Your cart

Are you trying to decide between transcranial magnetic stimulation (TMS) vs neurofeedback for mental health treatment? If so, this article will help you understand the differences between these two therapies, including their treatment approaches, applications, and possible side effects. 

Keep in mind that this article is for informational purposes only and does not constitute medical advice. It should not be used as a substitute for professional medical diagnosis, treatment, or advice. Always consult a qualified healthcare provider before making any decisions regarding your health.

Key Takeaways

• Transcranial magnetic stimulation (TMS) is a non-invasive therapy that uses magnetic pulses to stimulate specific brain areas. It is primarily effective for treatment-resistant depression, but it is FDA-approved for other mental health conditions.

• Neurofeedback therapy is typically done via electroencephalography, which analyzes brain activity. It helps individuals self-regulate their brain activity through real-time feedback. It is widely used for depression and anxiety, as well as other mental health concerns but also for wellness purposes, such as cognitive enhancement.

• Choosing between TMS and neurofeedback depends on individual symptoms, medical history, and preferences. Therefore, it is important to consult with a healthcare provider for personalized treatment guidance.

What Is Transcranial Magnetic Stimulation (TMS)?

Transcranial magnetic stimulation (TMS) is a procedure that utilizes magnetic pulses targeted at specific areas of the brain to stimulate nerve cells. This technique is considered non-invasive because it does not require surgery, anesthesia, and electrode implantation. But it does directly influence brain activity.

TMS is primarily used for treating treatment-resistant depression. It also has been FDA-approved for managing obsessive-compulsive disorder and migraine prevention. The procedure involves placing a TMS device on the patient’s head. The device generates magnetic pulses to the brain region responsible for mood control and depression.

A typical TMS session lasts about 20 minutes. During a session, the patient feels and hears tapping sounds on their scalp, followed by a pause. After this, the tapping resumes. The patient stays fully awake during the procedure. Afterward, they may have a mild headache. Generally, people require treatment for 4-6 weeks for TMS to be effective.

TMS is generally considered safe because of its non-invasive nature. However, side effects may occur, including scalp discomfort and pain, headaches, lightheadedness, or facial muscle spasms. Rare side effects include anxiety, seizures, fatigue, and depersonalization, among others, which are considered more common with higher-frequency stimulation. Future research is required to confirm whether TMS has any long-term side effects.

Additionally, people with metallic medical devices may not be able to undergo TMS. You should also tell your doctor if you're taking any medicine, have a history of seizures, have been diagnosed with a mental health condition, have frequent headaches, or anything else health-related, as it may affect the effectiveness of TMS or even indicate that you should not undergo this treatment.

What Is Neurofeedback Therapy?

Neurofeedback therapy is a non-invasive brain training technique that focuses on helping individuals control their brain function. It does so by providing real-time feedback on their brain waves or blood flow and oxygenation.

This therapy is rooted in neuroplasticity (the brain's ability to change and reorganize synaptic connections) and a learning technique called operant conditioning that teaches the brain to associate behaviors with rewards and punishments.

During an electroencephalography neurofeedback session (which is the most common neurofeedback technology used both in clinic and in at-home devices), sensors are placed on the patient's scalp to monitor brain waves. The patient then engages in an activity like watching a video, while a computer program provides visual or auditory feedback based on their brain activity.

In other words, when your brain is in a "desired" state, the patient gets positive feedback. When it is not, the positive feedback is taken away (e.g. the video stops). This process encourages the brain to self-regulate and reproduce desired behaviors.

Neurofeedback training has shown potential as a non-medication treatment complementary therapy for mental health disorders like depression, anxiety, and PTSD. However, it can also be used for wellness purposes, such as improving focus and stress resilience. Nonetheless, it is worth noting that many neurofeedback benefits haven't been fully confirmed, and future research is required in this regard.

Key Differences Between TMS and Neurofeedback

While both TMS and neurofeedback are designed to improve brain function and mental health, they employ fundamentally different methods. Understanding the differences between them is extremely important if you're considering these two treatment options. The table below highlights some key differences between these two therapies, and others will be further discussed in detail.

	Neurofeedback	TMS
Approach	Analyzes brain activity/teaches the brain to self-regulate	Sends magnetic pulses to the brain
Mechanism of action	Neuroplasticity + operant conditioning	Altering neuron firing patterns to reset and stimulate brain areas
Session duration	30-40 minutes	20-40 minutes
Treatment duration	10-40 sessions	30-40 sessions
Patient involvement	Active participation during training (watching a movie, playing a video game, or other similar activities)	Passive; the patient is not required to actively engage during a session
Cost	Generally lower than TMS, especially with at-home devices (used only for wellness practices)	Generally higher costs

Approach

As mentioned above, TMS involves using a TMS device that generates electromagnetic pulses to stimulate specific areas of the brain. These magnetic pulses travel through the scalp, reaching the targeted brain region, approximately 2-4 cm into the brain.

Although non-invasive, this therapy does influence brain activity directly. Therefore, it is of the essence for the treatment to be outlined correctly. This means that the dosage, frequency, and intensity should be determined with precision and the stimulation should be performed correctly to prevent any side effects.

On the other hand, neurofeedback observes how the brain functions and provides real-time feedback based on it. If done at a clinic, neurofeedback treatment is performed based on a personalized protocol that targets specific brain waves and brain regions. Therefore, it is of utmost importance to work with a qualified therapist who knows how to perform a quantitative EEG (basically a brain map showing all electrical activity in your brain) and then personalize the protocol based on it. If the protocol is not adjusted correctly, the patient may experience side effects.

Additionally, neurofeedback can also be done at home using wearable devices like the Mendi headband, which analyzes blood flow and oxygenation in the prefrontal cortex. However, this approach is only suitable for wellness purposes—such as improved focus, meditation, and enhanced stress resilience—and does not replace medical advice and treatment.

Mechanism of Action

In the case of TMS, the magnetic pulses delivered to the brain are basically small electric currents that can change neuron firing patterns. This way, these magnetic pulses stimulate and reset specific brain areas to improve someone's mood and break a depression cycle.

On the other hand, neurofeedback, as mentioned above, works with the brain's neuroplasticity and functions based on operant conditioning. In simple terms, it can potentially help people regulate their behaviors by associating desired states with positive outcomes. It is believed that we are much more likely to repeat a particular behavior if it is linked to positive outcomes.

Therefore, by providing immediate feedback on brain activity, neurofeedback teaches people how to self-regulate. This way, it can potentially help people achieve desired states without any neurofeedback technology over time.

Applications

According to Cleveland Clinic, TMS can potentially help with:

• Major depressive disorder that is resistant to other treatments

• Obsessive-compulsive disorder (OCD)

• Migraines

• Post-traumatic stress disorder (PTSD)

TMS shows potential for other conditions as well, such as nicotine addiction or Alzheimer's disease, but future research is needed to understand how exactly it can help and how exactly it should be performed for these therapeutic purposes.

Neurofeedback therapy boasts a broader range of applications, having been shown beneficial as a complementary therapy for:

• ADHD

• Depression

• Anxiety

• Chronic stress

• Autism

• PTSD

However, given that neurofeedback is a relatively recent therapy approach, future studies are needed to fully confirm its benefits for the above-mentioned conditions, as well as identify specific protocols that are best for specific diseases. This is why it is only recommended as a complementary approach and should only be performed by a qualified therapist with extensive experience in administering neurofeedback therapy.

Additionally, healthy individuals can also use neurofeedback for wellness practices, as it can potentially:

• Improve their focus and concentration

• Boost their cognitive performance

• Enhance emotion regulation and stress management skills

• Improve executive function

• Promote overall well-being

In conclusion, TMS may be more suitable for treatment-resistant depression, while neurofeedback may be better for conditions like ADHD, as well as for improving overall well-being.

Suitability for Children and Teenagers

Neurofeedback is widely used for people of all ages, including children. Even more, some devices and treatment protocols are also FDA-approved for children.

Conversely, there seems to be some controversy in regard to TMS's use for children and adolescents. Although studies have shown that it can be safe and effective for them, TMS hasn't been approved for people under 18 years old.

Contraindications and Side Effects

TMS has more contraindications than neurofeedback, and these include:

• The presence of conductive, ferromagnetic, or other magnetic-sensitive implants

• History of seizures or medical conditions that increase the risk of seizures

• Pacemakers

• Pregnancy

• Hearing disorders

• Epilepsy

• Sleep deprivation

In terms of side effects, TMS may cause mild headaches, lightheadedness, tingling, facial twitching, sleepiness, and others. There is also a risk of seizures and other adverse reactions. All in all, the possibility of experiencing side effects varies from patient to patient and depends on the treatment precision.

Conversely, neurofeedback isn't recommended (or should be performed with caution) for people with:

• Pre-existing neurological conditions

• Traumatic brain injury

• Migraines

Generally, anyone who wants to do neurofeedback should inform their therapist of any medical conditions and physical or mental health symptoms, as these may influence the treatment protocol, the therapy effectiveness, and the likelihood of experiencing side effects. Equally, it is important to talk to a healthcare professional before using an at-home neurofeedback device like Mendi if you have or suspect to have any medical conditions.

In terms of side effects, neurofeedback is known to cause short-term side effects like headaches or fatigue, which should resolve within 24-48 hours. If they don't, you need to inform your therapist, who should adjust the treatment protocol accordingly.

FDA Approval and Insurance Coverage

Both TMS and neurofeedback are FDA-approved, although you should confirm with the clinic whether the therapy you've chosen has been approved for the specific condition you want to alleviate the symptoms of. For example, TMS is approved by the FDA as a treatment option for depression but may not be approved for social anxiety, for example. The same goes for neurofeedback.

In terms of coverage, it all depends on your insurance company and your specific insurance plan. Some cover TMS and neurofeedback, while others don't.

Finding a Provider

Whether it'sTMS or neurofeedback, the effectiveness of your treatment and the risk of experiencing side effects are highly dependent on the experience of the therapist. Therefore, finding a qualified healthcare professional is probably the most important step in this process.

Look for specialists with:

• Qualifications either for TMS or neurofeedback

• Necessary licenses

• Experience in treating the specific condition you want to treat

• Good client reviews

• Good recommendations from other healthcare professionals

Furthermore, it is important to learn as much as you can about either TMS or neurofeedback before starting your treatment. This will help you understand the process and ask questions along the way.

For example, some neurofeedback therapists do not perform a quantitative EEG before starting treatment, although it is typically done when treating specific mental health conditions. Therefore, if you're familiar with the process, you can ask the therapist why exactly a qEEG is not needed and if this can reduce the effectiveness of your treatment.

In other words, being familiar with the process will help you understand if the treatment approach of a particular therapist aligns with your needs and expectations.

Frequently Asked Questions

What is the disadvantage of TMS?

Disadvantages of TMS include the possibility of experiencing scalp discomfort, headaches, lightheadedness, and tingling, among other potential adverse reactions. Additionally, there are several contraindications to consider, as well as the fact that certain medical conditions can reduce the effectiveness of TMS and increase the risk of side effects.

What is the downside of neurofeedback?

One downside of neurofeedback performed at a clinic is the possibility of experiencing short-term side effects like headaches, fatigue, or dizziness. They typically resolve within 24-48 hours. If they do not go away, you should inform your therapist. At-home neurofeedback devices generally do not cause side effects if used according to the manufacturer's recommendations by healthy individuals.

Is TMS the same as brain mapping?

TMS is not the same as brain mapping but brain mapping is an integral part of a comprehensive TMS treatment. Mapping the brain before starting TMS helps the therapist determine the correct amount of stimulation, as well as the specific treatment location. Neurofeedback protocols are also chosen and personalized based on the patient's brain map.

What is the primary difference between TMS and Neurofeedback?

The primary difference between TMS and neurofeedback is that TMS utilizes magnetic pulses to stimulate specific brain areas, whereas neurofeedback allows individuals to train their brains through real-time feedback on brain activity and self-regulation.

What factors should I consider when choosing between TMS and Neurofeedback?

When choosing between TMS therapy and Neurofeedback, it is essential to consider your specific symptoms, medical history, and personal preferences, as well as whether you're comfortable with their approaches. At the same time, look for scientific evidence and real-life cases that support the treatment's effectiveness for the specific symptoms you're experiencing.