Psychiatrist for Depression | TMS Therapy Treatment
What is TMS Therapy?
TMS stands for transcranial magnetic stimulation. TMS Therapy 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 the brain that research has demonstrated to be associated with depression. The typical initial course of treatment is about 19-37 minutes daily over 4-6 weeks.
Is there anything I should avoid during the treatment duration?
Patients are asked to stop the use of Wellbutrin before beginning TMS and to abstain from alcohol during the course of their TMS treatment.
How soon will I start feeling the effects of TMS?
Most patients start experiencing relief after 5-10 sessions but this can vary greatly depending on the severity of Depression and the individual’s unique genetic makeup. Some may not feel the effects of TMS until as many as 40 sessions while some may feel the effect almost immediately after their first.
What are the most common side effects?
The most commonly reported side effects during clinical trials were headache and scalp discomfort. These potential side effects were typically mild to moderate, and were less common after the first week of treatment. During clinical trials, less than 5% of patients treated with TMS discontinued treatment due to side effects. If necessary, headaches from TMS can be treated with over-the-counter pain medications. If the side effects persist, the strength of the TMS pulses can be temporarily reduced to ensure the comfort of the patient.
Will I be able to drive home after a TMS session?
Yes, patients are able to resume normal activities after the treatment.
When is TMS contraindicated?
TMS is typically contraindicated for individuals with permanent metal implants in or around the head, pacemakers, history of seizure disorder, on medications that reduce seizure threshold, serious head trauma, or have had brain surgery. In some cases TMS may still be applied at the discretion of the treating physician.
Is TMS painful?
Painful no. Uncomfortable? It depends on the individual. In the great majority of patients TMS is well tolerated with only minor discomfort on the scalp where TMS is applied. Most people describe TMS as a light to moderate tapping sensation where the coil is being applied. The sensation of the pulse may feel similar to a TENS unit.
The reason for this is that there are several nerves in the scalp where TMS is being applied. Naturally some of these nerves will also be lightly stimulated by the TMS coil as they are also conductive and will pick up the pulse. This is the part of the TMS that you can feel. You cannot feel TMS in your brain, as the brain has no pain receptors itself.
And even though stimulation of the scalp nerves may cause some discomfort at first, this too subsides as the patient progresses through treatment.
How does TMS Therapy work?
The mechanism of action of TMS is still not fully understood however the response to therapy is indisputable and has consistently demonstrated results in the majority of research being done in the field. The TMS electromagnetic pulse is generated by electrical current running through the TMS coil which by method of induction (Faraday’s law) generates a magnetic field perpendicular to the coil. This magnetic field passes through the skull unimpeded and in turn generates a corresponding electric field in the brain also by method of induction. This electric field is conducted by neural pathways under the coil in a somewhat unpredicable way as brain tissue is not uniform and anatomy varies from indivual to individual. Neurons are conductive just like the rest of the nerve fibers in your body. Depending on the protocol used and frequency of TMS pulse entire regions of neurons under the coil can either become excited or inhibited. In Depression, neurons in the left DLPFC (Dorsolateral prefrontal cortex) are targeted by the coil with an excitatory protocol (FDA cleared). Subtle changes in brain state as a result of TMS can last up to several hours and even days after a TMS session has been performed. If done repetitively over a 3-6 week period TMS induces structural changes in the brain where the coil has been placed. Increased gray matter density and blood flow to the part of the brain stimulated have all been clearly demonstrated in research using MRI brain scans.
Not everyone responds to TMS Therapy for Depression but most people will. Many clinicians see a 70% – 80% response rate in their patient population. At least half of these responders will achieve full remission. In the literature TMS response rates when treating Depression have been shown to be at least as effective as medications used to treat Depression. And of course without all the side effects that medications bring.
Many patients say they can still feel benefit from TMS Therapy years after their first round of TMS treatment. The effect appears to be quite durable especially in people who respond well to treatment. In some cases patients will go back for a few TMS maintenance sessions 3-6 months after their initial treatment.
Does the CloudTMS device get reimbursed similar to other machines?
Yes. The CloudTMS TMS Machine is FDA cleared for the treatment of Depression. As such is reimbursable like all the other TMS devices currently in the US market. Our customers tell us that reimbursements can range anywhere from $150 per session from Medicare and up to $600/session from private insurers