Once the TMS device is positioned, it creates a deep magnetic pulse that targets the left pre-frontal cortex. This pulse comes in rapid succession and is thought to stimulate regions of the brain that are linked to emotion. In depressed patients, these emotion-baring regions are shown to be very non-responsive compared to healthy patients.
TMS Therapy Basics
What Is The Science Behind TMS?
What Does TMS Feel Like?
Each treatment involves the gentle placement of the TMS coil against the patient’s head. Over a 30-40 minute period, pulses from the TMS coil are delivered in 30-second intervals. These pulses feel like tapping on the scalp. The taping should not be bothersome and the technician can make adjustments if the taping is uncomfortable. TMS therapy also produces a loud clicking sound, so earplugs are recommended and usually provided.
What Is TMS?
Transcranial Magnetic Stimulation is an MRI-strength magnetic pulse designed to stimulate the brain.
In depression treatment, the left pre-frontal cortex is stimulated. This is the area of the brain that is responsible for many emotional responsiveness.
How Is TMS Administered?
Transcranial Magnetic Stimulation is administered by placing a device around the front of the head which then sends a magnetic pulse to the brain. The device is not implanted; rather it is positioned temporarily by a technician and sits comfortably on the outside of the head. The device holds a large electronic magnet which creates and distributes the pulse. It is usually shaped like a figure-eight wand or a concave wedge.
Who Can Recieve TMS?
TMS therapy is an appropriate treatment for adult patients with major depressive disorder who have failed to achieve satisfactory improvement from antidepressant medications at or above the commonly effective dose and duration. If you or a loved one has been diagnosed with clinical depression or Major Depressive Disorder, then TMS Therapy may be able to help.
Who Should Not Receive TMS?
TMS Therapy is a very well tolerated treatment and there are very few limitations as to who can receive it. However, not all patients are appropriate candidates for TMS Therapy. Patients with a history of seizures or who have metal implants or objects in or near their head are not appropriate candidates for TMS Therapy. To determine if TMS Therapy may be right for you, your psychiatrist will carefully screen for the presence of medical conditions or metal objects which may make TMS harmful.
TMS Therapy Process
How Can I Begin TMS Therapy?
Almost all patients starting TMS Therapy do so by contacting a psychiatrist’s office to schedule an initial assessment with a TMS prescribing psychiatrist.
Who Administers TMS?
Regardless of who prescribed your TMS Therapy, a trained TMS technicians should administer the actual treatments and guide you through each session.
Will I Need to Be Hospitalized for a Treatment Session?
TMS is a very standard outpatient procedure, often times done right at the psychiatrist office. Though not as common, it is not unusual to receive TMS at a hospital. Because no sedatives or anesthesia is administered during TMS treatment, TMS patients can immediately resume normal daily activities and do not need to be hospitalized for treatment.
How Long Is A TMS Therapy Course?
The ability for TMS to provide relief of symptoms varies greatly from person to person. Therefore the length of a TMS Therapy course can vary greatly. Your psychiatrist will recommend a schedule of sessions based on your individual need and response to treatment. So while patients typically receive 20-30 treatments over a 4-6 week period, the actual number of treatments can range anywhere from 10-60 treatments over a 4-10 week period. Treatments are performed during the weekdays usually five days a week and each procedure lasts approximately 30-60 minutes.
Will I Need Retreatment?
Maintenance TMS is not well studied and opinions vary greatly on its necessity and effectiveness. At this time, there is no solid evidence to support the use of Maintenance TMS once the initial episode of treatment is over. However, many psychiatrists believe that Maintenance TMS sessions can prevent recurrence of symptoms. Some patients receive regular intermittent treatments after their initial course to alleviate symptoms such as low mood, and report satisfactory results from Maintenance TMS. Psychiatrists that support Maintenance TMS suggest a frequency of sessions that can range from 1 per week to as little as 1 per month. It is highly recommended that you talk to your doctor about Maintenance TMS before starting your initial course.
Why Do I Need An Initial TMS Assessment?
The assessment will review your treatment history and determine if TMS is right for you.
What Should I Expect At The Initial Assessment?
The assessment will determine a diagnosis and determine the risks and benefits of TMS compared to other available treatments for your diagnosis. Your supervising psychiatrist might also want to discuss the off-label treatments of TMS for symptoms such as bi-polar disorder, schizophrenia, and OCD. A physical examination from your primary care physician may be requested by your TMS psychiatrist, and would be used to screen for any limiting physical conditions.
What Should I Expect At My First TMS Session?
The first TMS session is about 1-2 hours long. The extra time is used to determine your motor threshold and to properly fit the coil or device to your head. After that, you should begin your first treatment.
What Happens During A TMS Treatment Session?
TMS treatment is very non-invasive. There is no anesthesia or sedatives so patients are awake and alert the whole time. For the patient it is a very straightforward process. Expect to sit in a specially designed chair; to wear ear-plug (due to the sound of the device); get comfortable and read or watch television.
What Should I Expect After A TMS Treatment Session?
Because no sedatives or anesthesia is administered during TMS treatment, patients can immediately resume normal daily activities after each session including driving, working, and other normal routines. Just as patients can transport themselves to treatment they can also drive themselves to work or home immediately following the treatment session. Most patients discover that with TMS treatment no post-session recovery period is required.
How Long Is Each Treatment Session?
Treatments are performed during the weekdays usually five days a week and each procedure lasts approximately 30-60 minutes.
Where Do I Go To Receive TMS Therapy?
TMS is a very standard outpatient procedure, often times done right at the Psychiatrist office.
Will I Still See My Psychiatrist During TMS Therapy?
Patients are usually asked to keep an appointment with a psychiatrist to assess progress and note the condition of your symptoms.
Benefits and Safety
How Soon Until Benefits Are Felt?
It is commonly reported that patients need 30 to 40 sessions of TMS to derive the most benefit in the treatment of their depression symptoms. In clinical trials, 1 in 2 patients achieved significant relief of symptoms after four weeks of treatment and 1 in 3 experience complete remission after six weeks of treatment. Some patients may experience results in less time, while others may take longer.
Do the Benefits Diminsh Over Time?
The benefits from TMS have been shown to hold up very well. Of the Patients who initially reported improvement in their depression symptoms from TMS Therapy, most reported continued benefits three years later.
What Are the Benefits of TMS Therapy?
TMS Therapy can be a life changing treatment for patients suffering from the most severe depression symptoms. Benefits of TMS include a reduction in: Emotional effects, Anxiety, Changes in appetite, Body aches, and Lack of energy.
What If I Feel No Benefits From TMS Therapy?
If you find that you or your loved one are not experience results from TMS, there are other options available. Patients with more severe resistant depression may find greater improvement from other brain stimulation techniques such as ECT and VNS. As always, you should work with your psychiatrist about what the next best treatment options are and ask them to make appropriate referrals for further treatment.
What Is the Most Common Side Effect?
Mild to moderate scalp irritation and mild headache effect nearly one half of all patients and usually goes away after the first week of treatment. If symptoms do persist after the first two weeks, over-the-counter analgesic may be taken. If symptoms still persist, the TMS physician can reduce the strength of the magnetic field pulses being administered to make treatment more comfortable.
Is TMS Safe?
TMS is a generally safe procedure with over two decades of intense clinical and scientific research behind it. In 10,000 treatments during clinical trials, the most common side effects are mild to moderate scalp discomfort and mild headaches, both of which usually went away in the first week of treatments. In a very small percentage of instances there were reports of acute memory loss, minimal cognition interruption, facial twitching, and seizures. These side effects were acute and TMS showed no long-term issues.
What Are the Potential Side Effects?
The most common side effects is mild to moderate scalp discomfort and mild headaches, both of which usually went away in the first week of treatments. In a very small percentage of instances there were reports of acute memory loss, minimal cognition interruption, facial twitching, and seizures.
Some TMS patients may experience an effect referred to as The Dip. The Dip is a possible effect which sometimes happens when progress of your TMS Therapy is temporarily reversed. Symptoms of The Dip can include a sudden and deepening increase in depression, and it can appear as though there has been an almost complete reversal of progress. For this reason, The Dip can feel very defeating and cause undue stress to a patient undergoing TMS Therapy. However, it is important to remember that these effects are only temporary. People who experience this reversal in progress appear to usually gain it back.
What is The Dip
The Dip is a term used to refer to the effect which sometimes happens when progress of your TMS Therapy is temporarily reversed. Initially, researchers dismissed this slide in progress as an anomaly in treatment. However, as more clinical studies are conducted, it is becoming very apparent that a sizable number of patients may experience The Dip during their treatment.
Symptoms of The Dip can include a sudden and deepening increase in depression, and it can appear as though there has been an almost complete reversal of progress. For this reason, The Dip can feel very defeating and cause undue stress to a patient undergoing TMS Therapy. However, it is important to remember that these effects are only temporary. People who experience this reversal in progress appear to usually gain it back, and tend to continue towards the goal of alleviating their depression symptoms.
Unfortunately at this time not much is know about what causes The Dip, only that it’s effects are temporary.
What Is the Likelihood of a Side Effect?
Mild to moderate scalp irritation and mild headache effect nearly one half of all patients and usually goes away after the first week of treatment. If symptoms do persist after the first two weeks, over-the-counter analgesic may be taken. If symptoms still persist, the TMS physician can reduce the strength of the magnetic field pulses being administered to make treatment more comfortable. Less than 5 percent of patients treated with TMS Therapy discontinued treatment due to side effects.
Does TMS Cause Memory Loss
In clinical studies, approximately 5 percent of patients experienced slight memory loss or confusion. These effects were only temporary though, and there is no evidence that TMS causes permanent or even long-term memory loss.
Does TMS Cause Brain Tumors?
Does TMS Hurt?
The actual TMS feels like a tapping on the head. TMS is essentially painless because the induced current does not pass through the skin, where most of the pain nerve endings are located.
However, there are some side effects that may cause mild to moderate discomfort. The most common of these side effects is scalp irritation and headaches. These and all observed side effects are acute and should only last temporarily. If symptoms persist, over-the-counter analgesic may be taken or the TMS physician can reduce the strength of the magnetic field pulses being administered to make treatment more comfortable.
Less than 5 percent of patients treated with TMS Therapy discontinued treatment due to side effects.
Has TMS Been Approved By Government Regulatory Agencies?
After more than two decades of research and clinical trials, TMS Therapy was cleared by Canada Health in 2003 and the FDA in 2008 . TMS has also been approved in Europe and Israel for treating patients. As such, the actual administering of TMS is very precise and well regulated the world over.
What Are the Potential Long-Term Side Effects?
In 10,000 treatments during clinical trials, there were no observed long-term side effects associated with TMS. While TMS is widely considered to be safe, it is important to point out that because it is a new treatment, there has not been enough time to gauge any unforeseeable risks that are not currently recognized.
What If I Experience A Side Effect From TMS Therapy?
If you experience a side-effect, alert your TMS technician and assessing psychiatrist. If symptoms persist, the TMS physician can reduce the strength of the magnetic field pulses being administered to make treatment more comfortable.
Less than 5 percent of patients treated with TMS Therapy discontinued treatment due to side effects.
TMS Therapy VS. Others
Is TMS Like ECT?
While both TMS and Electroconvulsive Therapy (ECT) are effective in the treatment of depression, there are many differences in safety and tolerability. Both are designed to treat depression through the application of energy into the brain, but the similarities quickly dissolve.
ECT is a much more intensive and invasive procedure than is TMS Therapy. ECT is designed to create seizures and requires hospitalization. The side effects from ECT are much more intense and occur in more instances. TMS is an outpatient procedure with little side-effects.
What Is The Difference Between TMS And Antidepressants?
- Antidepressants have numerous side effects such as nausea, diarrhea, insomnia, sedation, lack of emotion, and sexual problems; TMS has very little to no side effects.
- Antidepressants are systemic, meaning that the medicine enters the body and blood stream; TMS is non-systemic.
- TMS is usually prescribed when antidepressants fail.
Is TMS Therapy A Good Alternative To Antidepressants?
Most doctors and psychiatrists agree that TMS Therapy is also a good alternative for patients who cannot tolerate the side effects associated with antidepressant medications or do not wish to take them. Many patients suffer intolerable side effects to commonly used antidepressants, such as nausea, diarrhea, insomnia, sedation, lack of emotion, and sexual problems. TMS is non-systemic, so nothing enters your body or your bloodstream. That means that TMS is free of side effects typically associated with these medications. This also means that patients can immediately return to regular activity after TMS sessions.
Should I Take My Medications While Receiving TMS?
Patients may continue to take antidepressant medication while receiving TMS therapy if recommended by their physicians.
TMS Therapy Cost
How Much Does TMS Therapy Cost?
In 2013, the typical cost for a course of TMS Therapy ran from 8000 to 10000 dollars.
Is TMS Covered By Insurance?
It is highly recommended that patients work directly with their insurance companies to determine coverage. Contact your insurance company before your first visit to see if TMS is a covered benefit. Many insurance providers have pre-certification requirements for TMS and reimbursement can be delayed. So for instance, while the initial assessment for TMS is typically covered by insurance plans, the patient may be responsible for full payment until reimbursement from their provider. Worse still, the patient may be liable for full payment if TMS isn’t covered at all.
What Costs Are Covered By Insurance?
Some companies provide full reimbursement fees, while most offer only partial reimbursement.
Even for patients with insurance coverage, payment for TMS Therapy is usually made out-of-pocket by the patient at the time of service. This means patients are responsible to pay for all services until reimbursement from their provider. At the very least, patients should be prepared to cover all fees and copays. That is why it is important to call your insurance provider before starting even the initial assessment of TMS.
Can My Doctor Help Me With My Insurance?
Health insurance is notoriously difficult to navigate, and unfortunately the responsibility for proper understanding of insurance coverage falls on you the patient. However, most offices, clinics, and hospitals should be able to help you understand your benefits, file claims, and receive reimbursement. In an effort to help you negotiate reimbursement with your insurance company, your care provider should be willing to provide copies of your initial evaluation as well as ongoing clinical assessments which you can mail along with the insurance claim.
What Are the Insurance Codes for TMS Therapy?
Your carrier may ask you for the TMS CPT codes: the motor threshold CPT Code is 90867, the TMS treatment code is 90868, and the reassessment of the motor threshold code is 90869
What If My Insurance Doesn’t Cover TMS Therapy?
In most cases insurance companies do not list TMS as a regular benefit. However, it is possible to appeal these decisions to your insurance provider. Many patients who have appealed to their insurance provider have been able to obtain some coverage of the treatment. Either way, insurance companies usually determine eligibility for TMS on an individual basis and it is not guaranteed how insurance providers will decide your case.
If your insurance provider does not cover any costs or only covers partial costs of TMS Therapy, then the burden of payment falls squarely on the patient. However, there are options out there to help patients handle the high costs of TMS Therapy including Private Lenders, Flexible Spending Accounts, and Patient Financing Loans.
What If I Can’t Cover the Costs of TMS Therapy?
If you feel that covering costs for TMS Therapy may be a problem, it is important to use a TMS provider who is able to discuss and help you with payment options for TMS Therapy. You will want to choose a TMS provider who provides finance counseling and is able to help you in securing a loan and/or setting you up on a payment plan.
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