FAQs About TMS

What is TMS?

TMS stands for Transcranial Magnetic Stimulation, a safe and non-invasive treatment for Treatment Resistant Major Depressive Disorder (TRMDD) and Obsessive Compulsive Disorder (OCD).

Will this work?

TMS, when utilized for major depressive disorder has a good chance to work for you. Results in our clinic have shown that about 75% of our patients have had a response (a response is a reduction in symptoms of at least 50%) to TMS and about 50% have gone into full remission of their depressive symptoms. There are some individuals that TMS will not work for. TMS for OCD has varied results.

Does insurance cover TMS treatment?

Because of the large number of individuals benefiting from TMS, most insurance companies including Medicare are providing coverage. We can help you find out whether your insurance will cover treatment. TMS costs are more affordable than you may think or have heard.

TMS for OCD is not a widely covered treatment option. Call our office today to discuss further.

Who benefits most from TMS?

TMS treatment is beneficial for those suffering from TRMDD. Those who wish to avoid the side effects of antidepressants can also be helped.

What is a typical TMS treatment session like?

You will be seated comfortably in our private treatment room. A TMS device will be positioned onto your head and you will begin to feel a tapping sensation every few seconds. You may watch TV, read, or use your phone during treatment. A TMS technician will remain in the room to ensure your comfort and care. After the 20-minute session, you will be able to resume daily activities without limitations.

Is it safe?

Yes. TMS was cleared by the FDA in 2008 and is only contraindicated in patients with implanted metallic devices or non-removable metallic objects in or around the head (except for standard amalgam dental fillings).

Does it hurt or are there any side effects?

Generally, TMS is well tolerated.  A few patients have reported slight headaches, toothaches, or some discomfort at the treatment site which goes away at the end of each treatment session.

How long does a treatment take? How many sessions do I need?

A treatment session takes approximately 20 minutes a day, 5 days a week for 36 total treatment sessions or about 6-8 weeks.

Is TMS better than antidepressants?

Antidepressants work for some individuals. About 30% of the depressed population are resistant to antidepressant medications and others cannot tolerate the side effects of medication. This is where TMS becomes an option for you.

Is TMS better than Electroconvulsive Therapy (ECT)?

Both treatments have been found to be helpful for treatment resistant depression.  ECT is the preferred treatment for depression associated with psychotic features, catatonia or active suicidal thoughts; however, ECT is very invasive as it requires anesthesia, electrodes, and electric shocks, and often results in memory loss.  TMS uses safe, non-invasive magnetic pulses and has been shown most “treatment resistant” patients respond to TMS.

Will TMS affect my current medications?

Patients usually stay on their current medication regimen throughout the TMS treatment.

Why have I never heard of TMS before?

TMS was first widely used in the USA after receiving FDA clearance starting in 2008. It was in 2015 that insurance companies first realized how effective TMS treatment can be and thus started providing coverage for this treatment.

When will I start feeling the benefit of treatment?

Benefits of treatment vary person to person. While some individuals may notice a benefit within the first week, for a majority of individuals, the benefits aren’t realized until at least session number 20.  There are however a small number of individuals for which TMS unfortunately is not effective.

Should my hand twitch during treatment?

If you are utilizing the NueroStar Advanced Therapy device, it is uncommon for this to occur. However, if you are utilizing the Brainsway Deep TMS, the magnetic field may be broad enough to elicit an involuntary movement in your hand. This movement only occurs during the 2 seconds that you are receiving the magnetic pulses.

Can I skip treatment days for vacation, other appointment, etc.?

While it is recommended that treatments occur 5x a day for the first six weeks, we understand that it may be unavoidable to miss a day here and there. It is ok, and the efficacy of the treatment should not be impacted.

Can I use earbuds or headphones during the treatment?

No.

Do I need a referral?

No, a referral is not necessary. If you would like us to, we can collaborate with your existing health care providers.

What can I expect at my initial consultation?

Prior to your consultation, you will be emailed an intake packet. It is important that the intake packet be filled out. Particularly, please focus on the medication trials (names of medication, approximate dosages and dates started and stopped). You will then have a complete psychiatric examination completed by a Board Certified Psychiatrist. The Doctor will also explain what TMS is, how it works, examine the risks and benefits and answer all your questions.

Our office staff will also collect your insurance information and provide you with an estimate of your out of pocket cost, if any, and present to you, flexible payment arrangements.

What happens after my consultation?

If you meet the criteria to receive treatment, we will submit the necessary information to your insurance company for prior authorization of TMS. We have significant experience in collaborating with the insurance industry. We try only to present strong cases for consideration.  About a week or so after your initial consultation, we should have an answer from your insurance company on if TMS treatment will be authorized. Once authorized, we can begin your course of treatment soon thereafter.

When is your office open? How late or early can I schedule an appointment?

Our hours are flexible. We understand the time commitment that TMS therapy involves. Therefore, we operate by appointment and are able to accommodate times as early as 6:30am- 6:00pm.

What if my insurance changes during treatment?

If this occurs, please let us know right away. We would need to speak with your new insurance provider and attempt to gain prior authorization.

Can I pay out of pocket?

Yes, we offer a few different options for you. Contact us directly for details.

What if I don’t meet all the criteria, such as, trying three different medications?

If you have not tried the necessary number of medications to meet the insurance company guidelines for treatment, call our office and talk to our staff about your options.

Do I have to stop my current medications to get treatment?

No, this is not recommended. If necessary, medications can change during treatment, but we must be informed of any changes.

Can I switch between Neurostar and Brainsway?

This is not recommended but could be a conversation that you and the Doctor could have.

I’ve been treated with TMS before, can I get treatment again?

Yes. If after your first course of TMS treatments, you have experienced a 50% reduction or greater in symptoms and have a recurrent episode of your major depression, your insurance company may authorize an additional course of treatment. Typically, insurance companies like to see 6 months of sustained results before they will authorize another treatment course.

Maintenance:

While research suggests that maintenance therapy is beneficial, insurance companies are reluctant to provide benefit coverage. A recommended maintenance schedule for those who have achieved a response from TMS would be: 2 treatments per month for the first two months, then 1 treatment per month thereafter.

A recommended maintenance schedule if remission is achieved would be: 1 treatment per month. It is worth reiterating, insurance companies have not been known to authorize maintenance sessions and this would be an out of pocket expense.

What is the TMS Dip?

Most patients go through TMS with zero to mild side effects. But some patients may experience what is commonly called a “dip” early to midway through the course of treatment.  A dip is a temporary worsening of symptoms and can feel frustrating for those who had expected to only feel positive results from treatment. In our clinic, approximately 10-15% of patients experience a temporary exacerbation of symptoms, which often occurs in the 2nd or 3rd week of treatment. During a dip, patients may experience worsening symptoms of depression and/or anxiety.

TMS electrically stimulates neurons in the brain. This stimulation causes a temporary disruption of the brain’s normal pattern of activity (its “habits”). This disruption typically effects individuals in one of two ways: a) increased alertness and/or energy, or b) as a worsening of depressive and/or anxiety symptoms, “the dip”. This disruption is only temporary, and with time, the brain forms new neural pathways. Once these new neural pathways fully develop, patients start to experience the positive benefits of TMS.

I finished all 36 sessions, Now what?

We recommend that you continue your current medications as prescribed. If symptoms remain under control, you may decide to work with your current outpatient provider to simplify or decrease your current medication regimen. We recommend all medication adjustment be made slowly and under the close supervision of you outpatient provider. Some patients elect to engage in “Maintenance” TMS. Maintenance TMS is generally not covered by insurance and has not been widely studied for efficacy. Our clinic has developed a Maintenance TMS program and have seen positive results from Maintenance TMS.

Why do treatment sessions feel different from day to day?

Many factors may contribute to this: hydration, caffeine, medication timing, humidity, sleep variations, and sinus congestion to name a few. Think of the magnetic pulses as waves that especially on the periphery may bounce slightly differently based on subtle changes. The helmet position is aligned with one pre-determined coordinate and is placed in the same position each day. Although the primary target area for the magnetic field pulses is the dorsolateral prefrontal cortex and is always receiving the appropriate dose, the superficial and peripheral areas of the scalp, face, jaw, eyelids and hands may feel slightly different from day to day.

Can TMS help with PTSD, ANXIETY, or OCD?

In the United States, the Food and Drug Administration (FDA) has only approved TMS for treatment-resistant major depressive disorder (MDD) and obsessive-compulsive disorder (OCD). However, numerous clinical trials provide evidence that TMS can safely and effectively treat other conditions, such as anxiety, PTSD (post-traumatic stress disorder), Parkinson’s disease, and ADHD, any symptoms of these illnesses may improve as well, even though the primary treatment goal is to alleviate symptoms of clinical depression and/or OCD. Currently, our office does not explicitly use TMS to treat Bipolar Disorder, Psychosis or Schizophrenia.

Will missing a treatment affect my results?

Intermittently missing a treatment should not have an impact efficacy.

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