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Hi Noelle,
From my understanding, Medi-Cal will not cover TMS under any circumstances. However, I have recently discovered that some Medi-Cal plans are able to cover TMS if they have another policy attached. For instance, sometimes people will be on Medi-Cal, but also have a plan through Blue Shield. The question to ask yourself is: do you have more than one insurance card? If you do, you might be able to get TMS covered.
Regarding Kaiser – it depends where you’re located and if a Kaiser near you is doing TMS. I have heard that certain private clinics are able to get Kaiser to cover TMS since they don’t do it themselves.
If you are in the LA area, you can always give my clinic call and we can try to help you navigate the insurance portion of treatment.
Let me know if you have any other questions.
Ben
Yes, at the TMS clinic I help to run, we often treat patients with bipolar depression. As there is a small risk of getting flipped to mania, we have to be more careful with patients with a history of bipolar than the typical unipolar depression patients. I would definitely consider TMS before ECT… let me know if you have any questions.
Ben
Hi Caroline,
Yes, it actually is possible that TMS can trigger a manic episode in those with bipolar depressions. However, this is usually not rapid (e.g., one doesn’t go into full mania from one session). Definitely tell your doctor that you are experiencing manic symptoms – they should be able to put you on a bilateral (or right side only) protocol that should really help to balance you. We often treat those with bipolar depression, but just watch them carefully. If the bilateral approach doesn’t work, we sometimes use the regular protocol but for half the time.
I help to run a TMS clinic so let me know if yo have any questions.
Ben
Hi Vala,
I work at a TMS clinic, so I am happy to answer any questions you have. I want you to know that most of the people who do well with TMS don’t really end up posting on forums – this means that you end up reading the people for whom it did not work! Brainsway makes a machine that is a little different than most machines due to the stimulation frequency and coil shape, but many people do well with it. We don’t use Brainsway at our clinic, but rest assured, I know many people who have been helped by their machine. Btw, the 75% improvement, and 50% remission seems right to me, as can be explained by this blog here. Good luck!
Hi Aspen,
I would be concerned too, if I was in your position! I help to run a small clinic in LA, so I may be able to help. One important question to ask is whether or not he feels any pressure in his eye. If he doesn’t, there is no danger of damage to the brain whatsoever (despite very significant discomfort).
The stimulation dose is often figured out first by measuring how much energy makes the thumb move, which tells the provider approximately how much energy is required to make brain cells fire. This is called the motor threshold (MT). The actual stimulation dose is 120% of the MT.
People tend to feel the stimulation dose differently. Many people are able to tolerate the stimulation dose on the first session, but I also have a number of patients where I slowly taper the stimulation dose upwards throughout the first week. So, I might start with 80% MT day 1, 90% MT day 2, 100% day 3, 110% day 4, and 120% day 5. You might want to ask if they can do something like this with him. If they can’t, just know that the stimulation dose will eventually become tolerable. It can sometimes take a couple weeks, but by the end of treatment, many patients feel little to no discomfort from the stimulation. You could also try asking if they have a different TMS machine he can use. It sounds like they are using Brainsway’s “Deep TMS” machine, but there are other options available.
Feel free to let me know if you have any other questions!
Ben
Hi tshell282! I actually work in a TMS clinic, so I tend to see patients before, during, and after their respective TMS courses. It is definitely NOT uncommon to have a relapse into depression a few years down the line. The good news is that, in general, if TMS has worked successfully before, it is likely to work successfully again. Even better – insurance is more likely to improve the second course if there were documented improvements after the first.
Let me know if you have any questions.
Ben
