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TMS Questions and Answers
Here are answers to some common questions about transcranial magnetic stimulation (TMS).
What is TMS therapy?
Transcranial magnetic stimulation (TMS) is a noninvasive, non-drug, non-shock procedure (or therapy) that uses magnetic fields to stimulate certain nerve cells in the brain to improve symptoms associated with specific mental health conditions, such as depression or obsessive compulsive disorder (OCD). TMS is typically used when other forms of treatment haven’t been effective or when medications can not be tolerated due to undesired side effects. Depending on the condition being treated, the protocol for treatment will vary and the time could range from a few minutes up to 45 minutes if being treated for more than one condition during the treatment session. For example, a patient may receive depression and anxiety teatment in one TMS treatment session.
Who administers TMS?
TMS is generally prescribed by a psychiatrist and the initial treatment, called a ‘mapping session’ is performed by the psychiatrist. In this first session, the doctor will map (locate) the area of the brain to be treated. The subsequent treatments are most often performed or administered by a certified TMS technician under the supervision of the physician.
The TMS technician or physician will always be present in the treatment room to monitor the patient during the treatment.
Is TMS covered by insurance?
TMS is covered by insurance for specific conditions, such as major depressive disorder for adult patients who have not received benefit from their antidepressant medications or who can not tolerate the side effects associated with medications. A prior authorization is often required ; however, depending on the type of insurance you have, there are a few plans where a prior authorization may not be required.
The prior authorization is generally obtained by the TMS clinic. Some insurances will cover TMS for other FDA-approved conditions, such as obsessive compulsive disorder. There are few insurance companies that will cover maintenance treatments with authorization. Nearly all insurance plans will cover the full course of TMS every 6 months.
While many psychiatrists successfully treat patients for non-FDA approved conditions, such as bipolar depression, anxiety, or addiction, these diagnoses are generally not covered by insurance. In rare cases, your physician may present a letter of medical necessity for conditions such as bipolar depression – which can help to obtain prior authorization from your insurance for coverage.
Lastly, it is important to note that a prior authorization for any medical procedure is not a guarantee of coverage. However, with a prior authorization it is rare that your insurance would not cover the procedure.
What conditions does TMS therapy treat?
TMS is most often used for the treatment of severe depression. TMS was first approved by the FDA as an effective depression treatment in 2008. However, TMS is also FDA-approved for obsessive compulsive disorder (OCD), with other conditions being studied at present.
Reserach indicates that TMS can be an effective treatment for other conditions, such as anxiety, post-traumatic stress disorder, pain, Alzheimer’s disease (neurocognitive impairment), fibromyalgia, smoking cessasation, addiction, bipolar depression, and other behavioral, psychiatric and neurological conditions.
Not all TMS clinics will treat for all diagoses. It is important to speak with your doctor to determine if TMS is the right treatment option for you. If your doctor is not well-versed in TMS therapy, it may be helpful to locate a TMS clinic near you to discuss your specific condition and whether or not TMS would be beneficial for you.
What are the side effects of TMS?
Unlike medications, TMS has no systemic side effects. This means there are no side effects of weight gain, sexual dysfunction, brain fog, insomnia, gastrointestinal upset, memory problems, etc. Some patients report scalp irritation at the treatment site, or a mild headache immediately following treatment. Most patients who experienced these mild side effects reported it only during the first few sessions as they adjusted to the treatment.
Though very rare, the only adverse side effect of TMS is a seizure. Appropriate screening for history of seizures before starting TMS is essential. Certain medications and or substances, such as heavy use of alcohol can lower a persons seizure threshhold. When you visit a clinic, it is important to discuss whether or not your history or current medications present a seizure risk.
How long does TMS last?
Depression is a serious mental health disorder that is very individualized in each patient. TMS provides a much sought after relief from persistent symptoms of major depressive disorder (MDD) offering patients new hope for an improved quality of life. Because depression is so complex with varying degrees of severity, it is best to say that everyone responds differently. However, an average length of remission can last up to a year, and beyond for some patients.
For other diagnoses (conditions), it is recommended that you speak with a TMS certified doctor to determine the severity of your symptoms, the best TMS treatment protocol for you, and how long you can expect to be in remission, as well as the need for maintenance therapy.
Can I stop my medications once I'm done with TMS?
Every patient is different. However, most generally, no. Medication changes are not typically recommended during TMS treatment. Discontinuing antidepressants before TMS could result in serotonin discontinuation syndrome. This could interfere with your TMS outcome. The general approach is to decrease your medication whenever possible while you are stable. In other words, once you are better after you finish TMS then you can discuss the risks and benefits of decreasing or stopping antidepressants with your doctor.
If your goal is to be off medications and TMS helped you, then your doctor may recommend maintenance TMS. Lastly, if the reason for you seeking TMS is intolerance to medications, then the answer would likely be ‘yes’, but again this would need to be discussed with your doctor.
Is TMS the same as ECT?
No. TMS is not ECT and there really is no comparison between the two.
ECT is an invasive procedure that requires hospitalization, sedation (done by an anesthesiologist), and the induction of a seizure while you are strapped to a gurney, and can produce serious side effects.
TMS does not require hospitalization, and is a simple therapy that is noninvasive and does not require sedation or other medications of any kind. Further, TMS does not cause any systemic side effects, and no memory loss or general body aches and pains, as ECT can cause these side effects. TMS is typically done in a doctors office or TMS therapy clinic, and patients can immediately return to their normal daily routine.
It is important to note that ECT can be very effective for certain psychiatric conditions despite the potential side effects.
Which is better - TMS or Ketamine?
This is like comparing apples to oranges. TMS is much more of a benign treatment for depression that has only few minor side effects. While Ketamine can be highly effective, the actual state of remission can be short-lived, and the drug can actually be very dangerous if misused.
Some of the most common side effects of Ketamine include, dissociation (a perceived detachment of the mind from the emotional state or even from the body), anxiety, dizziness, spinning sensation, nausea, increased blood pressure, sedation, feeling drunk, and vomiting.
What should I expect during a TMS treatment?
During your first session (commonly referred to as the mapping session), the doctor will locate the area to be treated and your motor threshold (minimal amount of stimulation required to cause or evoke a motor response) will be determined. This initial session can take anywhere from 30 mintues to an hour. You will also receive your first treatment immediately following the motor threshold determiniation.
With each subsequent visit you will sit in a comfortable, often dental-like or reclining chair. The daily treatment sessions can last anywhere from 3 minutes to 37 minutes depending on the type of TMS system used and the protocol prescribed by the doctor.
The number of sessions will depend on the treatment protocol determined by the doctor. Treatment sessions may include several treatments in a day lasting for a 5-10 days, up to 36 daily treatment sessions over a period of 4-9 weeks. A typical depression treatment covered by insurance will last anywhere from 20-40 minutes depending on the TMS system being used for a total of 20-36 sessions. Patients attend treatments 5-days per week (Monday through Friday) for 4-5 weeks, followed by a 3 week tapering of the last few treatment sessions.
What is accelerated TMS or theta burst TMS?
Accelerated TMS refers to a protocol in which multiple iTBS (intermittent theta burst stimulation) sessions are performed within the same day. Sessions could be 2-10 per day. A typical treatment course might include up to five sessions a day with approximately 45-60-minute intervals between each treatment, for a period of approximately 6 days.
Stanford University has shown evidence of its effectiveness with navigated iTBS. This makes the treatment plan very convenient for people traveling a long distance to a TMS clinic.
Is TMS Therapy 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 popular use of low intensity, static magnetic fields. These products deliver weak and undirected static fields that are not capable of activating brain cells.
Does TMS cause memory loss or other brain problems?
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 memory loss, tumors, or any other problems related to the brain. The magnetic energy used in a full course of TMS Therapy is a small fraction of just one brain scan with an MRI.
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TMS Directory connects TMS groups, communities, and individuals across the U.S. and internationally. (TMS) or Transcranial magnetic stimulation (TMS) is a leading-edge technology that uses magnetic waves to gently stimulate nerve cells in the brain. Moreover, this is a non-invasive treatment most commonly used for the treatment of major depression.
Furthermore, TMS therapy is a particularly useful tool for treatment-resistant depression in patients who have failed to respond to medication or other treatments.
Therefore if you are someone who suffers from depression, anxiety, OCD, PTSD, or another condition, and you are seeking TMS therapy as a treatment option – TMS Directory can connect you with someone in your area who specializes in treating these conditions with the most advanced forms of medicine. Please Follow Us On Facebook.
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