Depression is the leading cause of ill health and disability worldwide, according to the World Health Organization (WHO). The Anxiety and Depression Association of America (ADAA) estimates that depression affects more than 16.1 million American adults every year, which is about 6.7% of the US population of people aged 18 or older.

Transcranial magnetic stimulation (TMS) and electroencephalography (EEG) neurofeedback therapy are two lesser-known forms of treatment for medication-resistant depression. Right now, the most common forms of treatment for depression include talk therapy and prescription antidepressants. However, sometimes depression can be medication-resistant, meaning it does not respond adequately to antidepressants.

Although electroconvulsive treatment (ECT) is a treatment option for medication-resistant depression, it’s considered a “last resort” treatment and, because it requires patients to be placed under general anesthesia, many people prefer to exhaust other, less invasive options first.

If you have been diagnosed with depression, it’s worth learning more about TMS and EEG as alternative treatment options.

TMS: A Quick Overview

Johns Hopkins’ Department of Psychiatry and Behavioral Sciences describes TMS as “a non-invasive method of brain stimulation that relies on electromagnetic induction using an insulated coil placed over the scalp, focused on an area of the brain thought to play a role in mood regulation.”

The coil generates a magnetic pulse, which is similar to those produced by MRI machines, that passes through the skull and into the brain.

In short, TMS therapy works by stimulating areas of the brain that appear underactive in people with depression.

Though the first TMS devices were developed in 1985, they were originally used for research and diagnostics. It wasn’t until 2008 that the FDA approved TMS as a treatment for mild medication-resistant depression.

Since then, TMS has been tested as a possible treatment for several other conditions and disorders, including pain, tinnitus, strokes, anxiety, schizophrenia, dystonia, amyotrophic lateral sclerosis (ALS), bipolar disorder, eating disorders, and Parkinson’s disease.

What should one expect from TMS therapy?

Though the treatment may sound daunting, TMS is completely non-invasive and has been proven to be safe and well-tolerated.

The procedure is carried out while patients are both awake and alert. Typically, each session lasts for 20 to 40 minutes and, for about six weeks, patients receive TMS five days a week.

According to the International Neuromodulation Society (INS), “the therapeutic effect has been reported to last for at least six months, with intermittent repeat sessions as an option to prevent relapse.”

“Around 1/3 of people who receive a series of TMS treatments sustain their improvements over time,” said Dr. Nicole Prause, Ph.D., founder of the California-based independent research company, Liberos. “Given that this is a population of people who consistently failed all other available therapies, this is actually a huge, exciting effect.”

Common side effects of TMS include mild headaches, facial twitching, and painful sensations on the scalp.

Though many people see these side effects diminish over the course of treatment, immediate adjustments in coil placement and stimulation settings can be made in order to reduce discomfort.

More serious side effects include seizures, but the chances of having one are exceedingly low and the risk factor is comparable to that of antidepressants that can also cause seizures.

“For this reason, TMS clinics should refuse treatments to anyone with significant seizure risks and have a physician available in the event that an unexpected seizure occurs,” said Dr. Prause. “Screening is so good, though, that seizures have been extremely rare.”

EEG Neurofeedback: A Quick Overview

The Psychiatric Times describes EEG neurofeedback as “an adjunctive treatment used for psychiatric conditions such as attention-deficit/hyperactivity disorder, generalized anxiety disorder, posttraumatic stress disorder, phobic disorder, obsessive-compulsive disorder, bipolar disorder, depression and affective disorders, autism, and addictive disorders.”

Though researchers don’t know exactly how neurofeedback works, they claim the changes in brain waves result in improved ability to focus and relax.

The treatment has been around since the 1960s and has garnered both support and opposition. Some research has found it promising, some has inferred that it does not yield any positive outcomes, and some has found it inconclusive.

That said, doctors who do believe in the efficacy of neurofeedback claim it can be a useful treatment for a variety of neurological issues, including depression, anxiety, strokes, concussions, PTSD, ADHD, and sleeping problems.

What should one expect from neurofeedback?

Like TMS therapy, neurofeedback is completely non-invasive. Patients usually require a total of 10 to 40 treatments in order to see results – they typically receive two or three sessions a week – and most sessions last for 30 minutes to an hour.

The Washington Post reports that in those sessions, patients watch movies or play video games while hooked up to sensors that send data to a computer. Meanwhile, a therapist follows the brain activity on a monitor and programs the computer to stop the movie or game if the brain waves are abnormal or erratic.

The stop-and-start feedback, which is repeated over a number of sessions, should then cause the brain waves to regulate themselves.

That said, because research findings are so inconsistent, it’s not known how long positive results of neurofeedback therapy generally last for or if those positive results are even more than just the placebo effect at work.

However, many people who have found success using this form of treatment claim that the positive effects are long-lasting, if not permanent.

Is either of these treatments right for you?

If you’re struggling with depression and medication hasn’t helped, TMS and neurofeedback may be viable options for you. Although neurofeedback does not require a psychiatrist’s referral, TMS does. You should discuss both options with your primary care doctor and/or psychiatrist before making a final decision. Don't have one? CareDash can help you search for the best doctor in your area to find the right care for you and your family.

For more information about TMS, visit Johns Hopkins’ TMS FAQ page. To learn more about neurofeedback, visit the NeuroDevelopment Center’s neurofeedback page.