TMS Therapy and Ketamine Questions and Answers

TMS Directory can answer any questions you may have about TMS therapy or ketamine. Discover all there is to know about these therapies that can change your life, including their benefits, insurance coverage, and more.

TMS is generally prescribed by a psychiatrist and the initial treatment, called a ‘mapping session’ is performed by a psychiatrist, physician, or a psychiatric nurse practitioner (NP). In this first session, the doctor or NP 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 technician should always be present in the treatment room to monitor the patient during treatment.

TMS therapy is covered by nearly all insurance plans for the treatment of major depressive disorder for patients with moderate to severe symptoms. TMS is generally covered under a mental health plan, but in some cases may be covered under a patient’s medical benefits with their insurance. However, coverage is dependent on the insurance plans medical guidelines for coverage. These guidelines generally require the patient to have tried a specific number of antidepressant medications (typically 1-3 depending on the insurance) and a trial of psychotherapy. TMS is typically not covered by insurance if the patient has a diagnosis of bipolar disorder, an active substance use disorder, eating disorder, or seizure disorder.

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, some will cover repeat TMS in 3-months for patients who meet criteria.

While many physicians 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 which can help to obtain prior authorization from your insurance carrier.

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 if treatment sessions are complete during the prior authorization coverage dates, insurance remains active, and the claim is billed  correctly.

This is like comparing apples to oranges. With only a few modest side effects and a long-lasting effect, TMS is a considerably more benign treatment for depression. Although intravenous ketamine can be quite beneficial in treating depression, the actual condition of remission is transient. Ketamine can cause sensations of unreality, visual and sensory distortions, a skewed perception of one’s body, momentary strange thoughts and beliefs, as well as a buzz or pleasure. There are no odd experiences during a TMS therapy session. Both are useful for treating moderate to severe depression. While TMS is used to provide longer-term relief for depressed symptoms, ketamine is particularly helpful for symptoms associated with suicidal ideation.

Dissociation (a perceived separation of the mind from the emotional state or even the body), anxiety, nausea, spinning sensations, elevated blood pressure, sedation, feeling inebriated, and in some cases vomiting are some of the most frequent side effects of ketamine. The two adverse effects of TMS therapy that are most frequently reported are pain at the treatment site and headaches, both of which usually go away after the first few sessions and may be managed with over-the-counter drugs like Ibuprofen or Tylenol.

Esketamine is a nasal spray that is given in a doctor’s office and is FDA-approved. Although not as effective as TMS, the drug may nevertheless be helpful for people who are experiencing severe depression symptoms, such as suicide thoughts. In addition, unlike TMS, the drug has a number of adverse effects, but it can be an excellent therapeutic option for some people who require relief right away.

In the medical literature, any TMS therapeutic treatment that involves more than one TMS session per day is referred to as rapid TMS. Today, the terms accelerated TMS and accelerated TBS are frequently used to refer to the TMS therapy protocol in which the patient receives a total of 50 TMS therapy sessions—10 TMS sessions per day for five days. With this expedited TMS therapy procedure, treatment lasts just 5 days as opposed to the usual 6 weeks. Because it has the potential to significantly improve outcomes, accelerated TMS therapy is gaining much attention. 

Patients in the Stanford trial received 10 rounds of 10-minute treatments each day, separated by 50-minute pauses. Each therapy was a customized variation of “theta burst” TMS treatment, which can only be administered with a TMS therapy system that offers theta burst technology. This trial proved the efficacy of accelerated theta burst treatment specifically using this treatment protocol.

Patients should perform their due diligence when seeking TMS therapy to ensure the provider is using treatment protocols that either FDA-approved or back by ample research.  

Patients who choose TMS therapy as a kind of treatment have left a lot of remarks online. While many of the comments emphasize TMS’s benefits, some of them are also made by people who did not experience those benefits or who say that TMS made their symptoms worse. Understanding how TMS works and who TMS therapy is designed for is crucial.

When a patient receives TMS therapy for depression, it’s crucial to confirm the patient’s diagnosis. Bipolar patients may go through extended spells of very bad depression. A patient will probably be given a major depression diagnosis if they are evaluated by a doctor just once and there is no indication that they have ever experienced mania. A manic episode and an increase in anxiety may occur when a patient with underlying bipolar illness undergoes TMS therapy using the depression treatment regimen. To prevent a bad experience with TMS, it is crucial for the patient to inform the doctor about any recent manic episode, history of bipolar disorder, or generalized anxiety condition.

Dissociative drugs like ketamine are a novel class of psychedelic drugs that are experiencing a comeback in popularity. Ketamine, sometimes known as “special K,” is a common anesthetic used in hospitals and veterinary clinics that was originally developed from PCP, also known as “angel dust.”

Both ketamine’s medical and recreational uses are supported by its consistent ability to generate the following effects: euphoria, intoxication, dissociation, pain relief, and amnesia. Esketamine (Spravato), a prescription form of ketamine that is administered through nasal spray, was approved by the FDA in 2019 for TRD; however, the guidelines specify that it can only be used “under the supervision of a health care professional in a qualified doctor’s office or clinic.” Therefore, medical personnel must observe you using it, then follow you after you’ve taken your dose to monitor your vital signs and your overall clinical progress.

R-ketamine and S-ketamine are both present in intravenous (IV) ketamine. Ketamine has advantages over other anesthetics because it doesn’t affect a patient’s cardiorespiratory or respiratory systems. When treating children, it’s frequently the anesthetic of choice because it can be administered safely on patients as young as three months.

Although racemic ketamine is FDA-authorized as an anesthetic, IV ketamine can be used to treat severe depression “off-label,” which means the FDA has not yet approved the medication for that application. When used as an anesthetic, IV ketamine is administered at far higher doses than when treating depression.

Our mission is to help those suffering from brain-health disorders and make it possible for them to find relief and remission from their symptoms so they too, can live a good quality of life.

If you are suffering from moderate to severe unrelieved depression, obsessive-compulsive disorder (OCD), or other brain-health conditions, then search TMS Directory for a certified TMS therapy or ketamine provider in your area.

TMS Directory will guide you to an unforgettable lifetime journey.

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