Maggie McKay (Host): Welcome to Wellness Waves from Bergen New Bridge Medical Center. I'm your host, Maggie McKay. Joining us is psychiatrist, Dr. Melis Coklar, to tell us about transcranial magnetic stimulation, what it is, how it's treated, and much more. Thank you so much for being here today.

Melis Coklar, MD: Yeah. Thank you so much for having me. I'm really excited to talk about TMS.

Host: I am too, because I have to say I really don't know that much about it. I know they also call it TMS for short. So, I'm looking forward to learning more. Let's start with: what is transcranial magnetic stimulation or TMS and how does it work in treating depression?

Melis Coklar, MD: TMS, basically, it stands for transcranial magnetic stimulation. It's a non-invasive treatment that uses magnetic fields to stimulate areas of the brain that is helping us with our mood and regulating our mood. So, it's commonly used to treat depression, especially when other treatments such as medications or therapy have not been effective.

Host: And who are the ideal candidates for TMS therapy? How is eligibility determined?

Melis Coklar, MD: So, people with major depression will typically start off with like antidepressants or therapy. And although these are very effective treatments, sometimes they take a long time to work or they don't work at all. So, a doctor might prescribe TMS as a way to help with treatment-resistant depression, meaning that they've tried at least one or two antidepressant medications without any relief. And it's just an exciting alternative to medication, especially if you haven't found success and if you want a drug-free approach.

Host: Can you describe the procedure of a typical TMS session, including what patients might experience?

Melis Coklar, MD: Number one, important, I'm sure a lot of people want to know that TMS does not require anesthesia. It's done in our clinic, the Depression Center of Excellence. Basically, during a treatment, the patient is reclining in a quite comfortable chair. A curved magnetic coil is placed on top of their head. Patients will hear like a clicking sound. They might feel like a slight tapping sensation, but the treatment is focusing on the area where it's the source of depression. Basically, they would come for 36 sessions total, which comes out to seven weeks because they will be coming five days a week and the sessions are fairly quick. They're under 20 minutes. And patients notice how fast the sessions go as they come day by day.

Host: Are there any specific types or subtypes of depression that respond better to TMS?

Melis Coklar, MD: The main one is the treatment-resistant depression, which is a patient who has tried psychotherapy, medications, nothing's working. They're at the maximum dose, they've taken them long enough, and their depression is not going away. So, it's best for patients who are their depression is just resistant to medications.

Host: Are there any side effects, negative?

Melis Coklar, MD: So luckily, there's not severe side effects. TMS is generally very well-tolerated. If anything, patients might say that they feel that their scalp might feel a little uncomfortable very slightly, maybe like a mild headache. Usually, these symptoms will go away after a week. Maybe they'll notice like twitching in their face during the session as the pulses are occurring.

But as soon as that ends, they go away. And again, it does not require anesthesia. There's no side effects that you would see in medications. The classic antidepressants like weight gain, there's no weight gain. There's no sedation. There's no sexual side effects. These are all very common with antidepressant medications. And then, there's no effect on your memory. You're not going to forget things, and then you're also not going to have any issues with your sleep.

Host: That's all really good to know and probably you get those questions all the time from your patients. Can TMS be used in conjunction with other treatments such as psychotherapy or medication?

Melis Coklar, MD: Definitely. If a patient comes to us already on a medication from their outside provider, we generally want to keep everything. We recommend everything stay the same. So, whether they're on Zoloft or Prozac, Lexapro, they could stay on their medications alongside getting TMS.

Host: Well, let's talk about lifestyle factors like diet and exercise. How does that interact with or support outcomes in TMS therapy?

Melis Coklar, MD: It's advocated that patients continue to eat healthy, get good sleep, exercise. If they're journaling or meditating, to continue doing that. Trying to limit whatever negative exposure that you're getting, whether it's through social media or the news. You want to focus and engage on more positive activities and habits that will help you throughout the TMS session.

Host: Dr. Coklar, would you please share a success story of a patient who responded well to a TMS intervention?

Melis Coklar, MD: Yes, there was one patient that I've heard a story about. And there's also a book that was written by a lady who did TMS and the book is called 3000 Pulses Later, and it just shares her journey through getting TMS and how it helps with her depression. A lot of patients are interested in that book. There's other stories about there was an athlete who suffered from depression and nobody told him about TMS. He was trying a lot of different medications, nothing was working, and eventually was introduced to TMS and he was in remission.

Host: How long has TMS been around?

Melis Coklar, MD: So, it was approved in 2008. The machine that we used, NeuroStar, was FDA-approved for treatment-resistant depression in 2008. So, it's been almost 20 years.

Host: Wow. Well, it sounds like a great alternative or option, or like you said, you can still take medication with it if you choose, but you don't have to. Is that accurate?

Melis Coklar, MD: Yeah, that's accurate.

Host: Is there anything else you'd like to add in closing?

Melis Coklar, MD: So, the treatment response is up upward to 70%, which is higher than medications. And just to trust the process and be patient, stay committed to the 36 treatments and stay positive. And again, just to continue to live a healthy lifestyle while you do the TMS sessions. But, you know, it's very promising and it's very exciting. It's an alternative approach to medication. So yeah.

Host: Thank you so much for sharing your expertise. This has been so interesting.

Melis Coklar, MD: Thank you.

Host: Again, that's Dr. Melis Coklar. To find out more, please visit newbridgehealth.org. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. Thank you for listening to Wellness Waves.