Treatments

Transcranial magnetic stimulation (TMS) is a safe, effecte, FDA-approved treatment for depression and OCD that can provide long-lasting relief without the side effects of medications. TMS can also help many other psychiatric conditions.

In studies, TMS helps about 60% of patients who have failed 2 or more antidepressants.  When someone has not achieved remission with 2 or more antidepressant trials in the current episode of depression, they are diagnosed with “treatment-resistant depression,” or TRD. In comparison to TMS in people with TRD, another antidepressant medication trial only helps about 5-10% of the time.

TMS seems to improve OCD symptoms in almost half of all patients, regardless of whether they have responded to antidepressants or psychotherapy (talk therapy) for OCD.

No! TMS seems to be even more effective for severe OCD symptoms.

No. Unfortunately, there are no known cures for any psychiatric disorder, and it is possible for relapses to happen. However, TMS can provide relief lasting for years for some patients.

A typical TMS treatment course involves treatment 5 days per week for 4-6 weeks, followed by tapered treatment, for 44 total sessions. Each treatment is about 15 minutes. There are occasionally reasons for shorter or longer courses. Your provider will discuss an optimal treatment schedule with you.

TMS uses pulsing MRI-strength magnetic fields to activate nerve cells in the area of the brain responsible for mood, anxiety, OCD or other disorders. By doing this repeatedly over time, TMS can change the level of activity of these areas of the brain, and improve how different parts of the brain communicate.

Not typically. Most patients find the sensation of TMS to be mildly or moderately annoying, but not painful.

Yes! TMS is extremely safe. TMS is considered a minimal risk procedure, with no evidence of long-lasting adverse side effects.

Yes! Although there are fewer studies about children than adults, the studies that have been done show that TMS seems to be as safe and effective in children and adolescents as in adults.  However, TMS is not FDA-cleared for use in children and adolescents, so insurance often declines to cover a treatment course.  Some insurance companies will cover a course of TMS in adolescents ages 15 and older.

Risk of seizure with TMS is extremely rare, about 6 in 10,000 with the coils we use. Your provider will discuss this risk, screen for anything that may increase this risk, and will help adjust treatment to ensure it is as safe as possible.  It is important to note that all TMS-induced seizures have occurred during active stimulation (while someone is receiving treatment).  All TMS-induced seizures have stopped on their own, and no one has developed recurrent seizures (epilepsy) from TMS.

TMS has almost no side effects for most patients. 10-20% of patients have headaches, usually mild or moderate. TMS may cause mild scalp discomfort during treatment. Ear protection is necessary during TMS treatment. TMS does cause clenching down during stimulation, so some people have mild temporal-mandibular joint (TMJ) tenderness with treatment.  We provide a mouthguard during treatment to help reduce TMJ tenderness.  However, most patients have no side effects, and in studies, TMS is just as gentle as placebo TMS.

None at all! Patients can work, go to school, drive, and do anything else they like before or after TMS treatments.

Nearly all major insurances cover conventional TMS for depression for adults, although requirements vary. Insurances determine if they cover TMS based on:

• How many antidepressants have been tried - most insurances require anywhere from 2 to 6 different antidepressants.
• Whether a patient has been in therapy.
• Some insurances will cover TMS in adolescents. Our staff can help to figure this out.
• Currently, most insurance carriers do not cover TMS for other conditions, including OCD, unless a patient also suffers from depression.

Accelerated TMS protocols are not covered by and is an out-of-pocket treatment.

Absolutely! There is evidence that TMS is helpful for a variety of conditions, including:

• Post-traumatic stress disorder (PTSD)
• Anxiety/generalized anxiety disorder
• Pain disorders
• Bipolar depression
• Many, many others

Because the above conditions have not been studied enough to be approved by the FDA, they are considered “off-label.” These treatments may not be covered by insurance unless a patient is also receiving treatment for depression.

Some patients improve as soon as 1-2 weeks, though it is most common to start improving after 2-4 weeks of daily treatment. Some patients improve during (or after) the taper phase of treatment.  In fact, over 70% of patients who do not appreciate improvement during the intensive phase (daily phase for 4 weeks) do go on to show a significant improvement during the twice weekly phase of treatment.

Some patients stay better for years after a successful course of TMS. However, some patients only stay better for months, and for some, maintenance treatments may be needed.