FAQs
- What is TMS?
- How does TMS work?
- Is TMS a good alternative for patients who cannot tolerate the side effects associated with antidepressant medications?
- Is TMS like other alternative therapies which use magnets to treat some illnesses?
- Is TMS like electroconvulsive therapy (ECT)?
- What is a typical course of treatment with TMS?
- What are the potential risks of TMS?
- Who should not receive TMS?
- Does TMS cause brain tumors?
- Does TMS cause memory loss?
- Is TMS used for other neuropsychiatric disorders besides Depression?
- Are there side effects of TMS Therapy?
- Is TMS uncomfortable?
- How long does the antidepressant effect last? Will I need any therapy beyond the first 4-6 weeks?
- Can I also take antidepressants if I am receiving TMS?
- What does FDA approval mean?
- Off-Label Applications of TMS Therapy
- Will TMS be covered by my insurance and/or Medicare?
- How long has TMS Therapy been used as a treatment for depression?
- How quickly does TMS Therapy work?
- How effective is TMS Therapy as a treatment for depression?
- Is TMS Therapy a cure for depression?
- How much does TMS Therapy cost?
- Is there a consultation fee?
- How Do I Refer a Patient?
What is TMS?
TMS stands for transcranial magnetic stimulation. It is used to treat depression by stimulating the brain non-invasively using an electromagnetic field, similar to those magnetic fields 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. The typical initial outpatient course of treatment is about 30-60 minutes daily over 4-6 weeks. With the newer Theta Burst TMS treatment, each treatment is shortened to about 5 minutes daily over 4-6 weeks.
How does TMS work?
TMS therapy uses short pulses of magnetic fields to stimulate the area of the brain that is thought to function differently in patients with depression. The magnetic field produces an electric current in the brain that stimulates the brain cells (neurons). This results in changes in the brain that are thought to be beneficial in the treatment of depression. Also, depending on the treatment parameters used, neuronal activity can be stimulated or inhibited. TMS is being used to reduce anxiety, hallucinations, and symptoms of PTSD by reducing brain activity in certain areas.
Is TMS a good alternative for patients who cannot tolerate the side effects associated with antidepressant medications?
TMS therapy is non-systemic (does not circulate in the blood throughout the body), so it does not have side effects such as weight gain, sexual dysfunction, nausea, dry mouth, sedation, among others that are commonly found with antidepressant drugs. The most common side effects reported with TMS during clinical trials were headache and scalp pain or discomfort – generally mild to moderate – occurring less frequently after the first week of treatment. TMS therapy may not work for all patients with depression. You should speak with your doctor to determine if TMS therapy is an appropriate treatment option for you.
Pregnancy: Many women choose to avoid antidepressant medications during pregnancy, but depression itself has been shown to cause complications. Based on a number of studies, TMS appears to be a promising treatment option for pregnant women who do not wish to take
antidepressant medications.
Click here for 2015 Medscape article
Is TMS like other alternative therapies which use magnets to treat some illnesses?
No. TMS therapy involves a unique method of using pulsed magnetic fields for therapeutic benefit. The intensity of the magnetic field is similar to that of the magnetic fields used in magnetic resonance imaging, or MRI. These techniques differ radically from the use of low intensity, static magnetic fields. These products deliver weak and undirected static fields that are not capable of activating brain cells.
Is TMS like electroconvulsive therapy (ECT)?
No, the two procedures are very different. While both are effective in the treatment of depression, there are many differences in safety and tolerability.
During the TMS Therapy procedure, patients sit in a chair and are awake and alert throughout the entire procedure – no sedation is used with TMS therapy. Unlike ECT, patients can transport themselves to and from treatment when receiving TMS.
In over 10,000 active treatments with TMS therapy in clinical trials, no seizures were observed. However, post-marketing surveillance has shown there may be a remote risk of seizure with TMS therapy. Current evidence places the risk of seizure with TMS at 1 in 30,000 treatments. TMS therapy has consistently been shown to have no negative effects on memory function in clinical studies.
In contrast, electroconvulsive therapy (ECT), intentionally causes a seizure. Patients receiving ECT must be sedated with general anesthesia and paralyzed with muscle relaxants. Recovery from an ECT treatment session may be rapid over several minutes, or take a few hours. Patients are not allowed to drive immediately after having ECT.
Short-term confusion and memory loss are common with ECT, and long-term disruptions in memory have been shown to occur in some people. Because of the side effects associated with ECT, a significant amount of caregiver support may be required.
What is a typical course of treatment with TMS?
In clinical trials of standard TMS protocol, patients received TMS 5 times per week for 37 minute sessions, over 4-6 weeks.
In clinical trials of Theta Burst TMS protocol, patients recieved TMS 5 times per week for 3-5 minute sessions, over 4-6 weeks.
Patients treated with TMS should receive treatment for a minimum of four weeks with additional treatments based on clinical judgment. Length of treatment varies from person to person based on factors such as motor threshold and treatment protocol.
What are the potential risks of TMS?
TMS therapy is well tolerated and has been proven to be safe in clinical trials. Throughout over 10,000 active treatments performed in clinical trials, the most commonly reported side effect related to treatment were scalp pain or discomfort during treatment sessions. These side effects were generally mild to moderate, and occurred less frequently after the first week of treatment. Less than 5% of patients treated with TMS therapy discontinued treatment due to side effects.
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. Current evidence places the risk of seizure with TMS at 1 in 30,000 treatments.
While TMS therapy has been proven effective, not all patients will benefit from it. Patients should be carefully monitored for worsening symptoms, signs or symptoms of suicidal behavior, and/or unusual behavior. Families and caregivers should also be aware of the need to observe patients and notify their treatment provider if symptoms worsen.
Who should not receive TMS?
TMS therapy should not be used in patients with implanted metallic devices or non-removable metallic objects in or around the head. TMS therapy should be used with caution in patients with implanted devices that are controlled by physiological signals. This includes pacemakers and implantable cardioverter defibrillators (ICDs). It should be used in caution with patients using wearable cardioverter defibrillators.
Does TMS cause brain tumors?
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.
Does TMS cause memory loss?
No, TMS therapy was systematically evaluated for its effects on memory. Clinical trials demonstrated that TMS therapy does not result in any negative effects on memory or concentration.
Is TMS used for other neuropsychiatric disorders besides Depression?
Currently, TMS is used primarily for the treatment of Major Depressive Disorder, which is the only indication approved by the FDA. However, since TMS can be used to stimulate different regions of the brain in different ways, it is also used as a treatment for Bipolar Depression, Anxiety, Obsessive Compulsive Disorder, PTSD, Auditory Hallucinations associated with Schizophrenia, Negative symptoms associated with Schizophrenia, Migraine Headaches, Fibromyalgia, and Tinnitus. As you can see this is a very exciting and evolving technology.
Are there side effects of TMS therapy?
Since TMS does not circulate through the body, it doesn’t cause any of the side effects that medications might have such as dry mouth, upset stomach, dizziness, drowsiness, weight gain, or sexual dysfunction. The most common side effect related to treatment is scalp pain or discomfort during treatment sessions. If necessary, you can treat this discomfort with an over-the-counter analgesic. If these side effects persist, your doctor can temporarily reduce the strength of the magnetic field pulses being administered in order to make treatment more comfortable.
Is TMS uncomfortable?
The most common side effect related to treatment is scalp pain or discomfort during treatment sessions — generally mild to moderate.
If necessary, you can treat this discomfort with an over-the-counter analgesic. If these side effects persist, your doctor can temporarily reduce the strength of the magnetic field pulses being administered in order to make treatment more comfortable.
In the FDA registration trial, less than 5% of patients treated with TMS therapy discontinued treatment due to side effects.
How long does the antidepressant effect last? Will I need any therapy beyond the first 4-6 weeks?
In most patients, the clinical benefit of TMS therapy was maintained through 6 months of follow-up study. Talk to your doctor about your long-term treatment path.
Can I also take antidepressants if I am receiving TMS?
Yes. In clinical trials, TMS therapy was safely administered with and without other antidepressant medications.
What does FDA approval mean?
The NeuroStar TMS Therapy system was the first TMS device to be approved by the U.S. Food and Drug Administration (FDA) for the treatment of Major Depressive Disorder. FDA approval was based on a large, multicenter, placebo-controlled trial for the treatment of Depression (O’Reardon. Biol Psychiatry, 2007). TMS devices are currently in use worldwide, targeting a number of psychiatric and non-psychiatric disorders.
Off-Label Applications of TMS Therapy
The term “off-label” refers to the absence of FDA clearance or approval for a device or medication. Pharmaceutical companies and device manufacturers are not allowed to promote a product for any other purpose then what was studied in the FDA trials. However, once a drug or device has been approved for sale for one purpose, physicians are free to prescribe it for any other purpose that in their professional judgment is both safe and effective, and are not limited to official, FDA-approved indications. There is growing research and clinical application regarding use of TMS targeting additional psychiatric and non-psychiatric disorders. TMS Therapeutics is on the cutting edge of new research in developing protocols to discover new applications in addition to expanding on currently known uses.
Will TMS be covered by my insurance and/or Medicare?
Several major insurance carriers currently cover TMS – click here to see if your insurance is listed.
In addition, TMS has been approved by most other commercial payors on a case-by-case basis. Several factors go into whether treatment will be covered. In some cases, your insurance may pre-authorize treatment. Otherwise, attempts will be made for reimbursement for treatments already received. Our practice manger will be able to assist in determining insurance coverage, and request prior or retro-authorization. More and more patients are able to get at least partial reimbursement from their insurance company. Other funding options include cash basis, withdrawal from a healthcare flexible spending account, or financing. Many providers and patient advocacy groups are actively working to ensure TMS therapy is available under more commercial insurance companies and Medicare.
How long has TMS Therapy been used as a treatment for depression?
TMS was invented in 1985. It was originally used for research, but has been used to treat depression since the late 1990s. In 2008, the FDA approved the first TMS device, known as the NeuroStar® TMS Therapy System, which is designed especially for the clinical treatment of depression.
How quickly does TMS Therapy work?
Depression is a syndrome that can have many different symptoms and not every person with depression has the same symptoms. Therefore responses to TMS vary from person to person. However, many people report thinking more clearly and improvements in sleep pattern, energy level, and appetite during the first week or two of treatment. Many times these symptoms improve before a person’s mood.
How effective is TMS Therapy as a treatment for depression?
Clinical studies have shown that TMS is effective about 75% of the time, which means that it is twice as effective as antidepressant medications and almost as effective as electroconvulsive therapy (ECT). Half of those who respond to TMS experience significant improvement in the first four weeks of treatment.
Is TMS Therapy a cure for depression?
Everyone’s depression is different, however 90% of patients who respond to TMS continue to do well a year after treatment. Some people may require periodic or “maintenance” TMS, which often consists of just one or two treatments every few weeks or months. Some people also begin to do well on medications, even if medications did not previously help before receiving TMS treatment.
How much does TMS Therapy cost?
In the event that your insurance plan does not have an established coverage policy for TMS therapy, out of pocket expenses may be necessary to receive treatment while we work to secure insurance coverage. Since the cost of treatment can vary based on a number of factors, including the total number of treatments, it is our policy not to quote specific costs. Please contact our office to inquire further about cost and financing.
Is there a consultation fee?
Since the initial consultation is a comprehensive consultation with a complete mental health assessment, complex medical decision making, communication with your other treatment providers and a detailed introduction to TMS therapy, how it works, and how it may or may not benefit you, there is usually a fee for the initial consultation. Most of this cost should be reimbursed by your insurance plan. Although TMS Therapeutics in San Diego, Inc. specializes in TMS therapy, it may not be the right treatment for you. As a specialist in Treatment Resistant Depression, Dr. Miller can discuss other treatments options which may be more appropriate. Whenever this is the case, we will tell you and provide additional referrals as needed.
Alternatively, if your current psychiatrist is familiar enough with TMS to recommend it, only a brief consultation will be required which will not incur a fee.
How Do I Refer a Patient?
If you have a patient that might benefit from TMS, there are several options available. You may refer them for a full evaluation regarding diagnosis and review of treatment options. Alternatively, there is an opportunity to collaborate during the initial consultation and move your patient right into treatment. Patients are seen 5 days a week for 4-6 weeks. Regular follow up visits or therapy may proceed during this time. If convenient, the clinician may visit with the patient at our office before or after treatment. Also, since they are awake and alert during the treatment, a visit can be performed during a treatment session as well.
Regular updates will be provided to referring providers during the course of treatment. TMS Therapeutics in San Diego, Inc. considers our services to be in addition to usual care, and all patients will continue with the referring provider as their primary clinician.
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La Mesa, California 91942
drmiller@tmssandiego.com
Testimonials
Since I started using TMS Therapy, my perspective on life has been so positive that I now know there is hope for a brighter future.
Natalie H.
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