Dr Sackeim’s comments on TMS: 

In May, 2014, at the second annual meeting of the Clinical TMS Society, Harold Sackeim, PhD*  was the featured speaker.   He emphasized that TMS is much better than ECT. Not only is it safer and more comfortable, but it is more durable.   When a patient receives ECT for a major depressive disorder, he often completely relapses in 6 to 12 months and needs another 10 treatments.  TMS patients usually stay in remission longer, sometimes for years–they typically stay on some maintenance medication, of course.  If and when a patient relapses into depression,   he rarely needs a full course of 20 or 30 TMS treatments. A few treatments is usually enough – sometimes only one. 

A year later, at the First International Brain Stimulation Conference in Singapore in March, 2015, Dr Sackeim made another thought provoking statement:   the dose we give of TMS is “homeopathic” and the brain cures itself.  A small area of the brain remains activated for 45 minutes or less after a 20-30 minute treatment.   For about an hour during and after the treatment, there is a mild increase in blood flow, metabolism, and EEG activity.  Then the EEG—and the brain—returns to its previous state.  There is observable difference in the patient.  He feels no different and goes to work as usual. But as 5, 10, 12 treatments pass, his depression typically begins to remit.

If the brain is curing itself, it would explain why the benefit is so surprisingly durable—so long-lasting.   TMS increases “neuronal plasticity”—the ability of brain cells to change and adapt.   Is this increase in plasticity allowing the brain to cure itself?   The brain wants to improve in the right direction, and the TMS enables it to do this.   The benefit frequently lasts a very long time. Since only a few treatments are necessary if and when a relapse occurs, this implies something has “permanently” changed for the better in the brain.

* He was head of research in brain stimulation