According to the Mayo Clinic, there’s a gender gap in depression. Women are close to twice as likely as men to be diagnosed with depression. While this is a complex issue and many societal and biological factors contribute to it, you may be asking yourself, “Does my sex or gender influence my depression treatments like TMS?”

Before diving into that complicated question, let’s cover the basics.

What is TMS?

Transcranial magnetic stimulation (TMS) is an FDA-approved brain treatment for various mental and neurological health problems. It’s:

• Non-invasive: Treatment only involves putting a coil on your scalp while some magnetic pulses go around your head.
• Non-systemic: Nothing is circulating throughout your body, causing unwanted side effects. Treatment is directed only to the area you need it.

There are two forms of TMS:

1. Standard TMS is one treatment daily for approximately six to eight weeks.
2. Accelerated TMS for depression consists of similar treatments delivered in a highly condensed form. Instead of one treatment daily, you can receive 5-10 treatments per day for a week or two. While initially more time-consuming, you can feel results in a few days rather than weeks. This treatment is not the same as SAINT TMS, but it is similar.

What the Research Says

• Sex Influences TMS’ Antidepressant Properties

  A study analyzed data over 16 years to examine the role of sex in TMS treatments aimed at reducing depression severity. The researchers found there was a positive relationship between females receiving TMS treatment and their depression reduction. Their exact findings were, “Short-term antidepressant properties of rTMS are independent of concurrent antidepressants [use] and might depend on sex…”

• Female Sex More Likely To Respond to TMS

  Researchers looking at data from over 5,000 individuals receiving TMS for treatment-resistant depression (TRD) found that women were more likely to respond to TMS and achieve remission thanks to TMS compared to their male counterparts.

• Females May Respond Better to TMS Augmentation, Too

  This study also looked at TMS and sex differences. However, when they delivered another form of brain stimulation (intermittent theta burst stimulation or iTBS) to participants not responding to TMS, they found females tended to respond better to the augmentation than men did.

• 3 Theories Why Females Respond Better To TMS

  A third study conducted by Hanlon and McCalley looks at three potential factors for these sex differences:

  1. Bone Structure

     The strength of the pulses weakens with distance, so the coil placement is critical. Placing the coil as close to the targeted brain area as possible is ideal. Craniofacial anatomical differences between men and women lead to the distance from the brain to the scalp being greater for men. This is especially true in the prefrontal region which TMS specialists target for depression treatment.

  2. Brain Matter

     Brains have gray matter and white matter, and the volume of each can vary in different brain areas. Greater volume is associated with increased activity caused by TMS treatment. Females tend to have more gray and white matter in the regions of the brain TMS targets for depression–another anatomical difference why females could respond slightly more than men.

  3. Hormones

     The hormone fluctuations of progesterone and estradiol, what most know as estrogen, that occur during females’ monthly cycles impact the excitability of brain cells. This means that at specific points of a woman’s cycle, their brain cells are more susceptible to TMS treatments than at other times. Men may be less susceptible because they do not experience these same fluctuations.

We Need More Research on TMS Response Differences

Overall, we need more studies to determine whether these three factors account for the differences in TMS response between men and women. Additionally, most of these studies separated participants into the binary categories of male and female and didn’t investigate or have enough data to look at other possibilities.

For example, if hormones are part of the equation, an assigned male at birth who has now transitioned to a female who’s using hormone therapy may see a greater treatment response to TMS. However, if bone structure and brain matter are more of the cause, they may see a less significant response.

The bottom line is that more research on this subject will shed some light on what each individual can expect regarding treatment results. TMS is a dynamic field; ongoing research helps us understand the mechanisms and outcomes. TMS experts in Olympia continually refine and optimize treatments to treat diverse populations–even to account for individual differences in bone structure or hormones.

However, TMS is Effective Across Sex and Gender

Of 257 patients with depression, this study found nearly 63% were still in remission a full year after a single course of TMS therapy. In the realm of TMS treatments, the impact of sex and gender is an area of consideration but not a determinant of success. TMS can be an effective treatment option for anyone, regardless of sex or gender.

Remember, open communication with your healthcare team is critical for personalized and inclusive care. Discuss any concerns related to sex or gender and their potential impacts on outcomes to ensure your TMS team tailors your treatment plan to your unique circumstances. Depression treatments have come a long way, and TMS can be a valuable tool for your mental health and well-being.