Transcranial Magnetic Stimulation
TRANSCRANIAL MAGNETIC STIMULATION
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WHAT IS TMS?
TMS, or Transcranial Magnetic Stimulation, is a non-invasive electromagnetic stimulation device that helps to fill the gap in treatment options for patients who need relief from their depression but have not found success with medications. It can resolve or significantly reduce depression and anxiety symptoms in a significant portion of patients. TMS gently stimulates the brain over a small area of
the brain called the Dorsolateral Prefrontal Cortex (DPC) which serves as a major connection hub for the brain. Research suggests this stimulation improves depressive symptoms by increasing the strength of this pathway to relieve depression and anxiety symptoms.
WHO IS TMS FOR?
If moderate to severe depression is still taking hold of your life after at least 4 failed attempts of different medications, TMS may be the next best option for you. It has demonstrated robust efficacy for depressive and anxiety symptoms in unipolar and bipolar depression. There are a few contraindications to TMS treatment, including a history of seizures and metal implants/clips above the shoulders that cannot be removed during treatment (with the exception of braces or dental fillings). There is an extremely small risk of a seizure from treatment, estimated at 0.01%, though
has been further reduced by refining treatment protocols/standards over the last number of years. Additionally, TMS is considered safe in pregnancy. Our TMS providers will review a complete list of possible contraindications before administering treatment to ensure your safety.
WHAT MAKES TMS AT PMA DIFFERENT?
We pride ourselves in offering a wide range of individualized psychiatric care across various specialties- TMS is one of many treatments we offer. We provide the highest level of attention to each patient to ensure the highest quality of patient care, comfort, and safety. We will coordinate with your current provider for TMS treatment though we have availability if you are also interested in establishing or transferring your care.
WHAT TO EXPECT:
Qualifying for Treatment:
Complete the TMS interest form (hyperlink here) or call our office and our TMS coordinator will help facilitate each step of this process. You will then meet with one of our psychiatrists specializing in TMS who will review your history and current concerns to determine if this is the most appropriate treatment for you.
TMS Treatment Experience: At the initial session, your treating Psychiatrist and TMS technician will make various measurements and assessments to calibrate your TMS treatment. During the treatment, the patient is seated in a comfortable reclining chair. You are awake for the duration of the treatment in a comfortable reclining chair. Some choose to relax by listening to music or a podcast (earbuds are fine)- or just taking a rest. Each treatment lasts approximately 20 minutes daily with the full course consisting of 30 sessions over 6 weeks. Many people describe the treatment as feeling and sounding like a tapping woodpecker on a small area of the scalp. Minor headaches and tenderness are the most common initial side effects, though they generally subside and can be treated with Acetaminophen. Patients generally report noticing a significant improvement in depressive symptoms after about 3 weeks of treatment.
PRICING & INSURANCE INFO:
TMS is an FDA-approved treatment; therefore, several insurance companies cover TMS. Remember that all policies vary, and most require prior authorization and are plan specific, subject to copays and/or coinsurance. We are contracted with Regence Blue Shield and Premera Blue Cross. The CPT codes used for TMS are 90867 ($425), 90868 ($275), and 90868 ($350). Our TMS coordinator will complete a complimentary benefits check with your insurance and complete the prior-
authorization process for you. You may pay out of pocket for treatment if you do not have a qualifying insurance plan.
Can I still take medication while doing TMS treatment?
Yes, patients may continue their normal medications, though we may recommend lowering a few specific medications during the course of treatment to increase the likelihood of response from TMS.
How do the treatments feel?
Many patients describe the sensation as a woodpecker tapping on a small, localized spot on the scalp. We provide patients with earplugs to protect their hearing from the tapping sound that comes from the magnetic coil during the stimulation pulses to increase comfort. Most patients report the tapping is the most uncomfortable during the first week of treatment, is much less intense the second week of treatment, and is barely noticeable after that. Some patients report twitching of the eye area, cheek, and jaw during the pulses as well, which is not painful.
How will I feel after each treatment?
Some patients report a very mild headache or scalp tenderness during the first week of
treatment. These symptoms are temporary. There is no recovery time for TMS treatments, so patients can immediately resume their normal activities including driving and going to work directly after their daily appointments.
Is TMS safe?
Yes. TMS is a safe, effective, non-invasive, non-systemic, and FDA-approved treatment for treatment-resistant depression for Major Depression and Bipolar Major Depressive Disorders It is currently being studied for more conditions including anxiety, fibromyalgia, OCD, Parkinson’s, and much more. There are no negative cognitive side effects to TMS.
How long do the results of TMS typically last?
Because of the various factors that influence each person's depression, there's no definitive answer to how long the TMS results will last. Most patients who respond experience improvement in their symptoms for six months to a year or more.
Is TMS similar to Electroconvulsive Therapy (ECT)?
Both TMS and ECT work by stimulating specific areas of the brain that regulate mood. ECT uses electric currents to stimulate a seizure, while TMS uses a magnetic coil to stimulate a small area of the cortex. In most cases, it makes sense to try TMS first as it can improve brain function without cognitive side effects and does not require anesthesia. ECT requires sedation and is associated with a prolonged recovery time and short-term memory impairment. In contrast, TMS is non-invasive and no recovery time is necessary. You can drive yourself home immediately after the appointment and resume your activities as you normally would.
How does this compare to Ketamine?
Esketamine, the FDA approved version of Ketamine, is approved for severe Major
Depression and can relieve depressive symptoms for those needing a quick, though
temporary improvement. However, the benefits tend to diminish by 2 weeks. Further, the more accessible intravenous administration of Ketamine is not FDA approved with greater potential risks.
Is TMS approved during pregnancy?
TMS is safe for pregnant and breastfeeding mothers. There are no known side effects to either mother or baby. TMS might even be a preferred method of treating depression since standard medications are systemic and can affect the baby, though would still be subject to usual insurance plan requirements.
What if my insurance doesn’t cover treatment?
Please reference your insurer’s out-of-network benefits for reimbursement or choose from a self-pay payment plan for your treatment.
Call us at 206-386-3103 and ask our TMS Coordinator for more information.
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