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TMS Therapy Basics
What Is TMS?
TMS stands for transcranial magnetic stimulation. It is used to treat depression by stimulating the brain non-invasively using electromagnetic fields, similar to those produced by an MRI machine. During TMS Therapy, a magnetic field is administered in very short pulses to the part of your brain that research has demonstrated to be associated with depression.
How Does TMS Therapy work?
Once the TMS device is positioned, it creates a deep magnetic pulse that targets and stimulates brain cells (neurons) in the left prefrontal cortex to restore normal function in these under-performing areas of the brain. This pulse comes in rapid succession and stimulates regions of the brain that are linked to emotion. This results in changes that are beneficial in the treatment of depression.
Who is TMS suitable for?
TMS Therapy is indicated for the treatment of Major Depressive Disorder (MDD) in adult patients who have failed to receive satisfactory improvement from prior antidepressant medication. TMS is available upon the prescription by a licensed physician. It can be used in both inpatient and outpatient settings including physicians’ offices, clinics, and hospitals.
While TMS Therapy is considered to be a well-tolerated treatment with very few limitations, there are some patients it is not suitable for:
- Patients with a history of seizures
- Patients with any type of non-removable metal in their heads (with the exception of braces or dental fillings)
- Patients with any type of non-removable metal within twelve inches of the coil should not receive TMS Therapy
What is a typical course of treatment?
In clinical trials, patients received TMS Therapy 5 times per week for 4-6 weeks. Patients treated with TMS Therapy should receive treatment for a minimum of four weeks; however, a course of TMS Therapy can vary and our practitioners will recommend and schedule the number of sessions based on your needs and in response to how your treatment proceeds.
Success And Safety Of TMS
Is TMS Therapy safe?
TMS Therapy is well tolerated and has been proven to be safe in clinical trials. It is FDA approved for the treatment of depression. Because it is not a depression drug, TMS Therapy does not have the side effects that are often associated with antidepressant medications.
To date, more than 30,000 patients have been treated with TMS Therapy. In the 10,000 treatments during the clinical trials, the most common side effect was mild to moderate scalp discomfort and mild headache, both of which usually went away after the first week of treatment.
Are there side effects?
The most common side effect related to treatment during clinical trials was scalp discomfort during treatment sessions. This side effect was generally mild to moderate, and occurred less frequently after the first week of treatment. Individuals with migraine headaches tolerate the treatment well and some find their migraine headaches improving as a result of TMS Therapy. If necessary, you can treat this discomfort with an over-the-counter analgesic.
In clinical trials, over 10,000 TMS treatments demonstrated its safety, with no occurrence of seizures. However, there is a small risk of a seizure occurring during treatment, although this risk is no greater than what has been observed with oral antidepressant medications.
Has TMS Therapy been cleared or approved by the FDA?
After more than two decades of research and clinical trials, TMS Therapy was cleared by Canada Health in 2003 and cleared in the USA by the FDA in 2008. TMS has also been approved in Europe, Israel, and Australia for treating patients. As such, the actual administering of TMS is very precise and well regulated the world over.
Is TMS Therapy uncomfortable?
TMS treatments feel like a tapping on the skull. TMS is essentially painless because the induced current does not pass through the skin, where most of the pain nerve endings are located. In clinical trials, less than 5 percent of patients treated with TMS Therapy discontinued treatment due to side effects.
However, there are some side effects that may cause mild to moderate discomfort. The most common side effect is scalp irritation and headaches. These and all observed side effects are acute and should only last temporarily.
What Benefits Can I Expect From TMS?
How long before I feel differently or better?
TMS is typically recommended for 4 to 6 weeks based on how quickly a patient’s mood improves and remains stable. Not uncommonly, patients begin to experience results within the first 2-3 weeks of treatment. In clinical trials, over 50% of patients achieved significant relief of symptoms after 4 weeks of treatment. Some patients may experience results in less time, while others may take longer.
What are some benefits of TMS Therapy?
In many cases, TMS Therapy can be a life changing treatment for patients suffering from severe depression symptoms. Some of the benefits of TMS include increased vitality, better sleep, clearer focus, and improvement in relationships.
Unlike medications and other forms of depression treatment, TMS is not associated with the common side effects of weight gain, sexual problems, sleepiness or memory loss. TMS is ideal because it has none of the side effects of tradition medications and because it is a noninvasive procedure, it does not involve surgery or sedation of any kind.
Although TMS was originally used in the treatment of depression, it can also be effective in the treatment of a wide range of different disorders, including Tinnitus, Generalized Anxiety, Obsessive Compulsive Disorder (OCD), PTSD, and Postpartum Depression. TMS is also undergoing clinical trials for the treatment of Autism, Parkinson’s and Alzheimer’s.
Does TMS Therapy cause brain tumors? How about memory loss?
No. TMS Therapy uses the same type and strength of magnetic fields as MRIs (magnetic resonance imaging), which have been used in tens of millions of patients around the world and have not been shown to cause tumors. The magnetic energy used in a full course of TMS Therapy is a small fraction of just one brain scan with an MRI. Moreover, clinical trials demonstrated that TMS Therapy does not result in any negative effects on memory or concentration.
How long do the results of TMS last?
The long-term antidepressant effect of TMS has been shown to last beyond 12 months following treatment. In a clinical trial, 2 out of 3 patients who had either responded to treatment or completely remitted their depression symptoms reported a year later that they remained at the level they were at upon completing their treatment. Additionally, after the trial, only 1 in 3 patients needed to return for ‘maintenance’ TMS sessions.
TMS vs. Other Treatments
Is TMS like Electroconvulsive Therapy (ECT)?
No, the two procedures are very different. ECT is a treatment based on using electricity to induce seizures. Conversely, Transcranial Magnetic Stimulation uses magnetic pulses to non-invasively stimulate specific brain regions associated with major depressive disorder. ECT requires anesthesia and has serious side effects, including memory loss. TMS therapy is performed in our offices, requires no anesthesia, and has no systemic side effects.
What is the main difference between TMS and antidepressants?
Antidepressant medications have numerous side effects such as weight gain, sexual side effects, gastrointestinal distress, insomnia, fatigue, and others. Unlike medications, TMS is non-systemic and does not enter the blood stream, meaning there are little to no side effects.
Do I take my medication(s) while receiving TMS? After?
Many patients who suffer from antidepressant medication side effects or feel they are taking too much medication to manage their mood disorder have the desire to lessen medications during or after TMS Therapy. Our goal is to help get patients to a stable mood state and potentially lessen the dosage or amount of medications. In many cases, we have had success in lowering or eliminating medications in patients who maintained mood stability after TMS. However, each patient is different, and we carefully monitor each patient’s needs individually.
Is brain imaging necessary for TMS Therapy for depression?
Brain imaging (MRI’s, CT’s, etc.) is not necessary to determine the appropriate area of TMS treatment for depression. The area of treatment known as the Dorsal Lateral Pre-Frontal Cortex (DLPFC) can be properly located and confirmed without the use of brain imaging scans. There is no research supporting the notion that treating an area of your brain other than the DLPFC or using scans to locate other areas delivers better outcomes than the FDA method.
Cost & Coverages
How much does TMS Therapy cost if paid out of pocket?
The typical cost of TMS Therapy ranges from $250-400 per session, or $7,500-10,000 for the full 30-session course. If your insurance provider is not presently covering TMS and you would like assistance securing coverage, NeuroStim can check on your benefits and help you negotiate with your insurance provider for reimbursement, which is determined on a case-by-case basis.
Is TMS covered by my insurance?
TMS Therapy is covered by many insurance companies, including Premera Blue Cross, Regence, United Healthcare, Humana, Aetna, and the VA (TriCare) to name a few. If your insurance provider is not presently covering TMS and you would like assistance in securing coverage, NeuroStim can work as a patient advocate, on your behalf, to determine benefits and help you negotiate with your insurance provider for reimbursement, on a case-by-case basis.
What if my insurance doesn’t cover TMS Therapy?
In some cases, insurance companies do not list TMS as a regular benefit. However, NeuroStim will work on your behalf to appeal these decisions to your insurance provider. In many cases where we have appealed to an insurance provider we have been able to obtain some or complete coverage of the treatment.
In some cases, or for treatment outside of depression, your insurance provider may not cover any costs of TMS Therapy. Then the burden of payment falls squarely on the shoulders of the patient. However, NeuroStim has options to help patients handle the costs of TMS Therapy, including use of credit cards and Patient Financing Loans.