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Precision Neuromodulation Clinic

VA Palo Alto’s Precision Neuromodulation Clinic (PNC) provides therapeutic options for treatment-resistant depression.

About PNC

We are a team of nurses, psychologists, psychiatrists, brain scientists and educators who apply the latest brain science research and technology to help Veterans with treatment-resistant depression (TRD), or episodes of major depressive disorder that fail to respond to normal anti-depressant medications. Some of our new therapeutic options include repetitive transcranial magnetic stimulation (rTMS), an electromagnetic hand-held device that can induce or stimulate electrical currents in the targeted brain region.

For depression, we stimulate the dorsolateral prefrontal cortex, one of the major control centers of the brain. Stimulation of this region is thought to enhance its control of various symptoms of depression.

Ultimately, we work closely with our Veterans to develop an individualized treatment plan that considers their unique history and circumstances.

What is rTMS?

rTMS is an alternate approach to treating depression. Anti-depressant medications normally target the chemical messenger system of the entire brain.

rTMS has no chemical component and instead, uses a hand-held device that creates rapid magnetic field changes within the brain to stimulate electrical currents in a targeted region of your brain. This electrical stimulation is thought to enhance activity of brain regions that may not be working properly.

For depression, we stimulate the “dorsolateral prefrontal cortex,” or DLPFC, one of the major control centers of the brain. Stimulation of this region can enhance the control of other brain regions that affect various symptoms of depression.

A patient receiving repetitive transcranial magnetic stimulation

Is rTMS safe?

rTMS has undergone rigorous testing to ensure its safety and has been cleared by the FDA for major depressive disorder. This treatment is generally well-tolerated with the most common adverse effects being scalp discomfort and/or mild headache.

Severe side effects are very rare and include seizures. All Veterans will undergo a thorough evaluation to ensure that only Veterans who are not at significant risk for severe side effects are treated with rTMS.

How to access care

The first step is to discuss the possibility of receiving rTMS with your mental health provider (you can also discuss with your primary care physician). Your provider will submit a consultation request to our clinic and one of our staff members will contact you for an in-person (or video-based) assessment.

During the assessment, we will be asking for your detailed psychiatric and medical history. We will also provide detailed information about rTMS, including the treatment process, risks, benefits, as well as answer any questions you might have.

Clinic outcomes

rTMS has been shown in large, controlled studies to be consistently effective in treating TRD. The following results were obtained from treating more than 800 Veterans for TRD with rTMS at outpatient VA clinics across the country:

repetitive transcranial magnetic stimulation response chart - more than 50% of responders had a reduction in symptom levels

What our Veterans are saying

61.1% of Veterans surveyed would recommend rTMS treatment to others

What to know before receiving rTMS

rTMS is time-intensive. You will be required to attend daily treatment sessions at the VA Palo Alto campus that may extend across several weeks.

Veterans who live more than 60 miles from Palo Alto may be provided free lodging accommodations at the Defenders Lodge located on campus.