In January, Duke Health opened a transcranial magnetic stimulation (TMS) clinic at Duke Regional Hospital. TMS is primarily used to treat major depressive disorder but has also proven effective in treating obsessive-compulsive disorder and helping people quit smoking.
In many cases, medication or psychotherapy, or a combination of the two, are highly effective in treating depression—a condition that can significantly impair one’s quality of life, relationships, and ability to function. However, finding relief through these treatment options remains elusive for some individuals.
TMS can provide hope and healing for these patients. Nearly two thirds of patients who have not improved with medications benefit from TMS, according to Jacob Feigal, MD, the clinic’s medical director and an assistant professor of psychiatry and behavioral sciences and medicine. Notably, one third of patients who have not improved with medications experience full remission from depression after receiving TMS.
“Duke has long been recognized for our contributions in clinical and research advancements in brain stimulation, including TMS, and expanding our clinical footprint to include this treatment is a natural progression for our interventional psychiatry program,” said Johana Troccoli, MHA, associate vice president for behavioral health in the Duke University Health System. “Our goal is to provide multiple treatment avenues for patients, and the TMS clinic will significantly enhance our system's ability to do that.”
“Our goal is to provide multiple treatment avenues for patients, and the TMS clinic will significantly enhance our system’s ability to do that.”
— Johana Troccoli, MHA
What is TMS?
TMS is a non-invasive outpatient procedure that uses magnetic fields to stimulate nerve cells in the brain. By targeting brain areas with this electrical current, TMS “rewires” dysfunctional neural circuity associated with depression.
At the state-of-the-art facility in Duke Behavioral Health North Durham—part of Duke Regional Hospital—TMS is given once a day, five days a week, for six weeks. During the 30-minute sessions, clinicians remain at their patient’s side to answer questions, respond to concerns, and support the patient.
TMS is compatible with other therapies, including medication and therapy, making it an adaptable treatment option. Its potential side effects, including scalp discomfort and mild headaches, are minimal and temporary. Other possible side effects, such as jaw pain and seizures, are rare and occur at rates comparable to those associated with common psychiatric medications.
Leveraging Robust Research & Clinical Expertise
Over the years, Duke has been at the forefront of efforts in developing and refining TMS and electroconvulsive therapy (ECT), another brain stimulation treatment. Some of the earliest advancements in technology can be attributed to researchers at Duke, with several Duke Psychiatry & Behavioral Sciences faculty members continuing to contribute to this ongoing research.
Building on the institution’s longstanding expertise in brain stimulation, the decision to open the TMS clinic reflects Duke’s commitment to offer patients a wide range of evidence-based psychiatric treatment options. The clinic also offers ECT, and all providers in the clinic are trained in both TMS and ECT to offer the best possible care tailored to the patient’s specific needs.
“Our ability to reach out to those who have been integral to the development and the implementation of new therapies is a unique aspect to our clinic,” said Feigal. He further noted that Duke hopes to be a part of future developments that would make TMS even more effective.
Since its recent opening, the clinic has received positive responses from patients, many of whom have seen notable improvements in their conditions.
“Psychiatric illness has such profound effects on quality of life, and we are so grateful to be in the position to provide another treatment option for treatment-resistant conditions that can help patients get back to their lives,” said Feigal.
“Psychiatric illness has such profound effects on quality of life, and we are so grateful to be in the position to provide another treatment option for treatment-resistant conditions that can help patients get back to their lives.”
— Jacob Feigal, MD
What to Expect
The process to be treated at the TMS clinic starts with a referral from a psychiatrist. After the referral is processed by the team at the clinic, the patient will then come in for a consultation, during which the clinician works with the patient to determine whether TMS—or another interventional psychiatry option such as ECT— is an appropriate course of treatment for their specific condition(s).
If the patient meets all the criteria for TMS and receives insurance approval, they can typically start receiving treatment within a few weeks.
Learn More
Duke Health is dedicated to advancing care that offers new possibilities for psychiatric patients who haven’t found relief through other treatments. TMS offers a promising alternative for adults struggling with severe, treatment-resistant major depressive disorder. While the clinic does not currently offer TMS for patients with obsessive-compulsive disorder or those seeking to quit smoking, Feigal hopes these services will be available at the clinic in the future.
To learn more, visit the clinic website or call (919) 684-0105.