The first line of treatment for depression and other mood disorders typically involves a combination of medication and talk therapy. This treatment strategy proves effective for many people. However, some patients may experience troublesome side effects or have persistent symptoms that fail to respond to treatment.
Every individual’s experience with depression is different, and as a result, experiences with depression treatments vary. At Principium Psychiatry, we believe everyone deserves access to the mental health care they need to feel better. That’s why, in addition to traditional psychotherapy and psychopharmacology, we offer innovative treatment options like Transcranial Magnetic Stimulation (TMS).
TMS is a safe, non-invasive treatment method approved by the U.S. Food and Drug Administration (FDA) for the treatment of major depressive disorder and other mental health conditions like obsessive compulsive disorder. Although patients with a variety of mental health needs and concerns can benefit from TMS therapy, it is primarily recommended for patients with treatment-resistant symptoms and those who have had intolerable side effects from antidepressants.
At Principium Psychiatry, we offer TMS in New York, where our medical director Dr. Cohen and the rest of our experienced staff supervise treatment sessions and create individualized plans to help patients find relief and regain energy, motivation, peace of mind and joy in their lives. Learn more about TMS therapy in New York and feel free to contact our Manhattan office with any questions you may have. We see patients in our comfortable midtown office between 9 a.m. and 8 p.m. on weekdays and on weekends by special appointment. We are located near Central Park in the heart of New York.
TMS, which stands for transcranial magnetic stimulation, is a form of neuromodulation that utilizes a pulsing magnetic field to induce electrical current. This innovative psychiatric treatment utilizes Faraday’s law of electromagnetic induction, such that a magnetic field is produced by passing electric current through a wire coil (Horvath et al., 2011). When placed against the scalp, current from the magnet passes through the skull and electrically stimulates neurons directly beneath it. This electrical stimulation, when tuned to a high enough frequency of more than 10 Hz, results in depolarization, or excitation of nerve cells, causing them to fire at an increased rate. Increased neuronal firing in turn modulates connectivity and activates pathways involved in mood regulation.
TMS received FDA approval for the treatment of major depression in 2008, and it is recommended by the American Psychiatric Association. In patients with major depressive disorder, daily, repetitive TMS works to induce long-term activation of nerve cells that are otherwise underactive.
To create electrical currents, TMS therapy relies on a device containing a metal coil, which the supervising doctor or technician places gently against the side of the head. The magnetic pulses generated match those produced by magnetic resonance imaging (MRI) machines in type and strength. TMS doesn’t require you to take any medication or deviate from your regular routine aside from attending scheduled treatments. The treatment is completely non-invasive and endorsed by the American Psychiatric Association. It is often used for pregnant or breastfeeding women who do not wish to take medication.
Decades of clinical research support the idea that in patients with major depressive disorder, the left dorsolateral prefrontal cortex is hypoactive (or less active relative to control). Thus, TMS treatment involves placing the magnet on the head so as to target this region in a precise manner, allowing for the reversal of this underactivity and therefore, alleviation of depressive symptoms.
The dorsolateral prefrontal cortex, which is the area being targeted during TMS treatment, is implicated in functions such as cognitive control, working memory, and motivation. Furthermore, the DLPFC is involved in modulating other areas of the default mode network, including cingulate cortex and parietal areas, as well as areas within the limbic system, responsible for emotional response and memory consolidation, such as the amygdala and hippocampus.
TMS therapy comes with a number of advantages for patients who have struggled to find symptom relief in the past. Some of these advantages include:
Another major advantage of TMS therapy is that it produces relatively few side effects in comparison to antidepressant medications. The most common include headaches and soreness at the treatment site, which usually disappear following the first few sessions and can be easily managed with over-the-counter pain medications.
Although typically safe, TMS may have increased risks for certain patients. Individuals with metal implants such as aneurysm coils or metal plates in the skull should not receive TMS treatment, and special precautions may be necessary for patients with other implanted devices. Before you start TMS at Principium, our staff will work closely with you to understand your medical history, determine your eligibility for TMS and identify any potential risks unique to your situation.
Knowing exactly what to expect when starting a new mental health treatment helps many patients feel more confident about their decision. TMS in NYC is typically a straightforward process that helps people begin to feel better in around six weeks or less.
The standard treatment protocol involves 36 sessions daily, administered over 4 – 6 weeks. TMS treatments are done five times a week from Monday to Friday. Each session ranges from 20 minutes to one hour. Treatment parameters, which are determined during the initial appointment, are tailored to each individual patient and modified across the treatment course as needed.
Before starting treatment, your TMS doctors in NYC will need to determine the treatment location and energy level that will produce the best results for you. In a process called brain mapping, our team members use a single magnetic pulse to stimulate the motor cortex of the brain and observe involuntary hand movement to find just the right spot and energy level. This step is completed during a separate appointment and only takes around 20-30 minutes.
After brain mapping, you can move on to your first TMS therapy session. During this appointment, you will sit on a reclining chair similar to those found in dentist’s offices. Your doctor, TMS technician or nurse will then place the magnetic coil gently against the top-left side of your head. When you’re comfortable and ready to start, the machine will deliver quick magnetic pulses for several seconds before pausing for a short break. This cycle repeats for the length of the session, which will be determined between you and Dr. Cohen based on your specific needs. Sessions can range from 20 minutes to one hour.
During the session, you’ll hear a clicking noise with each magnetic pulse. You may also feel a slight tapping sensation. You’ll be able to stay awake during treatment, and you’ll have the option of listening to music, reading a book, watching television or chatting with the nurse or technician, who will stay in the room with you to ensure your safety and comfort.
During treatment, patients sit comfortably in a reclining chair, and a magnetic coil is gently placed against the left side of their scalp. Each treatment session ranges from 20 minutes to one hour. During sessions, patients can chat, watch television, or listen to music. Patients will hear a clicking noise, but they do not typically feel pain or discomfort. Patients are awake, and there is no use of anesthesia. TMS produces few to no side effects. Some patients may experience a mild headache and slight tenderness in the treatment area over the first few sessions, but this can easily be addressed with over-the-counter Advil or Tylenol.
We welcome local as well as international clients. Located near Carnegie Hall and Columbus Circle, our location offers proximity to top of the line hotels and accommodations. Clients will have access to New York’s numerous attractions while receiving treatment.
Principium Psychiatry is one of the few clinics licensed to provide innovative treatments like TMS in New York City. Our team members dedicate themselves to helping patients like you receive the personalized care they need to feel better — whether that’s TMS therapy for depression, psychotherapy, psychopharmacology, addiction treatment, ketamine therapy or another option.
We strive to treat every patient who walks into our office with the utmost compassion and respect, no matter how severe or mild their symptoms may be, and we welcome both local and international clients. If you’re ready to take the first step toward feeling better, schedule an appointment online or call us at 212-335-0236 today.
Dr. Ziv E. Cohen is a Weill Cornell-affiliated and board certified psychiatrist with extensive experience treating mood disorders, trauma, PTSD, and a variety of other disorders. His experience lies with individuals across the lifecycle, including adolescents and adults. Dr. Cohen is also Clinical Assistant Professor of Psychiatry at Weill Cornell Medical College of Cornell University, and on the medical staff of New York Presbyterian Hospital, both in New York City.
Dr. Irina Kogan is a board certified psychiatrist with a thorough knowledge of psychopharmacology across the full spectrum of psychiatric disorders. She is expert in the treatment of mood, anxiety, and attentional disorders. In addition, she completed addiction psychiatry training at Mount Sinai Beth Israel Medical Center, where she gained expertise in the treatment of co-occurring substance use disorders
Ashley Strongwater is a Physician Assistant with extensive experience as a Psychiatric PA. She completed a BS in neuroscience at the University of Michigan and her physician assistant training at Mercy College in New York. Ashley’s passion for neuroscience led her to pursue psychiatry as her speciality. Ashley is a skilled psychopharmacologist, using the best regimens to control symptoms of depression, anxiety, bipolar disorder, ADHD, and other conditions.
