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We’ve compiled dozens of frequently asked questions and sorted them into general categories such as “cost” and “safety” and even just “the basics.” Scroll through to see if one of your questions is listed below, or jump to the section you need by using the menu on the left side of the screen.
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What Is The Science Behind TMS?
Once the TMS device is positioned, it creates a deep magnetic pulse that targets the left pre-frontal cortex. This pulse comes in rapid succession and is thought to stimulate regions of the brain that are linked to emotion. In depressed patients, these emotion-baring regions are shown to be almost non-responsive when compared to healthy patients.
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Each treatment involves the gentle placement of the TMS coil against the patient’s head. Over a 30-40 minute period, pulses from the TMS coil are delivered in 30-second intervals. These pulses feel like tapping on the scalp. The tapping should not be bothersome and the technician can make adjustments if the taping is uncomfortable. TMS therapy also produces a loud clicking sound, so earplugs are recommended and usually provided.
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Transcranial Magnetic Stimulation is an MRI-strength magnetic pulse designed to stimulate the brain. In depression treatment, the left pre-frontal cortex is stimulated. This is the area of the brain that is responsible for connecting to a variety of important functions, but it’s particularly integral to our emotional responses.
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Transcranial Magnetic Stimulation is administered by placing a device around the front of the skull which then sends a magnetic pulse to the brain. The device is not implanted; rather it is positioned temporarily by a technician and sits comfortably on the outside of the skull. The device holds a large electronic magnet which creates and distributes the pulse. It is usually shaped like a figure-eight wand or a concave wedge.
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TMS therapy is an appropriate treatment for adult patients with major depressive disorder who have failed to achieve satisfactory improvement from antidepressant medications at or above the commonly effective dose and duration. If you or a loved one has been diagnosed with clinical depression or Major Depressive Disorder, then TMS Therapy may be able to help.
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TMS Therapy is a very well tolerated treatment and there are very few limitations as to who can receive it. However, not all patients are appropriate candidates for TMS Therapy. Patients with a history of seizures or who have metal implants or objects in or near their head are not appropriate candidates for TMS Therapy. To determine if TMS Therapy may be right for you, your supervising doctor or psychiatrist will carefully screen for the presence of medical conditions or metal objects which may make TMS harmful.
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If it is determined that you are not a candidate for TMS Therapy, there are other options for treatment of depression such as ECT and Vagus Nerve Stimulators (VNS). As with everything, please consult with your supervising doctor or psychiatrist to determine the best course of treatment for your depression.
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Almost all patients starting TMS Therapy do so by contacting a psychiatrist’s office or clinic to schedule an initial assessment with a TMS prescribing psychiatrist or doctor.
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Regardless of who prescribed your TMS Therapy, a trained TMS technician should administer the actual treatments and guide you through each session. A doctor or the TMS technician should always be present to monitor the patient during treatment. The patient should be allowed to stop a treatment at any time by asking the staff member present.
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TMS is a standard outpatient procedure, often times done right at the doctor’s office or clinic. Though not as common, it is not unusual to receive TMS at a hospital. Because no sedatives or anesthesia is administered during TMS treatment, TMS patients can immediately resume normal daily activities and do not need to be hospitalized for treatment.
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The ability for TMS to provide relief of symptoms varies greatly from person to person. Therefore the length of a TMS Therapy course can vary greatly. Your doctor will recommend a schedule of sessions based on your individual need and response to treatment. So, while patients typically receive 20-30 treatments over a 4-6 week period, the actual number of treatments can range anywhere from 10-60 treatments over a 4-10 week period. Treatments are performed during the weekdays, usually five days a week, and each procedure lasts approximately 30-60 minutes.
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Maintenance TMS is not well studied and opinions vary greatly on its necessity and effectiveness. At this time, there is no solid evidence to support the use of Maintenance TMS once the initial episode of treatment is over. However, many doctors believe that Maintenance TMS sessions can prevent recurrence of symptoms. Some patients receive regular intermittent treatments after their initial course to alleviate symptoms such as low mood, and report satisfactory results from Maintenance TMS. Doctors and clinics that support Maintenance TMS suggest a frequency of sessions that can range from 1 per week to as little as 1 per month. It is highly recommended that you talk to your doctor about Maintenance TMS before starting your initial course.
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The assessment will review your treatment history and determine if TMS is right for you.
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The assessment will determine a diagnosis and determine the risks and benefits of TMS compared to other available treatments for your diagnosis. Your supervising psychiatrist or doctor might also want to discuss the off-label treatments of TMS for symptoms such as bi-polar disorder, schizophrenia, and OCD. A physical examination from your primary care physician may be requested by your TMS prescribing doctor or psychiatrist and would be used to screen for any limiting physical conditions.
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The first TMS session is about 1-2 hours long. The extra time is used to determine your motor threshold and to properly fit the coil or device to your skull. After that, you should begin your first treatment.
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TMS treatment is very non-invasive. There is no anesthesia or sedatives so patients are awake and alert the whole time. For the patient, it is a very straightforward process. Expect to sit in a specially designed chair, to wear ear-plugs (due to the sound of the device), and to get comfortable and read or watch television.
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Because no sedative or anesthesia is administered during TMS treatment, patients can immediately resume normal daily activities after each session including driving, working, and other normal routines. Just as patients can transport themselves to treatment they can also drive themselves to work or home immediately following the treatment session. Most patients discover that with TMS treatment no post-session recovery period is required.
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Treatments are performed during the weekdays usually five days a week and each procedure lasts approximately 30-60 minutes.
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TMS is a standard outpatient procedure, often times done right at the doctor’s office or clinic. Though not as common, it is not unusual to receive TMS at a hospital.
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Patients are usually asked to keep an appointment with a doctor, psychiatrist, or therapist to assess progress and note the condition of your symptoms. You are also encouraged to attend recommended appointments with the psychiatrists, therapists, or other providers of your ongoing mental health care.
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It is commonly reported that patients need 30 to 40 sessions of TMS to derive the most benefit in the treatment of their depression symptoms. In clinical trials, 1 in 2 patients achieved significant relief of symptoms after four weeks of treatment and 1 in 3 experience complete remission after six weeks of treatment. Some patients may experience results in less time, while others may take longer.
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The benefits from TMS have been shown to hold up very well. Of the Patients who initially reported improvement in their depression symptoms from TMS Therapy, most reported continued benefits three years later.
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TMS Therapy can be a life changing treatment for patients suffering from the most severe depression symptoms. Benefits of TMS include a reduction in Emotional effects, Anxiety, Changes in appetite, Body aches, and Lack of energy.
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If you find that you or your loved one are not experiencing results from TMS, there are other options available. Patients with more severe, resistant depression may find greater improvement from other brain stimulation techniques such as ECT and VNS. As always, you should work with your supervising doctor or psychiatrist about what the next best treatment options are and ask them to make appropriate referrals for further treatment.
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Mild to moderate scalp irritation and mild headache effect nearly one half of all patients and usually goes away after the first week of treatment. If symptoms do persist after the first two weeks, over-the-counter analgesic may be taken. If symptoms still persist, the TMS physician can reduce the strength of the magnetic field pulses being administered to make treatment more comfortable.
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TMS is a generally safe procedure with over two decades of intense clinical and scientific research behind it. In 10,000 treatments during clinical trials, the most common side effects was mild to moderate scalp discomfort and mild headaches, both of which usually went away in the first week of treatments. In a very small percentage of instances there were reports of acute memory loss, minimal cognition interruption, facial twitching, and seizures. These side effects were acute and TMS showed no long-term issues.
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The most common side effects are mild to moderate scalp discomfort and mild headaches, both of which usually go away in the first week of treatments. In a very small percentage of instances there were reports of acute memory loss, minimal cognition interruption, facial twitching, and seizures.
Some TMS patients may experience an effect referred to as The Dip. The Dip is a possible effect which sometimes happens when the progress of your TMS Therapy is temporarily reversed. Symptoms of The Dip can include a sudden and deepening increase in depression, and it can appear as though there has been an almost complete reversal of progress. For this reason, The Dip can feel very defeating and cause undue stress to a patient undergoing TMS Therapy. However, it is important to remember that these effects are only temporary. People who experience this reversal in progress appear to usually gain it back.
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The Dip is a term used to refer to the effect which sometimes happens when progress of your TMS Therapy is temporarily reversed. Initially, researchers dismissed this slide in progress as an anomaly in treatment. However, as more clinical studies are conducted, it is becoming apparent that a sizable number of patients may experience The Dip during their treatment.
Symptoms of The Dip can include a sudden and deepening increase in depression, and it can appear as though there has been an almost complete reversal of progress. For this reason, The Dip can feel very defeating and cause undue stress to a patient undergoing TMS Therapy. However, it is important to remember that these effects are only temporary. People who experience this reversal in progress appear to usually gain it back, and tend to continue toward the goal of alleviating their depression symptoms.
Unfortunately at this time not much is know about what causes The Dip, only that its effects are temporary.
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Mild to moderate scalp irritation and mild headache affect nearly one half of all patients and usually go away after the first week of treatment. If symptoms do persist after the first two weeks, over-the-counter analgesic may be taken. If symptoms still persist, the TMS physician can reduce the strength of the magnetic field pulses being administered to make treatment more comfortable. Less than 5 percent of patients treated with TMS Therapy discontinued treatment due to side effects.
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In clinical studies, approximately 5 percent of patients experienced slight memory loss or confusion. These effects were only temporary though, and there is no evidence that TMS causes permanent or even long-term memory loss.
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No.
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The actual TMS feels like a tapping on the skull. TMS is essentially painless because the induced current does not pass through the skin, where most of the pain nerve endings are located.
However, there are some side effects that may cause mild to moderate discomfort. The most common of these side effects is scalp irritation and headaches. These and all observed side effects are acute and should only last temporarily. If symptoms persist, over-the-counter analgesic may be taken or the TMS physician can reduce the strength of the magnetic field pulses being administered to make treatment more comfortable.
Less than 5 percent of patients treated with TMS Therapy discontinued treatment due to side effects.
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After more than two decades of research and clinical trials, TMS Therapy was cleared by Canada Health in 2003 and the FDA in 2008 . TMS has also been approved in Europe and Israel for treating patients. As such, the actual administering of TMS is very precise and well regulated the world over.
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In 10,000 treatments during clinical trials, there were no observed long-term side effects associated with TMS. While TMS is widely considered to be safe, it is important to point out that because it is a new treatment, there has not been enough time to gauge any unforeseeable risks that are not currently recognized.
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If you experience a side-effect, alert your TMS technician and assessing doctor. If symptoms persist, the TMS physician can reduce the strength of the magnetic field pulses being administered to make treatment more comfortable.
Less than 5 percent of patients treated with TMS Therapy discontinued treatment due to side effects.
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While both TMS and Electroconvulsive Therapy (ECT) are effective in the treatment of depression, there are many differences in safety and tolerability. Both are designed to treat depression through the application of energy into the brain, but the similarities quickly dissolve.
ECT is a much more intensive and invasive procedure than is TMS Therapy. ECT is designed to create seizures and requires hospitalization. The side effects from ECT are much more intense and occur in more instances. TMS is an outpatient procedure with few side-effects.
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Is TMS Therapy A Good Alternative To Antidepressants?
Most doctors and psychiatrists agree that TMS Therapy is also a good alternative for patients who cannot tolerate the side effects associated with antidepressant medications or do not wish to take them. Many patients suffer intolerable side effects to commonly used antidepressants, such as nausea, diarrhea, insomnia, sedation, lack of emotion, and sexual problems. TMS is non-systemic, so nothing enters your body or your bloodstream. That means that TMS is free of side effects typically associated with these medications. This also means that patients can immediately return to regular activity after TMS sessions.
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Patients may continue to take antidepressant medication while receiving TMS therapy if recommended by their physicians.
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In 2013, the typical cost for a course of TMS Therapy ran from 8000 to 10000 dollars.
If your insurance provider is not presently covering TMS and you would like assistance in securing coverage, the manufacturer of the TMS machine NeuroStar has developed the NeuroStar Reimbursement Support, whose number is 1-877-622-2867. Reimbursement Support can check on your benefits and help you negotiate with your insurance provider for reimbursement, which is determined on a case-by-case basis.
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It is highly recommended that patients work directly with their insurance companies to determine coverage. Contact your insurance company before your first visit to see if TMS is a covered benefit. Many insurance providers have per-certification requirements for TMS and reimbursement can be delayed. So for instance, while the initial assessment for TMS is typically covered by insurance plans, the patient may be on the hook for full payment until receiving reimbursement from their provider. Worse still, the patient may be liable for full payment if TMS isn’t covered at all. For a list of providers that currently cover TMS, see our TMS Insurance Help page.
If your insurance provider is not presently covering TMS and you would like assistance in securing coverage, the manufacturer of the TMS machine NeuroStar has developed the NeuroStar Reimbursement Support, whose number is 1-877-622-2867. Reimbursement Support can check on your benefits and help you negotiate with your insurance provider for reimbursement, which is determined on a case-by-case basis.
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Some companies provide full reimbursement fees, while most offer only partial reimbursement.
Even for patients with insurance coverage, payment for TMS Therapy is usually made out-of-pocket by the patient at the time of service. This means patients are on the hook to pay for all services until reimbursement from their provider. At the very least, patients should be prepared to cover all fees and copays. That is why it is important to call your insurance provider before starting even the initial assessment of TMS.
If your insurance provider is not presently covering TMS and you would like assistance in securing coverage, the manufacturer of the TMS machine NeuroStar has developed the NeuroStar Reimbursement Support, whose number is 1-877-622-2867. Reimbursement Support can check on your benefits and help you negotiate with your insurance provider for reimbursement, which is determined on a case-by-case basis.
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Health insurance is notoriously difficult to navigate, and unfortunately the responsibility for proper understanding of insurance coverage falls on you the patient. However, most offices, clinics, and hospitals should be able to help you understand your benefits, file claims, and receive reimbursement. In an effort to help you negotiate reimbursement with your insurance company, your care provider should be willing to provide copies of your initial evaluation as well as ongoing clinical assessments which you can mail along with the insurance claim.
If your insurance provider is not presently covering TMS and you would like assistance in securing coverage, the manufacturer of the TMS machine NeuroStar has developed the NeuroStar Reimbursement Support, whose number is 1-877-622-2867. Reimbursement Support can check on your benefits and help you negotiate with your insurance provider for reimbursement, which is determined on a case-by-case basis.
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Your carrier may ask you for the TMS CPT codes: the motor threshold CPT Code is 90867, the TMS treatment code is 90868, and the reassessment of the motor threshold code is 90869
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In most cases insurance companies do not list TMS as a regular benefit. However, it is possible to appeal these decisions to your insurance provider. Many patients who have appealed to their insurance provider have been able to obtain some coverage of the treatment. Either way, insurance companies usually determine eligibility for TMS on an individual basis and it is not guaranteed how insurance providers will decide your case.
If your insurance provider does not cover any costs, or only covers partial costs of TMS Therapy, then the burden of payment falls squarely on the patient. However, there are options out there to help patients handle the high costs of TMS Therapy including Private Lenders, Flexible Spending Accounts, and Patient Financing Loans.
If your insurance provider is not presently covering TMS and you would like assistance in securing coverage, the manufacturer of the TMS machine NeuroStar has developed the NeuroStar Reimbursement Support, whose number is 1-877-622-2867. Reimbursement Support can check on your benefits and help you negotiate with your insurance provider for reimbursement, which is determined on a case-by-case basis.
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If you feel that covering costs for TMS Therapy may be an issue, it is important to use a TMS provider who is able to discuss and help you with payment options for TMS Therapy. You will want to choose a TMS provider who provides finance counseling and is able to help you in securing a loan and/or setting you up on a payment plan.
If your insurance provider is not presently covering TMS and you would like assistance in securing coverage, the manufacturer of the TMS machine NeuroStar has developed the NeuroStar Reimbursement Support, whose number is 1-877-622-2867. Reimbursement Support can check on your benefits and help you negotiate with your insurance provider for reimbursement, which is determined on a case-by-case basis.