about TMS Therapy
What is TMS therapy?
TMS is a non-systemic form of neuromodulation, which stimulates neurons in the prefrontal cortex by delivering highly focused MRI-strength magnetic pulses. TMS was FDA cleared in 2008 for the treatment of depression in patients who have not benefited from prior antidepressant medication. Patients undergo treatment five times weekly for approximately 6 weeks and remain awake and alert throughout the treatment. Because TMS is non-invasive and is virtually free of adverse effect, with the exception of transient discomfort and a minimally increased seizure risk.
Is TMS therapy covered by my insurance?
Most regional and national health insurers have a coverage policy for TMS therapy. This includes Medicare. The coverage requirements vary depending on your health plan. Most major health insurance plans offer coverage that ranges from partial to complete reimbursement.
Bay TMS is In-Network with most insurance carriers. We recognize that navigating insurance coverage, deductibles, co-pays, and co-insurance details is not easy. We make that our job. We have a dedicated and experienced team to verify your benefits and help you gain coverage. We manage all required documentation and communication with the health insurer to relieve this burden from you and your family.
For those without insurance or high deductibles and co-pays, Bay TMS offers long-term financing plans.
How Effective is TMS therapy at BayTMS?
Our clinical team administers weekly clinical rating scales to measure each patient’s progress during and after treatment. This practice is essential for us to accurately assess the clinical impact of TMS therapy on symptom reduction and to make any adjustments in order to achieve a greater clinical response.
Here are the actual results in our first 500 patients:
Over 80% of our patients have a response to TMS therapy (see graph below)
Over 95% of our patients have received minimal or no relief from 4 or more antidepressants
Many patients seek TMS therapy due to the side-effect burden of antidepressants. We find the most common side effects are:
Sexual dysfunction (including reduced desire)
Our Approach to Treatment
At BayTMS we recognize that each person is unique and requires treatment that is optimally suited for him or her. We are fortunate to have three different FDA-cleared devices - the Brainsway, MagVita, & Neurostar TMS Therapy systems - so that we can match the patient's clinical needs to the many different treatment approaches that we have available. Each of the devices has been proven to be clinically sound in treating Major Depressive Disorder and yet each has unique features.
Having this variety of TMS devices also allows us to treat other medical and mental health conditions such as:
• Bipolar Depression
• Obsessive-Compulsive Disorder
• Auditory Hallucinations
• Chronic Pain
• Generalized Anxiety Disorder
The typical initial course of treatment at BayTMS is usually under 20-minutes per treatment. Treatments are given Monday through Friday, five times per week for six weeks, often followed by a three-week taper period, Patients typically complete 36 treatments over the nine-week period.
How does it work?
This non-systemic therapy stimulates nerve cells in the area of the brain responsible for mood regulation (the dorsolateral prefrontal cortex). Through a treatment coil, the TMS therapy system generates highly concentrated magnetic fields which turn on and off rapidly to stimulate regions of the brain that are thought to be linked to emotion. These magnetic fields are the same type and strength as those produced by a magnetic resonance imaging (MRI) machine. They do not directly affect the whole brain, as they only reach a few centimeters into the brain directly beneath the treatment coil.
TMS stimulates brain cells or neurons in the prefrontal cortex area of the brain, inciting the electrical signal to travel through the neurons to their synapses which triggers the release of neurotransmitters like serotonin, norepinephrine, and dopamine. With more neurotransmitters released into the synaptic cleft, more receptor sites are needed on the receiving neuron. As a result, neurons begin to develop greater connectivity with each other. As the stimulation is repeated, this neuronal activity eventually becomes self-sustained. This process, called “neuroplasticity” involves actual changes within the brain, which allows the benefits of TMS to persist even after treatment ends. With increased activation in this area of the brain, patients' symptoms diminish and patients may achieve remission of their depression.
During treatment, the patient hears a clicking sound and feels a tapping sensation on the head as the pulse is being delivered. The most common side effect is generally mild-to-moderate pain or discomfort at or near the treatment area during the session. When this occurs it is temporary, and typically occurs only during the first week of treatment. The patient remains awake and alert throughout the treatment, and each treatment takes about 20-45 minutes per day. TMS is administered five days a week, for a minimum of six weeks. Patients can drive themselves to and from their treatment sessions.
Who does not qualify for TMS therapy?
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 who have metal implants or objects in or around their head (like surgical clips) may not be appropriate candidates for TMS Therapy. Dental fillings are not a problem, nor are most other metal dental implants. TMS may be used with caution in patients with implanted devices such as pacemakers.
While TMS has not yet been specifically cleared for these situations, is has been shown in preliminary studies to be safe and effective when used in pregnant women, the elderly, and adolescents. There is an extremely low risk of having a seizure – less than 1 in 10,000 – but if you have had a seizure in the past, special precautions may be necessary.
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. ECT, while highly effective, is a much more intensive and invasive procedure than TMS therapy. ECT requires an intravenous line and general anesthesia. It induces seizures that affect the entire brain and is usually performed in a hospital. Recovery from an ECT treatment session occurs slowly, and patients are usually closely monitored for several hours after a treatment. Short-term confusion and memory loss are common, and long-term disruptions in memory may occur in some people. When ECT is performed in an outpatient setting, patients require caregivers to transport them home and are usually not able to resume normal activities for at least 24 hours after each treatment.
TMS therapy requires no anesthesia or sedation and uses non-invasive magnetic stimulation to target one specific brain region. It does not produce a seizure. During TMS therapy, the patient sits in a chair and is awake and alert throughout the entire procedure. Patients may transport themselves to and from treatment and may resume full normal activities immediately following each treatment.
TMS therapy can be effective in treating depression for those who have failed ECT previously.
Does it 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 and in fact in some promising early studies, it has been shown to be effective in treating memory loss due to Alzheimer’s Disease.
How long does the antidepressant effect of TMS therapy last?
Most patients maintain the benefits of TMS for months to years afterward. About 20% of our patients return for treatment, either a brief series or full retreatment at some point in time, but most of the time that is not needed.
Can I take antidepressants if I am receiving TMS therapy?
Yes. In clinical trials, TMS therapy was safely administered with and without other antidepressant medications.
Will I need TMS therapy again?
About 50 % of patients who have has a successful treatment of TMS therapy find it beneficial to receive periodic single sessions of TMS if depressive symptoms begin to reemerge. These treatments are often called “maintenance” or “booster” treatments and are usually administered once or twice per month to alleviate mild symptoms.
Is TMS effective for other neuropsychological disorders other than depression?
At the present time, TMS is used primarily for the treatment of Major Depression, which is the indication currently approved by the FDA. However, TMS can be used to stimulate different regions of the brain in different ways, and many clinical studies are currently underway. TMS has demonstrated efficacy for numerous other conditions, including Bipolar Depression, Anxiety, PTSD, Chronic Pain, Obsessive Compulsive Disorder, Migraine, Fibromyalgia, Auditory Hallucinations, and Tinnitus.
What are some of the studies done and results with TMS clinical trials?
Please view our list of abstracts from clinical studies done with TMS therapy here.
Is TMS therapy safe, and are there side effects?
TMS therapy is well tolerated and has been proven to be safe in clinical trials. Over 1 million TMS treatments have been performed in the US, with low complications and side-effects. The most commonly reported side effect related to treatment was mild to moderate scalp discomfort during treatment sessions. When it occurs, scalp discomfort occurs less frequently after the first week of treatment. If symptoms do persist, over-the-counter analgesic may be taken. Other, more rare side-effects may include facial or eye pain, toothache, facial muscle twitching, fatigue, sleepiness, or irritability. TMS therapy also produces a clicking sound, so earplugs are provided for each treatment. In the clinical trials, more than 10,000 TMS treatments demonstrated its safety with no occurrence of seizures. However, there is a small risk of a seizure occurring during treatment, estimated at 1 in 10,000.This risk is no greater than what has been observed with oral antidepressant medications.
Bay TMS has performed close to 25,000 treatments and has seen very few side effect issues and excellent success. While TMS therapy has been proven effective, not all patients will benefit from it. Patients should monitor for worsening symptoms, new symptoms, suicidal thinking or behavior and report such changes to us. Families and caregivers should also be aware of the need to observe patients and notify their treatment provider if symptoms worsen.
No side effects such as weight gain, sexual problems, stomach problems, impairment of cognition or function, or dry mouth were seen during clinical trials. TMS does not impair memory or the ability to concentrate. At BayTMS, 5% percent of patients elected to discontinue treatment.
Like any treatment option, you and your doctor will discuss the risks and success of TMS therapy and work together to find the most appropriate treatment option for you.