A magnetic therapy for persistent depression is in high demand.

While antidepressant medications and talk therapy are still the first options, Dr. Bennett Poss of Allina Health in Minnesota said alternatives are needed for the growing share of patients who aren’t helped by those treatments alone. Transcranial magnetic stimulation has been an option in the United States for 15 years, but it emerged in the post-pandemic era as more people sought depression treatment and more research validated its potential.

“Evidence-wise, it’s one of those things that has actually panned out better or at least as advertised,” said Poss, a psychiatrist who provides TMS at Allina’s Abbott Northwestern Hospital in Minneapolis. “There are so many things that look good in clinical trials and then they make it to patient care and they’re not so good.”

TMS involves magnetic coils that are placed on the scalp for around 30 minutes and direct pulses into the brain, usually at a golf ball-sized target on the front left side that regulates mood.

After one to two months of treatment five days a week, about half of patients report some benefit and a third see remission of depressive symptoms, studies have shown.

Poss likened it to lifting weights or running, and he said it stimulates a part of the brain that is underutilized in people with depression.

“We put it into use more than you would otherwise, and over time it causes some of the same changes you would actually see with exercise” to the body, he said.

TMS is only recommended for a fraction of those patients who have been diagnosed with major depressive disorder, which is marked by severe and prolonged sadness and hopelessness. But clinicians said the condition is being diagnosed more often as well.

“The cool thing about (TMS) is, once people have received the treatment, and if they respond to it, they don’t have to continue it, necessarily. So it’s distinct in some ways from medication,” said Dr. Sophia Albott, who heads the University of Minnesota’s division of adult mental health.

The magnetic therapy has roots at the University of Minnesota, where Dr. Ziad Nahas was involved in clinical trials that persuaded the U.S. Food and Drug Administration to approve it in 2008 as a treatment for major depression in adults.

Albott said the magnetic therapy was originally limited to patients who had tried therapy and had no success, or had severe side effects, with at least four antidepressant drugs. The federal Medicare program recently expanded its coverage so that patients only had to try two drugs before being eligible for TMS, which partly explains the recent growth.

Albott said she hopes it becomes more of a first-line therapy, although its time commitment will remain a barrier along with the roughly $10,000 cost shared between patients and insurers.

Recent research has tried to figure out which patients respond best to TMS, whether it substantially increases interest in daily life and activities and reduces suicidal thoughts and behaviors, and whether it can be expanded for use by adolescents and for neurological conditions, such as stroke.

The treatment already has been approved for smoking and obsessive compulsive disorder, and some researchers believe it can treat the ear-ringing condition known as tinnitus, which also reportedly increased during the pandemic.

Becky Steffens, 39, of Coon Rapids didn’t believe TMS would work, not after 15 years of dealing with depressive symptoms. Success at the University of Minnesota’s clinic for treatment-resistant depression came when her doctors switched sides and directed magnetic pulses into the right side of her brain.

Research has found that some patients need stimulation on that side to regulate another portion of the brain that fuels negative thoughts.

Treatment wasn’t easy because it disrupted work and was noisy and uncomfortable, Steffens said. “It’s like a little bird is pecking on the same spot on your head over and over for like 50 minutes.”

It also wasn’t one-and-done success, as she needed two rounds and once-a-week maintenance treatments along with other depression therapies. But TMS gave Steffens several months of complete remission and reduced symptoms the rest of the time that allowed her to rediscover joys in everyday life, such as painting and volunteering.

“I’m able to have a baseline where I’m not necessarily, like, happy and joyful and everything is great,” she said, “but I’m not sad and stuck. I feel like it’s kind of a place where I’m able to have emotions, feel them and then come back to a baseline ... and not get stuck in those negative sticky thoughts.”

Poss said other treatments can support TMS in folks who have medication-resistant major depressive disorder, including highly effective electroconvulsive therapy that causes patients’ brains to “reset” without depressive symptoms. He said he is particularly optimistic about TMS now that it is gaining interest and access is expanding.

“I’m able to have a baseline where I’m not necessarily ... happy and joyful and everything is great, but I’m not sad and stuck.”— TMS patient Becky Steffens