Magnetic Stimulation

Transcranial Magnetic Stimulation (TMS)

Magnetic Brain Stimulation Therapy in San Diego

Transcranial Magnetic Stimulation (TMS) is a non-invasive brain stimulation treatment that uses precisely targeted magnetic pulses to stimulate or inhibit activity in specific areas of the brain. This technique helps regulate neural circuits involved in mood, focus, motivation, and emotional regulation—areas that may become imbalanced in conditions such as depression, anxiety, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), among others.

TMS works by delivering magnetic pulses through a specialized coil placed gently on the scalp. These pulses influence underlying brain cells, either increasing activity in underperforming regions or calming down overactive areas, depending on the treatment goal.

Conditions Treated with TMS Therapy

Transcranial Magnetic Stimulation (TMS) can treat a wide range of mental health and psychiatric conditions. While depression, anxious depression, and obsessive-compulsive disorder are the only FDA-approved indications, research shows TMS may benefit many other disorders—especially when standard treatments haven’t worked.

Major Depressive Disorder (MDD)

FDA-approved for adults and adolescents (ages 15–21). TMS helps restore mood by targeting brain areas that regulate emotional balance.

Anxious
Depression

FDA-approved for adults with overlapping symptoms of anxiety and depression. TMS helps calm the brain’s overactive fear centers and improves mood.

Obsessive-Compulsive Disorder (OCD)

FDA-approved for adults. TMS modulates circuits involved in obsessive thoughts and compulsive behaviors, offering relief without the side effects of medication.

Anxiety
Disorders

TMS is used off-label to aid in anxiety disorders including GAD, Panic disorder, and social anxiety. It reduces persistent worry, tension, and physical anxiety symptoms.

(White 2015, Paes 2011, Pallanti 2009)

Bipolar
Depression

TMS is applied off-label to manage the depressive phase of bipolar disorder. It must be used cautiously and only under psychiatric supervision to avoid manic activation.

(Canali 2014, Zendjidjian 2014, Harel 2010)

Attention Deficit Hyperactivity Disorder (ADHD)

TMS is used off-label to enhance focus, reduce impulsivity, and support executive functioning by targeting frontal lobe activity.

(Zaman 2014, Bloch 2010)

Dementia & Mild Cognitive Impairment (MCI)

TMS is applied off-label in dementia to support attention, working memory, and mental clarity by stimulating cognitive control areas of the brain.

(Cantone 2014, Isaac 2013, Pennisi 2011)

Post-Traumatic Stress Disorder (PTSD)

Used off-label, TMS helps regulate the brain’s threat detection system and improve emotional control, reducing symptoms like flashbacks, hypervigilance, and avoidance.

(Karen 2014, Harris 2021)

Addiction & Substance Use Disorders

As an off-label application, TMS may help reduce cravings and compulsive behaviors when integrated with behavioral therapy or recovery programs.

(Barr 2008, Mehta 2024)

Tinnitus
(Ringing in the Ears)

Off-label TMS treatment can help reduce the intensity and emotional distress caused by chronic tinnitus through auditory cortex modulation.

(Yilmaz 2014, Forogh 2014, Peng 2012)

Migraine & Chronic Headaches

TMS is used off-label to decrease the frequency and severity of migraines and tension headaches by regulating pain-processing pathways.

(Lipton 2010, Dodick 2010, Brighina 2013 )

Parkinson’s
Disease

TMS is used off-label to support motor control, reduce tremors, and enhance mood and cognition by targeting motor and prefrontal circuits.

(Vonloh 2013, Rothwell 2013)

Who Can Benefit from TMS Therapy?

At our brain stimulation clinic in San Diego, we offer TMS therapy in Del Mar as a non-invasive, drug-free option for individuals who haven’t found lasting relief through traditional treatment methods.

Who Qualifies for TMS? TMS is typically recommended for adults and adolescents (15+) who:

• Have tried one or more medications without sufficient improvement

• Prefer a treatment that avoids daily pills or medication side effects

• Do not have a history of seizures or metal implants in the skull

TMS is:

• Non-invasive (no surgery or implants)

• Well-tolerated by most patients

• Drug-free—no systemic side effects like those from medications

• Outpatient-based—no anesthesia or recovery time needed

• Involves 20-36 sessions – Over 4 to 6 weeks

Side effects are typically mild and may include:

• Light scalp discomfort during treatment

• Temporary headache in about 10% of patients

• Very rare risk of seizure (less than 1 in 30,000 treatments) – We have never had one at our clinic.

TMS does not cause memory loss, unlike older treatments such as ECT (electroconvulsive therapy).

Many patients report benefits beyond mood improvement, including:

• Improved memory and focus

• Better decision-making and executive function

• Reduced impulsivity and emotional reactivity

• Better sleep and more stable energy

Some individuals even report a reduction in cravings for alcohol or other substances, making it a valuable option for those in recovery.

Does TMS WORK?

TMS Outcomes

When it comes to treating depression, Transcranial Magnetic Stimulation (TMS) is a powerful alternative to traditional medications—especially for patients who haven’t seen results from medications alone.

Clinical Outcomes

Carpenter et al. (2012) found:

• 37% of TMS patients achieved full remission—with no medications

• 54% experienced significant relief and were able to reduce or stop medications

• In contrast, only 32% of patients on medications alone reach remission—and most must continue medication use indefinitely

Dunner et al. (2014) confirmed these benefits are long-lasting:

• 67.7% of patients still showed improvement one year after treatment

• 45.1% remained in remission at 12 months, without needing ongoing treatment

This means that for many, TMS offers both faster relief and more durable results compared to medications alone.

Side Effects Comparison

• TMS: Mild and temporary—like scalp sensitivity or light headache (10%)

• Medications: May cause weight gain, sexual side effects, fatigue, sleep issues, emotional blunting, and more

TMS therapy is not only effective—it’s also better tolerated and does not require you to be on medications indefinitely.

How Does TMS Work?

Transcranial Magnetic Stimulation (TMS) is a non-invasive therapy that uses a special magnetic coil placed gently on the scalp. When activated, the coil delivers magnetic pulses in specific patterns and frequencies. These pulses create a small, painless electric current in the outer part of the brain—called the cerebral cortex.

This electric current causes neurons to fire and helps reset communication in brain circuits that are involved in mood, focus, and emotional regulation. Depending on the area being targeted, TMS can either stimulate underactive regionsor calm overactive ones—making it especially helpful for conditions like depression, anxiety, and OCD.

What Does TMS Feel Like?

• During the session, you’ll hear a series of clicking sounds, similar to a woodpecker tapping.

• Some patients feel a light tapping on the scalp.

• Occasionally, a mild headache or twitch may occur during or after treatment—but these side effects are temporary and uncommon.

• There’s no need for anesthesia, and you’ll be awake, alert, and comfortable the entire time.

How Long Does a Session Last?

• Theta Burst Protocol: Only 3 to 10 minutes per session

• Standard Protocol (10Hz): About 20 to 40 minutes per session

Neuronavigation

Precision Brain Targeting

At American Brain Stimulation Clinic, we use Neuronavigation technology to increase the precision and effectiveness of your TMS treatment. This advanced system allows us to identify and stimulate the exact brain region that will give you the best possible results.

Using 3D imaging and anatomical markers, Neuronavigation creates a real-time digital map of your head and brain. This allows our team to:

• Accurately target the ideal treatment area

• Adjust the coil’s position with millimeter-level precision

• Ensure consistent stimulation across sessions

Why Neuronavigation Matters

Every brain is different. Standard TMS setups use general landmarks on the scalp, but these don’t account for individual differences in brain size, shape, or structure. Neuronavigation solves that by:

• Using either your personal MRI or population-based averages

• Calibrating the system to your unique anatomy

• Visually guiding the provider to place the coil in the most effective location

This technology is especially useful when treating OCD, executive dysfunction, or more complex cases of depressionwhere exact targeting improves outcomes.

A First in the Region

We are proud to be the first clinic south of Los Angeles to implement Neuronavigation for TMS. Since 2015, we’ve been leading the way in delivering personalized, precision-guided brain stimulation.

Reaching Further into the Brain

Deep TMS

At American Brain Stimulation Clinic, we also offer Deep Transcranial Magnetic Stimulation (Deep TMS) using advanced coil technology that allows us to reach not just the surface of the brain, but also deeper neural circuits involved in mood, motivation, and complex behavior.

Unlike traditional TMS, which affects only the outer layers of the brain (cortex), Deep TMS can penetrate up to 6 cm, stimulating broader and deeper networks involved in depression and other psychiatric conditions.

Advanced Coils for Deeper Reach

We use two specialized deep stimulation coils:

• 🌀 MagPro Cool D-B80 Butterfly Coil

Designed for high-intensity, repetitive stimulation sessions. Its magnetic and electrical properties allow for deeper cortical penetration and are ideal for advanced protocols.

• 🌀 Magstim 110mm Double Cone Coil (Model 9902-00)

In use at our clinic since March 29, 2016. This coil configuration is particularly useful for stimulating medial and deeper structures of the brain.

These coils are part of our commitment to offering next-generation TMS therapy in San Diego and Del Mar, especially for patients with treatment-resistant depression or complex neurological profiles.

What Makes Deep TMS Different?

Deep TMS allows us to:

• Reach deeper regions of the brain without surgery

• Stimulate both cortical and subcortical networks

• Treat conditions that may not respond to standard surface-level stimulation

It has been studied extensively for:

• Major Depression (MDD)

• Bipolar Depression

• Autism Spectrum Disorders

• Auditory Hallucinations

• Schizophrenia (negative symptoms)

As noted in Bersani et al., European Psychiatry, 2013, Deep TMS is considered a promising approach for drug-resistant psychiatric disorders. Read the full review (PDF)

Trusted TMS Systems

We use TMSt systems from two of the most respected manufacturers in the field:

• MagPro (Denmark)

• MagStim (UK)

Both were FDA-approved in 2015, and unlike newer devices, they have been extensively validated through independent clinical trials.

A review by Kedzior (2014) of 40 randomized controlled trials for depression found:

• MagStim was used in 22 studies

• MagPro in 9 studies

• Other systems (NeuroStar, BrainsWay, etc.) were used far less frequently and often at higher cost due to per-treatment licensing fees

TMS SCIENCE

Factors That Influence TMS Outcomes

The effectiveness of Transcranial Magnetic Stimulation (TMS) can vary depending on several factors. These can be divided into two main categories: mechanical factors and biological factors.

Mechanical Factors (Adjustable Parameters)

These are the most straightforward to manage when planning a study or clinical treatment. They include:

Frequency of Pulses: The number of magnetic pulses per second (e.g., 10 Hz or theta burst).
Intensity of Stimulation: The power of the magnetic field, often set as a percentage of the patient’s motor threshold.
Duration of Treatment: The length of each session (e.g., 6 minutes for theta burst, 37 minutes for standard 10 Hz).
Pattern of Stimulation: Whether continuous (like standard TMS) or intermittent (like theta burst).
Number of Sessions: The total number of treatments over a period, typically ranging from 20 to 30 sessions.

By carefully adjusting these parameters, clinicians can optimize the stimulation protocol for each patient, aiming to achieve maximum therapeutic benefit.

Biological Factors (Patient-Specific)

These factors are more complex and require a priori knowledge of the brain’s functional and structural characteristics:

Target Brain Region: Accurate selection of the brain area to be stimulated, often the dorsolateral prefrontal cortex (DLPFC) for depression.
Individual Brain Anatomy: Differences in brain size, shape, and structure, which can affect coil positioning and depth of penetration.
Neural Circuit Dysfunction: Variations in brain connectivity or abnormal activation patterns that influence treatment response.
Patient Demographics: Age, gender, comorbid conditions, and medication use may affect how the brain responds to stimulation.

Because these biological factors are patient-specific, they often necessitate the use of advanced targeting techniques like Neuronavigation, which helps tailor treatment to the individual’s unique brain anatomy.

Standing on the Shoulders of giants

TMS: Not Just “New” or “Experimental”

Contrary to common misconceptions, TMS is not an experimental treatment. It has a robust history of research and clinical application, making it a well-established therapy for depression and other mental health conditions.

Timeline of TMS Development

- 1985: Barker & Jalinous introduce TMS technology in a landmark publication in The Lancet.
- 1994: Dr. Mark George publishes the first observations on using TMS for treating depression.
- 2007: Over 4,000 studies have been published, confirming the efficacy of TMS for depression and other neurological disorders.
- 2008: The FDA approves TMS as a treatment for Major Depressive Disorder (MDD).
- 2010: The journal Brain Stimulation is established, focusing on neuromodulation research.
- 2013: FDA approves the second TMS device (BrainsWay) for MDD.
- 2015: FDA approves the MagStim and MagPro devices, solidifying TMS as a mainstream clinical option.
- 2015: More than 11,000 studies have validated TMS safety and efficacy, establishing it as one of the safest neuromodulation techniques available.

Safety Milestones

- Of the 60,000 patients treated by 2007, only two experienced seizures. Improved safety protocols have since reduced this risk significantly, and no seizures have been reported since 2008.
- Long-term follow-up (2, 3, 4, and 10 years) has shown no late-onset side effects, confirming that TMS is 50 to 100 times safer than pharmacological treatments.

A Breakthrough Protocol

Theta Burst Stimulation (TBS)

Theta Burst Stimulation (TBS) represents an evolution of traditional TMS, offering faster sessions with equal efficacy. TBS mimics natural brain rhythms—specifically those seen in the hippocampus and cerebral cortex—promoting long-term potentiation (LTP), which is crucial for mood regulation and cognitive improvement.

Advantages of TBS:

Natural and Physiological: TBS patterns are modeled after the brain’s own theta rhythms, enhancing neuroplastic changes.
Time-Efficient: Sessions typically last 6 minutes compared to the standard 37 minutes of traditional TMS.
Cost-Effective: Shorter sessions reduce clinical time and patient costs—often up to 50% less than standard protocols.
- Study Highlight: Bakker et al. (2015) from the University of Toronto compared 185 patients, showing that both the 10 Hz method (30 minutes) and Theta Burst (6 minutes) were safe and equally effective.
  Equally Effective: Research shows that despite the shorter session duration, TBS achieves comparable clinical outcomes.

Scientific Insight:

A comprehensive review published in European Psychiatry (Bersani et al., 2013) highlights how deep TMS (using the H-coil) can reach 6 cm into the brain, targeting both cortical and subcortical structures. This makes it particularly useful for treatment-resistant depression, bipolar disorder, autism, and schizophrenia.
For more information, read the full review: Bersani et al., European Psychiatry, 2013

Non-Invasive vs. Surgical Brain Stimulation

TMS vs. Deep Brain Stimulation

When it comes to treating conditions like depression and Parkinson’s disease, patients may encounter two advanced brain stimulation techniques:

Repetitive Transcranial Magnetic Stimulation (rTMS)
Deep Brain Stimulation (DBS)

While both methods aim to modulate brain activity, they differ significantly in terms of procedure, safety, and impact on cognitive functions.

What Is TMS?

Transcranial Magnetic Stimulation (rTMS) uses a magnetic coil placed on the scalp to deliver targeted magnetic pulses. These pulses generate small electric currents that stimulate or inhibit specific brain regions, such as the Dorsolateral Prefrontal Cortex (DLPFC).

Non-invasive: No surgery required
Outpatient procedure: Performed while fully awake
Enhanced Executive Function: Studies show improvements in mood, decision-making, and cognitive control
Minimal Side Effects: Usually limited to mild headache or scalp discomfort

What Is DBS?

Deep Brain Stimulation (DBS), on the other hand, involves surgically implanting electrodes directly into the brain. These electrodes are connected to a neurostimulator device implanted in the chest, which continuously delivers electrical impulses to brain structures such as the subthalamic nucleus (STN).

Invasive surgery: Requires implantation
Hospital-based procedure: Involves anesthesia and recovery
Risks to Executive Function: Research shows DBS may impair cognitive abilities, particularly executive function
Potential for Complications: Including infection, hardware issues, and cognitive decline

Choosing Between rTMS and DBS

Why to Consider TMS?

Patients with treatment-resistant depression who want a non-surgical option
Individuals seeking to improve executive function while addressing mood disorders
Those who prefer outpatient, non-invasive therapy

When to Consider DBS:

Only after all other treatments have failed
For severe movement disorders (like advanced Parkinson’s) where motor symptoms significantly impair quality of life
When the potential benefits outweigh the surgical risks

Why TMS Is Often the First Choice

For most patients, especially those dealing with depression or mild cognitive impairment, TMS is preferred due to its safety profile and positive impact on cognitive function. In contrast, DBS is typically reserved for cases where symptoms are severe and unresponsive to all other therapies.

Research Insights:

Several studies highlight the cognitive risks associated with DBS, particularly regarding executive function:

Brain Hope