NeuroStar® TMS Therapy

What happens in the brain during depression

Depression is linked to changes in how the brain circuits that regulate mood, attention and emotion communicate. Brain imaging studies show that during depression, activity is often reduced in parts of the prefrontal cortex involved in focus, planning and emotional control, including the dorsolateral prefrontal cortex (DLPFC), while deeper limbic regions tied to sadness, such as the subgenual cingulate, tend to be overactive.^{[1, 2]} These regions work like a see-saw: in brain imaging, recovery from depression is accompanied by the reverse pattern, with limbic activity falling and prefrontal activity rising.^[1] Depression has also been linked to changes within the medial prefrontal “default mode” network, which is involved in self-focused thinking and rumination.^{[3, 4]}

How NeuroStar® TMS works

NeuroStar uses a curved wire coil, positioned against the scalp over the left DLPFC, to generate a pulsed magnetic field. The field passes painlessly through the scalp and skull and changes the excitability of nerve cells in the targeted area. Repeated sessions can produce lasting effects that researchers believe reflect the brain’s ability to adapt and rewire, known as neuroplasticity.^[5] In the large multisite randomized trial of this approach, treatment was given five days a week for 4 to 6 weeks, at 10 pulses per second and 3,000 pulses per session.^[6] Today, NeuroStar sessions last about 19 to 37 minutes, depending on the protocol your provider recommends.

How TMS may help rebalance mood networks

TMS appears to work through the brain networks connected to the stimulation site, not just the spot under the coil. Research found that left DLPFC sites with the best clinical results are those most strongly “anticorrelated” with the subgenual cingulate, meaning the two regions normally work in opposition.^[7] In patients imaged before and after a 5-week course of TMS, treatment normalized overactive connectivity between the subgenual cingulate and the default mode network, and strengthened the opposing relationship between the DLPFC and medial prefrontal regions.^[4] A review of imaging research found that clinical improvement is linked to changes in regions distant from the stimulation site, and that TMS may help normalize relationships between brain networks.^[8] Scientists are still studying the exact mechanism, and these imaging studies are relatively small, but together they help explain how stimulation of one area can influence mood circuits throughout the brain.

Clinical outcomes and long-term durability

• Randomized trials. In a sham-controlled trial of 301 medication-free patients who had not benefited from prior treatment, active TMS to the left DLPFC was significantly more effective than sham, with remission rates about twice as high at 6 weeks and mostly mild, temporary scalp discomfort as a side effect.^[6] A separate NIH-funded multisite trial confirmed that daily left prefrontal TMS was superior to sham.^[9]
• Real-world practice. In a 42-site study of 307 patients whose depression persisted despite antidepressants, the clinician-rated response rate was 58% and the remission rate was 37%.^[10]
• The NeuroStar Outcomes Registry. In the largest registry of clinical outcomes in depression for any treatment, response rates ranged from 58% to 83% and remission rates from 28% to 62%, depending on the rating scale and patient group. By clinician rating (CGI-S), 83% of patients responded to an acute course of NeuroStar and 62% reached remission; patient-rated rates were lower.^{[11, 12]}
• 12-month durability. In a one-year follow-up of 257 patients who completed TMS, improvement was sustained throughout the year. Of the 120 patients who responded or remitted, 62.5% continued to meet response criteria through 12 months, while continuing medication and with access to additional TMS sessions if symptoms returned (about 36% of patients received some retreatment).^[13]
• Clinical guidelines. International evidence-based guidelines rate high-frequency TMS of the left DLPFC, the approach NeuroStar uses, as having definite efficacy (Level A) for depression.^[14]

Individual results may vary. TMS is not right for everyone, and a consultation with our team can help determine whether NeuroStar® TMS is appropriate for you.