Below you will find a list of the most frequently asked questions people ask about TMS. We want to make sure we provide you with the best information and answer any of your questions to help you determine if TMS therapy may be right for you or a loved one.
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TMS Therapy Basics
TMS, which stands for Transcranial Magnetic Stimulation, is a non-invasive treatment currently FDA approved for patients with Major Depression. TMS is an alternative treatment for when medications don’t work.
TMS uses a MRI – strength magnetic pulse to stimulate an area of the brain. In the treatment of depression, we target the Left Dorsolateral Pre-frontal Cortex (L-DLPFC), which is associated with emotional control and response.
The TMS coil is positioned on the patients scalp to target the Left Dorsolateral Pre-frontal Cortex. This part of the brain controls emotional response. Pulses are delivered in rapid succession, delivering a total of 3000 pulses per treatment session.
In the treatment of depression, TMS causes the brain cells, call neurons, to become more active and strengthen the neural connection between them. Similar to exercise, TMS “exercises” the L-DLPFC. As the L-DLPFC becomes stronger, depression is reduced.
Up to 60% of patients respond to TMS therapy and see a decrease in their symptoms of depression. Around 25% of patients will be depression free.
During TMS patients will feel a rapid pulse against their forehead. TMS is not painful and is often described as feeling like a woodpecker.
When patients start their treatment, the TMS Technician will monitor the intensity of the pulses to insure the patient’s comfort.
The durability of TMS is often dependent on the response patients have to TMS. Those who respond well to TMS may see a decrease in response after 9 – 12 months.
Here are Southeastern Psychiatric Associates, we stay in contact with our patients throughout the year to check in with them. When patients feel a increase in their symptoms of depression, it is encouraged that they contact us and they may receive TMS re-treatment.
Transcranial Magnetic Stimulation is administered by placing the TMS coil on the patient’s scalp. Patient’s are not anesthetized and are fully conscious and aware during their treatment.
Patient’s are sat comfortably in a dentist-style chair and are able to chat with the TMS Technician or friends and family, watch tv, read a book, or use an iPad during their appointment.
TMS therapy is an appropriate treatment for patients with Major depressive disorder and have failed to achieve satisfactory benefit from medications and therapy.
TMS therapy may not be appropriate for patients who are or have:
- Pregnant
- Presence of an implanted magnetic-sensitive device located less than or equal to 30 cm from the TMS magnetic coil or other implanted metal items, not limited to:
- Cochlear implant
- Implanted cardiac defibrillator
- Pacemaker
- Vagus nerve Stimlator
- Menal aneurysm clips, coils, staples, or stents
- Seizure disorder or any history of seizures (except those induced by ECT or isolated febrile seizures in infancy without subsequent treatment or recurrence)
- Neurological conditions that include epilepsy, cerebrovascular disease, dementia, increased intracranial pressure, history of repetitive or severe head trauma, or primary or secondary tumors in the central nervous system.
- Presence of acute or chronic psychotic symptoms or disorders in the current depressive episode
- Current active history of:
- Bipolar Disorder
- Eating Disorder
- Psychotic Disorder, including Schizoaffective Disorder
Yes, it is advised that patient’s continue their medication regimen as prescribed by their providers.
TMS Therapy Process
If you think TMS may be a good fit for yourself or a loved one, please call our facility to complete the initial phone screening. Patient’s who meet the initial requirements, are sent a packet to complete, which will be reviewed by our TMS Physicians prior to an in person TMS Consultation with a doctor.
After the TMS Consultation, our facility acquires prior authorization from your insurance and your first TMS appointment will be scheduled shortly after.
Yes. Patient’s are fully aware during their treatment session and can drive to and from their appointments.
TMS treatments are run over a 9 weeks period for a total of 36 sessions. Patient’s will have appointments Monday – Friday for the first 6 weeks. Tapering will begin after week 6.
During week one of tapering, patient’s will have 3 treatments, 2 the following week, and 1 treatment during the last week of tapering.
Each individual appointment will last between 30 – 45 minutes.
During the phone screening, you will speak with the TMS Technician who will ask you a series of questions about your medical and clinical history. If you are determined to be a good fit for TMS, the technician will send you a packet to be filled out. This packet will include further information about TMS, Questionnaires, and Request for Information forms that will allow us to acquire your health records from your providers.
Once we receive this information back from you and have received your medical records from your providers, an Initial TMS Consultation will be scheduled with one of our TMS doctors.
During this appointment, the doctor will cover your clinical history with you and determine if TMS is an appropriate treatment for you.
The mapping session will be your first TMS appointment and may last 1 – 1.5 hours. During this appointment, your TMS doctor and the TMS technician will determine your motor threshold and the appropriate intensity for all following appointments.
To measure the motor threshold, the coil is place on the area of your brain that controls hand movements of your right hand. Having the patient relax their hand, your doctor will deliver single pulses and adjust the power output to involuntarily make their thumb move.
Measuring your motor threshold is a visible way to determine the minimum intensity needed to stimulate your cortex.
At the beginning of your TMS appointments, you will be greeted by the TMS Technician who will be administering your treatments.
Patient’s will sit in a dentist-style chair and are fully awake during their session. They have the choice of chatting, watching TV, reading, using a tablet, or taking the time to sit quietly. Appointments last from 30 – 45 minutes.
Yes, we advise patient’s to continue to see their psychiatrist, therapist, or other providers as they normally would.
Benefits and Safety
Trancranial Magnetic Stimulation is a non-invasive, safe, and drug free therapy with no systemic side effects. It is a great alternative for when medications do not meet satisfactory benefit.
TMS is a safe procedure. Patients are not anesthetized and are fully aware during each treatment. There are minor side effects and the research shows little evidence for long term side effects.
If you or your loved one are not experiencing results from Transcranial Magnetic Stimulation, other options may be available. Other brain stimulation techniques such as ECT or VNS may be an option for you. You should consult with your doctor or psychiatrist about the next best treatment options.
TMS has minimal side effects. The most common side effects are: Mild sensitivity or irritation at the treatment site and mild headaches.
There is a 1/10,000 incidence of a seizure during treatment.
There is no evidence that TMS causes permanent or long-term memory loss.
Yes, in 2008 TMS was FDA approved as a treatment for Major Depressive Disorder.
TMS Therapy Vs. Other Treatments
No. Although TMS and ECT are both effective treatments of depression, there are many differences in safety and tolerability.
ECT is a more intense and invasive therapy which is designed to induce controlled seizures and requires hospitalization. The side effects of ECT include memory loss, anxiety, dizziness, dry mouth, insomnia/drowsiness, and nausea.
TMS is a non-invasive outpatient treatment with minimal side effects.
- Antidepressants are systemic, which means the medication must enter the body and blood stream. TMS is not systemic
- Antidepressants can cause numerous side effects including nausea, diarrhea or constipation, insomnia or drowsiness, lack of emotion, weight gain, headaches, dizziness, anxiety and sexual dysfunction. TMS has little to no side effects.
Financial & Insurance
- Blue Cross Blue Shield
- Tufts Health Plan
- United Behavioral Health
- Optum
- Harvard Pilgrim
- Medicare
- Many Others
If you do not have an insurance that covers Transcranial Magnetic Stimulation, some patients may have the option to pay out of pocket.