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Doctors brief council on transcranial magnetic stimulation as a treatment option for depression
Summary
Dr. Eric Jewell and Dr. Brennan Friedman presented TMS basics, evidence, safety profile and operational details; they noted NeuroStar’s recent FDA expansion to ages 15–21, discussed accelerated and theta‑burst protocols, and said many insurers still require prior medication trials.
Dr. Eric Jewell and Dr. Brennan Friedman told the Hawaii State Council on Mental Health that transcranial magnetic stimulation (TMS) is a noninvasive, generally well‑tolerated option for people with treatment‑resistant depression and other conditions.
The presenters described how TMS delivers brief magnetic pulses to brain regions such as the left dorsolateral prefrontal cortex to modulate activity. Typical courses involve daily sessions five days a week for about six weeks, with common short‑term side effects such as transient scalp discomfort and headaches. Serious adverse events such as seizures are rare when standard screening and safety protocols are followed; the presenters cited seizure risk at 0.01% or less for the NeuroStar system.
Recent regulatory and research developments were highlighted. NeuroStar received FDA approval extending an adolescent indication (presenters said the approval covers ages 15–21). Research into accelerated protocols and theta‑burst approaches, which can condense treatment, is ongoing; some condensed theta‑burst protocols can complete a session in minutes for patients who tolerate it.
A persistent practical barrier is payer policy: many insurers continue to require prior failed medication trials (typically two trials for adults, sometimes fewer for military/Tricare) before authorizing TMS. The presenters and council members discussed advocacy work that has reduced prior‑treatment requirements in some plans and urged continued engagement with insurers and Medicaid to broaden access. Presenters recommended close collaboration among prescribers, therapists and payers to optimize screening, monitoring and treatment coordination.
Council members asked about evidence for TMS in addiction and traumatic brain injury; the presenters said research is emerging and clinics are monitoring developments, but more evidence is needed before broad clinical adoption for those indications.
