More patients are searching for alternatives to ADHD medication. Is TMS the answer?
Since the turn of the 21st century, Attention Deficit Hyperactivity Disorder (ADHD) diagnoses have steadily increased—especially among adults. A 2017 study estimates that between 2007 and 2016, adult diagnoses more than doubled.
And what’s behind this sharp uptick? While genetic factors do play a role (with research indicating that ADHD runs in families) it’s hard to ignore the timing. From 2007 to 2016, smart phones and social media moved into the center of our culture, fracturing our attention spans along the way.
This increase in diagnoses also shines a spotlight on treatment options—including alternatives to traditional ADHD medications.
But before we dive into the potential of alternative treatments like TMS, let’s explore the specifics of ADHD.
What is ADHD?
ADHD is a complex neurodevelopmental disorder, characterized by persistent patterns of inattention, hyperactivity, and impulsivity. If left unmanaged, these neural patterns can make it difficult to function in work, academic, and social settings.
Experts think genetics are important in ADHD, but environmental and neurological factors also contribute to its development. Genetics play a significant role in ADHD. Environmental and neurological factors also play a part in its development. While the exact causes of ADHD remain unclear, a combination of genetic, environmental, and neurological factors is thought to contribute to its development, and neuroimaging studies have found that people with ADHD have brain structure and function differences.
Common symptoms of ADHD include:
- Difficulty focusing
- Difficulty listening
- Hyperactivity
- Poor organization and time management
- Forgetfulness
- Impulsiveness
Traditional Medications vs. TMS
As a true psychiatric disorder, ADHD is often treated with medication, and the FDA has approved a range of medications for use, including Adderall, Ritalin, Concerta and Vivanse.
While there are nuances between types of medications, most ADHD medications work by levels of neurotransmitters, like dopamine and norepinephrine. The boost in neurotransmitters can increase attention span, reduce hyperactive, and help to control impulses.
But not everyone with ADHD experiences the same results on medications; treating symptoms pharmaceutically may require some clinician-guided trials with different medications.
Stimulant medications such as Ritalin and Adderall have been commonly used to treat ADHD for many years. However, they may not work for everyone and can have side effects. Consequently, researchers and clinicians have been exploring alternative therapies, one of which is TMS, which has gained attention in recent years for its potential to modulate brain activity non-invasively. But does TMS therapy help ADHD?
Understanding TMS
TMS is a chemical-free, non-invasive magnetic pulse treatment that stimulates mood regulation.
By applying magnetic pulses to targeted areas, TMS treatment can either excite or inhibit neural activity, depending on the parameters used. This innovative treatment has been used in various neurological and psychiatric conditions, including depression, anxiety disorders, and chronic pain.
The Promise of TMS for ADHD
The rationale behind using TMS for ADHD lies in its ability to modulate neural circuits implicated in the disorder. Patients who have been diagnosed with ADHD experience dysregulation in frontal-subcortical circuits involved in attention, impulse control, and executive functions. By targeting and modulating these circuits, TMS holds the promise of alleviating ADHD symptoms.
Evidence from Research
While the use of TMS for ADHD is still relatively new, there’s growing interest and research in this area. Several studies have investigated the effectiveness of TMS in managing ADHD symptoms, albeit with varying results.
A 2020 study confirmed that TMS applied to the right pre-frontal cortex (which is implicated in ADHD neuropathology) is a safe and effective means of alleviating ADHD symptoms in adults. Similarly, a 2023 study confirmed the therapeutic efficacy of TMS in improving improving sustained attention and processing speed.
While these studies underscore the potential of TMS to gain mainstream recognition as an alternative to ADHD medication, we still need more large-scale clinical trials to solidify its efficacy as a valuable treatment for adolescents and adults with ADHD.
Potential Advantages of TMS
One of the significant advantages of TMS over traditional pharmacotherapy is its non-invasiveness and minimal side effects. Unlike medications, which can cause adverse effects such as insomnia, loss of appetite, and mood changes, TMS is generally well-tolerated and does not involve systemic administration of drugs. This aspect makes it an attractive option, especially for individuals who may not tolerate or respond well to stimulant medications.
Additionally, TMS offers the flexibility of targeting specific brain regions implicated in ADHD, allowing for personalized treatment approaches. By tailoring stimulation parameters to individual neurobiology, clinicians can potentially optimize treatment outcomes and minimize adverse effects.
Challenges and Considerations
Despite its vast potential, several challenges and considerations need to be addressed before TMS can be widely adopted as a treatment for ADHD.First and foremost, although the FDA has approved TMS to treat depression and OCD, TMS for ADHD is still considered to be an off-label treatment, which may impact insurance coverage.
TMS is a non-surgical treatment that is generally well-tolerated. However, some patients may experience side effects following a treatment session. These side effects can include headaches, jaw pain, and discomfort at the site of the pulses. It’s important for TMS patients to talk openly with their doctors and TMS clinicians about any possible side effects.”
The future of TMS for ADHD
Transcranial Magnetic Stimulation has demonstrated promising results in modulating neural circuits associated with ADHD. And as more people diagnosed with this mental health condition seek medication alternatives, TMS as a treatment for ADHD may become increasingly accessible and mainstream.
Patients with ADHD should have more treatment options beyond just medications. Transcranial Magnetic Stimulation (TMS) provides a non-invasive method for achieving significant improvements without the potential side effects of medication.
New research on TMS is being conducted with both adults and children. This research aims to confirm that TMS is a safe and effective method for managing long-term symptoms.
References:
Alyagon U, Shahar H, Hadar A, Barnea-Ygael N, Lazarovits A, Shalev H, Zangen A. Alleviation of ADHD symptoms by non-invasive right prefrontal stimulation is correlated with EEG activity. Neuroimage Clin. 2020;26:102206. doi: 10.1016/j.nicl.2020.102206. Epub 2020 Feb 6. PMID: 32062566; PMCID: PMC7021642.
Faraone, S.V., Larsson, H. Genetics of attention deficit hyperactivity disorder. Mol Psychiatry 24, 562–575 (2019). https://doi.org/10.1038/s41380-018-0070-0
