Brain Stimulation Services

Electroconvulsive Therapy (ECT) Service

ECT is a safe and effective treatment that involves passing a carefully controlled electrical current through a person’s brain to trigger a seizure — a rapid discharge of nerve impulses throughout the brain. In recent years, the National Institute of Mental Health, the American Psychiatric Association, and the U.S. Surgeon General all endorse ECT as a valuable tool in the treatment of certain psychiatric disorders, and major depression in particular. Each year hundreds of patients are treated with electroconvulsive therapy (ECT) in the Department of Psychiatry and Behavioral Sciences. This procedure can be done on an inpatient or outpatient basis.

Johns Hopkins now provides ECT treatment with ultra-brief pulses to reduce cognitive side-effects. Recent studies demonstrate that ECT delivered with ultra-brief pulses produces less memory loss and other cognitive side-effects than ECT delivered with standard pulses. Historically, ECT has been administered with pulses that are one millisecond in width whereas recent studies have delivered ECT with pulses in the range of 0.25-0.37 milliseconds, which also triggers a seizure but more efficiently and with fewer cognitive side effects.

Frequently Asked Questions about ECT Services

ECT Resources

ECT Books

  • Shock by Kitty Dukakis
  • Undercurrents: A Therapist’s Reckoning with Depression by Martha Manning
  • Understanding Depression by J. Raymond DePaulo, M.D.
  • Depression: The Mood Disease by Francis Mondimore, M.D.
  • Bipolar Disorder: A Guide for Parents and Families by Francis Mondimore, M.D.

External Websites

Note: External websites are meant for informational purposes only. Johns Hopkins is not responsible for any aspect of the external web site.

Transcranial Magnetic Stimulation (TMS) Service

Doctor places a NIBS device on a patient's head

TMS is a non-invasive method of brain stimulation that relies on electromagnetic induction using an insulated coil placed over the scalp, focused on an area of the brain thought to play a role in mood regulation. The coil generates brief magnetic pulses, which pass easily and painlessly through the skull and into the brain. The pulses generated are of the same type and strength as those generated by magnetic resonance imaging (MRI) machines. TMS was FDA-cleared in 2008 and now is widely available at clinics and hospitals across the country. The Johns Hopkins Brain Stimulation program offers a few TMS services:

Repetitive TMS (rTMS)

When these pulses are administered in rapid succession, it is referred to as “repetitive TMS “ or “rTMS”, which can produce longer lasting changes in brain activity. rTMS has been shown to be a safe and well-tolerated procedure that can be an effective treatment for patients with depression who have not benefitted from antidepressant medications or cannot tolerate antidepressant medications due to side-effects. If you reside locally and are interested in being evaluated for outpatient rTMS treatment,  contact Michael Tibbs.

Deep Transcranial Magnetic Stimulation (dTMS)

We are pleased to announce that the Johns Hopkins Brain Stimulation Program is now offering Deep Transcranial Magnetic Stimulation (dTMS) utilizing the H-coil, which is a novel rTMS tool that enables direct stimulation of deeper and larger brain volumes. This coil is designed to affect extensive neuronal pathways, including deeper cortical regions and fibers targeting subcortical regions, without a significant increase in the electric field induced in superficial cortical layers (Levkovitz et al., 2015).

Transcranial Direct Current Stimulation (tDCS)

Transcranial direct current stimulation (tDCS), is a non-invasive, painless brain stimulation treatment that uses direct electrical currents to stimulate specific parts of the brain. A constant, low intensity current is passed through two electrodes placed over the head which modulates neuronal activity. There are two types of stimulation with tDCS: anodal and cathodal stimulation. Anodal stimulation acts to excite neuronal activity while cathodal stimulation inhibits or reduces neuronal activity. 

Although tDCS is still an experimental form of brain stimulation, it potentially has several advantages over other brain stimulation techniques. It is cheap, non-invasive, painless and safe. It is also easy to administer and the equipment is easily portable. The most common side effect of tDCS is a slight itching or tingling on the scalp.

Several studies suggest it may be a valuable tool for the treatment of neuropsychiatric conditions such as depression, anxiety, Parkinson’s disease, and chronic pain. Research has also demonstrated cognitive improvement in some patients undergoing tDCS. Currently, tDCS is not an FDA-approved treatment.

Our neurology colleagues at Johns Hopkins Physical Medicine and Rehabilitation use brain stimulation to address a variety of conditions, including:

  • Traumatic brain injury (TBI)
  • Stroke
  • Language disorders
  • Movement disorders
  • Impaired cognition
  • Chronic pain.