• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia
    • Books
    • eBooks
    • ABPN SA Courses
    • Social Work Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
    • Psychiatry News Videos
    • Medication Guide Videos
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
    • Psychotherapy and Social Work
  • FAQs
  • Med Fact Book App
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » New Approvals for TMS

New Approvals for TMS

November 1, 2018
Talia Puzantian, PharmD, BCPP and Chris Aiken, MD
From The Carlat Psychiatry Report
Issue Links: Learning Objectives | Editorial Information | PDF of Issue
Talia Puzantian, PharmD, BCPP Chris Aiken, MD Drs. Puzantian and Aiken have disclosed that they have no relevant financial or other interests in any commercial companies pertaining to this educational activity.

We know that transcranial magnetic stimulation (TMS) works for treatment-resistant depression (TRD) (see TCPR July/August 2017 for our most recent coverage), but one disadvantage is the length of the treatment sessions. We also don’t know if TMS works for other disorders.

Recently, the FDA granted new approvals that address both these issues. One approval was for “Express TMS,” a rapid form of TMS for depression that reduces the treatment time from 20–38 minutes to 3 minutes. The other approval was for using TMS in OCD.

The approval for Express TMS was based on a randomized non-inferiority study that showed its efficacy was similar to traditional TMS. Express TMS works faster because it uses a high-intensity magnet that produces something called “intermittent theta burst stimulation (iTBS).” It sounds a little scary, but the treatment was generally well-tolerated, though it did cause a bit more scalp pain than the lower-intensity magnet. The main risk with TMS is seizures, and we don’t yet know if this risk will be greater or lower with Express TMS because the frequency of these events is too rare to capture in a single study. Like standard TMS, Express TMS requires treatment sessions every weekday for 6 weeks.

The OCD indication was based on a randomized, sham-controlled multicenter trial of 100 adults with OCD. Response rates were 38% with TMS vs 11% in the sham group, and the number needed to treat to see response (NNT) was 4. Responses were maintained 1 month after treatment ended. Patients continued their usual medications during TMS. Side effects were limited to headaches.

Each of these approvals is tied to a specific manufacturer. Express TMS is available through an upgrade to the MagVita device, made by MagVenture. TMS for OCD requires a modification to Brainsway’s Deep TMS machine, which has been approved for TRD since 2013. To modify the machine for OCD, a magnetic coil is attached to aim the magnet at the anterior cingulate cortex—the brain region thought to be involved in OCD. Patients are directed to conjure their obsessive thoughts prior to each 20-minute treatment, which activates that brain region and improves response.

The diagnostic reach of TMS is expected to grow in the future. It is being investigated for schizophrenia, PTSD, anxiety, addictions, autism, migraines, chronic pain, dementia, and Parkinson’s disease.
General Psychiatry
KEYWORDS brain_devices news_of_note
    Puzantian 150x150
    Talia Puzantian, PharmD, BCPP

    Medication Fact Book for Psychiatric Practice, Seventh Edition (2024)

    More from this author
    Aiken eic 150x150
    Chris Aiken, MD

    Ketamine Assisted Therapy Part I

    More from this author
    www.thecarlatreport.com
    Issue Date: November 1, 2018
    SUBSCRIBE NOW
    Table Of Contents
    CME Post-Test - Drug Metabolism, TCPR, November/December 2018
    New Approvals for TMS
    Is Clozapine the Next Step After a Single Failed Antipsychotic Trial?
    Does TMS Really Work in Depression?
    Probiotics for Bipolar Disorder
    Ask the Editor: Which Antipsychotic Is Best When Patients Complain of Akathisia?
    Effects of Drug Interactions
    Harnessing Beneficial Drug Interactions
    New Stimulants: From Remixed Amphetamines to Bedtime Ritalin
    DOWNLOAD NOW
    Featured Book
    • MFB7e_Print_App_Access.png

      Medication Fact Book for Psychiatric Practice, Seventh Edition (2024) - Regular Bound Book

      The updated 2024 reference guide covering the most commonly prescribed medications in psychiatry.
      READ MORE
    Featured Video
    • KarXT (Cobenfy)_ The Breakthrough Antipsychotic That Could Change Everything.jpg
      General Psychiatry

      KarXT (Cobenfy): The Breakthrough Antipsychotic That Could Change Everything

      Read More
    Featured Podcast
    • shutterstock_2622607431.jpg
      General Psychiatry

      Should You Test MTHFR?

      MTHFR is a...
      Listen now
    Recommended
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png

    About

    • About Us
    • CME Center
    • FAQ
    • Contact Us

    Shop Online

    • Newsletters
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN Self-Assessment Courses

    Newsletters

    • The Carlat Psychiatry Report
    • The Carlat Child Psychiatry Report
    • The Carlat Addiction Treatment Report
    • The Carlat Hospital Psychiatry Report
    • The Carlat Geriatric Psychiatry Report
    • The Carlat Psychotherapy Report

    Contact

    carlat@thecarlatreport.com

    866-348-9279

    PO Box 626, Newburyport MA 01950

    Follow Us

    Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

    © 2025 Carlat Publishing, LLC and Affiliates, All Rights Reserved.