a total of approximately 35 to 36 treatments.

In this video, Dr. David Eiler explains conventional Transcranial Magnetic Stimulation.

SAINT

For people struggling with MDD (major depressive disorder), SAINT is an advanced and accelerated form of TMS.

While both types of TMS treatment use magnetic stimulation, SAINT is different because:

It's personalized

It's a highly personalized neurostimulation treatment. It finds the optimal stimulation spot to treat your depression. This is based on your individual structural and functional brain imaging.

It's accelerated

It offers rapid and lasting remission from depression. The entire treatment is completed in just five days, not weeks.

It has high remission rates

80% of people entered remission from their MDD, in an average of 2.6 days

It's the first and only FDA-cleared therapy

That combines functional brain imaging with a precise, individualized approach – helping people feel like themselves again

SAINT treatment process

Step 1: Scanning your brain

The journey begins with a structural and functional MRI scan, which can take up to one hour. This scan provides us with a detailed map of your brain, which is the key to personalizing your treatment.

Step 2: Finding your unique target

We use a special computer program to analyze your brain scan. This program identifies the precise location in your brain that needs stimulation to treat your depression.

Step 3: Receiving the 5-day treatment series

You receive ten short treatment sessions each day for five consecutive days. Each session involves 10 minutes of gentle stimulation with a 50-minute rest period between sessions.

I felt like a cloud was lifted; like I was coming out of a fog. It made me more accessible to my therapy and to my family, and able to engage in my surroundings and with the people that want to support and help me.

TMS patient

Safety precautions for TMS patients

TMS is not safe for patients who have magnet-sensitive objects in their heads. TMS also may not be safe for patients who have implants within 12 inches of the treatment coil, such as:

  • Aneurysm clips or coils
  • Brain stents
  • Bullet fragments
  • Cardiac pacemakers or defibrillators
  • Cochlear implants
  • Shunts inside the brain

TMS may also not be safe if you have a history of seizures or other medical conditions. Before starting TMS, we review your medical history with you.

In rare cases, TMS can cause an unintentional seizure. This can occur in less than 0.1% of patients.

TMS medical insurance coverage

Insurance coverage for each option can vary based on your diagnosis, treatment history, and your individual plan. We work with you to understand your specific coverage options. Note that:

  • Insurance companies have requirements for approving TMS.
  • Adults with MDD can be eligible if they have failed treatments in the past.
  • We recommend talking to your doctor to learn more about your specific diagnosis.

For mental health clinicians who want to make a TMS referral

For our mental health clinicians: When referring a patient, place the referral in eDH and indicate the following:

  • Refer to the department: "DHMC PSYCH MED MOOD DO"
  • Refer to provider: Mehmet E. Dokucu, MD, PhD
  • In the comments field: “referring for TMS”

For outside mental health clinicians: To refer a patient for consultation, contact our Physician Connection Center. Please use our Outpatient Referral Form (PDF).