STARTING TMS THERAPY

Most patients starting TMS Therapy do so by first contacting a private office or clinic to schedule an initial assessment with a TMS prescribing psychiatrist or doctor.

This assessment is a two-part process that involves a review of your medical history and then a second visit for your initial treatment. Both sessions usually lasts about one and a half hours, but plan on two just to be safe. This first aspect of TMS Treatment is far and away the most intensive. But then again, this is the all-important first step on your road to therapy and recovery.

Here’s a look into what you can expect from treatment with the Neurostar, which is the most widely-used TMS device on the market:

Initial Assessment

The initial assessment (or consultation) will be used to evaluate the appropriateness of TMS Therapy in treating your depression. The TMS prescribing psychiatrist or doctor will use the assessment to determine a diagnosis and the risks and benefits of TMS compared to other available treatments for your diagnosis. Your TMS prescribing psychiatrist or doctor might also want to discuss the off-label treatments of TMS for symptoms such as bi-polar disorder, schizophrenia, and OCD.

The TMS prescribing psychiatrist or doctor will also want details about previous treatment for your depression including counseling history, names of medications and maximum dosage, duration of treatment, and reasons treatment was discontinued, such as lack of benefit or side effects. You should be prepared to complete formal medical history evaluations and sign consent forms.

There is also a chance that your TMS prescribing doctor or psychiatrist will request a physical examination from your primary care physician. This is not always the case, though, and will vary from doctor to doctor. If a physical examination is requested, it will most likely be used to carefully screen patients for the presence of medical conditions such as seizure disorder or epilepsy, and underlying risk factors such as the presence of metal within the head, which might make the administration of TMS unsafe clinically.

At the end of the assessment the TMS prescribing psychiatrist or doctor will decide if you are a candidate for TMS Therapy. If TMS Therapy is right for you, the TMS prescribing psychiatrist or doctor will create a plan for your treatment. Your next appointment will be your first treatment of TMS and will focus on Motor Threshold and Coil Placement.

Motor Threshold

At your first TMS treatment, the TMS prescribing psychiatrist or doctor, or the attending TMS technician, will perform tests to identify your motor threshold. The motor threshold is determined by measuring the minimum amount of power necessary to make the patient’s thumb twitch. The amount of power needed varies from individual to individual. Measuring the motor threshold helps your TMS prescribing psychiatrist or doctor personalize the treatment settings and determine the amount of energy required to stimulate brain cells. This test is important because it identifies the magnetic field strength that will be used in treatment and is customized for each patient in order to deliver the optimal treatment dose.

Succeeding treatment sessions do not require that the motor threshold be determined again, unless otherwise indicated, such as when changes in medications are made during the course of the treatment.

Fitting the Coil

For coil devices such as the Neurostar, the coil is fitted by first bringing it forward so that it rests above the front region of the patient’s brain. The TMS prescribing psychiatrist or doctor will make several measurements to ensure that the TMS coil is properly positioned over the patient’s head. Finally the psychiatrist or doctor will be able to determine the place on the head where the TMS treatment will be applied. This placement is crucial to the TMS Therapy as it will allow you to receive optimal treatment.

** Different devices may demand different coil fitting techniques. For instance, the Brainsway Deep TMS device utilizes a full head helmet that is properly fitted for patients.

After the motor threshold is determined and the coil is placed properly, treatment can commence.

TMS Devices Cleared for Treatment

We briefly explore the TMS devices that are on the market today and the cleared uses.

Neurostar

The Neurostar by Neuronetics was the first TMS device to be offered to the market and was cleared for the treatment of Major Depressive Disorder by the FDA in 2008. This device is the most widely-used and widely-available TMS device on the market today.

Brainsway

Rapid2

MagVita

NeuroSoft TMS

Spring TMS

TMS is a relatively new procedure and every health insurance provider has different guidelines for treatment. Contact your insurance provider before your initial assessment to determine what part of TMS may be covered under your plan. Be prepared to talk to your supervising psychiatrist or doctor to discuss payment options.

STARTING TMS THERAPY

TMS Devices Cleared for Treatment

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