Insurance coverage for TMS varies depending on individual carriers and plans and may be determined on a case-by-case basis; several health insurance plans now offer coverage that ranges from partial to complete reimbursement. The insurance plans that currently have coverage policies in California are Anthem Blue Cross, Blue Shield of California/MHSA, Health Net/Managed Health Network, United Behavioral Health, and Kaiser Permanente. If you qualify under your insurance company’s criteria for coverage, you may be able to receive authorization for TMS Therapy.
In the meantime, out-of-pocket payment may be necessary. Check with your local TMS office for financing options. Long-term financing may be available, and many offices offer reimbursement support for the appeals process if your insurance denies coverage. We are committed to helping you get better as quickly as possible.
TMS is used primarily for the treatment of Major Depression, which is the indication currently approved by the FDA. However, TMS can be used to stimulate different regions of the brain in different ways, and many clinical studies are currently underway. TMS is being used as a treatment for Bipolar Depression, Anxiety, Obsessive Compulsive Disorder, Migraine, Fibromyalgia, Auditory Hallucinations, and Tinnitus.
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 been incorporated into several treatment guidelines for MDD, including the 2010 American Psychiatric Association “Practice Guideline for the Treatment of Patients with Major Depressive Disorder, 3rd Edition.” The American Medical Association has also determined that TMS Therapy is consistent with current medical practice, and it is now widely practiced throughout the country.
TMS is utilized in clinical settings at major institutions including the Mayo Clinic - Rochester, University of Michigan Depression Center, Walter Reed Army Medical Center, Brown University, UCLA, Harvard medical system (McLean Hospital and Beth Israel Deaconess), Boston University Medical Center, Johns Hopkins University, and Weill Cornell Medical School, Rush University, University of South Florida, as well as being used at freestanding psychiatric hospitals and in private physicians’ offices.
Antidepressants are systemic, meaning that the medicine enters the body and blood stream; TMS is non-systemic.
Both medications and TMS affect the electrochemical signaling between neurons in the brain, however the mechanism by which they do so differs. One of the most obvious differences is that medications are chemicals and must be taken by mouth and must travel through the bloodstream in order to reach the brain. Along the way, they must travel through every part of the body, which is why they can often cause side effects, such as nausea, diarrhea, insomnia, sedation, lack of emotion, weight flucuation, and sexual problems. TMS has very little to no side effects.
Some medications work by disrupting the process by which neurons reabsorb the neurotransmitters (which all neurons need to communicate with one another), thereby allowing the neurotransmitters additional time to reach the receptor sites of the next neuron. Other medications work by encouraging the creation and release of more neurotransmitters. TMS works by stimulating brain cells in the prefrontal cortex of the brain, inciting the electrical signal to travel through the neuron to its synapse and trigger the release of neurotransmitters across the synaptic cleft. With more neurotransmitters released into the synaptic cleft, the more receptor sites are needed on the receiving synapse. As a result, neurons begin to develop more connections with each other. As the stimulation is repeated, the rate of electrical signaling increases and this neuronal activity eventually becomes self-sustained.
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 ECT is a much more intensive and invasive procedure than TMS Therapy. ECT is designed to induce seizures and requires anesthesia and hospitalization. Recovery from an ECT treatment session occurs slowly, and patients are usually closely monitored for minutes or a few hours after a treatment. Short-term confusion and memory loss are common, and long-term disruptions in memory have been shown to occur and may persist indefinitely in some people. Because of the side effects associated with ECT, a significant amount of caregiver support is required.
TMS is an outpatient procedure with minimal side effects. TMS Therapy uses non-invasive magnetic stimulation to the left prefrontal cortex to target the region in the brain that affects mood. These fields are sufficient to produce an action potential across the membranes of the neurons and this transfer of energy brings the unique ability to stimulate selected spatially-discrete regions of the cortex which is not possible when using ECT’s unfocused electrical stimulation method. During the TMS therapy procedure, the patient sits in a chair and is awake and alert throughout the entire procedure. No sedation is used with TMS Therapy, and patients can transport themselves to and from treatment.
TMS therapy could be a good alternative to treating depression for those who have failed ECT previously.
No. TMS Therapy involves a unique method of using pulsed magnetic fields for therapeutic benefit. The intensity of the magnetic field is similar to that of the magnetic fields used in an MRI. These techniques differ radically from the popular use of low intensity, static magnetic fields. Those products deliver weak and undirected static fields that are not capable of activating brain cells.
In 10,000 treatments during clinical trials, there were no observed long-term side effects associated with TMS. TMS uses the same type and strength of magnetic fields as MRIs, which have been used in tens of millions of patients around the world and have not been shown to cause long-term consequences. The amount of magnetic field exposure for a full course of TMS Therapy is only a small fraction of one brain scan with an MRI. If a patient had multiple courses of acute TMS, the magnetic field exposure would be less than exposure from a few MRI sessions.
NeuroStar TMS is the only TMS system with the durability of its effects established over 12 months. In a clinical trial, 2 out of 3 patients who had either responded to treatment or completely remitted their depression symptoms reported 12 months later that they remained at the level they were at the end of the trial. Additionally, after the trial, only 1 in 3 patients needed to return for 'maintenance' TMS sessions.
No, TMS Therapy was systematically evaluated for its effects on memory. Clinical trials demonstrated that this treatment does not result in any long-term negative effects on memory or concentration.
No, TMS uses the same type and strength of magnetic fields as MRIs (magnetic resonance imaging), which have been used in tens of millions of patients around the world and have not been shown to cause tumors. The magnetic energy used in a full course of TMS Therapy is a small fraction of just one brain scan with an MRI.
In most patients, the clinical benefit of TMS Therapy was maintained through 6-12 months of follow-up study. A small percentage of patients return for some type of maintenance. Talk to your local TMS provider about your long-term treatment path.
Everyone’s depression is different, however 90% of patients who respond to TMS continue to do well a year after treatment. Some people may require periodic “maintenance” TMS, which often consists of a few treatments every few weeks or months. Some people may also begin to respond to medications even when they did not help before TMS treatment, which can help maintain the long-term therapeutic benefit of TMS Therapy.
It is important that patients also continue to develop healthy sleeping, eating, activity, and relaxation habits in order to equip them with skills to cope with any “triggers,” which they may encounter after their course of TMS Therapy. Most patients continue outpatient therapy for ongoing support as well.
Clinical studies have shown that TMS is effective about 75% of the time, which means that it is twice as effective as antidepressant medications and almost as effective as electroconvulsive therapy (ECT). Half of those who respond to TMS experience significant improvement in the first four weeks of treatment.
Throughout over 10,000 active treatments performed in clinical trials, the most commonly reported side effect was mild to moderate scalp irritation and mild headache. This affected nearly one half of all patients. Scalp discomfort 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. In clinical trials, fewer than 5% of patients discontinued treatment due to adverse events.
Other side effects may include eye pain, toothache, facial muscle twitching, facial pain, or pain of the skin. In clinical trials, more than 10,000 TMS treatments demonstrated its safety with no occurrence of seizures. However, there is a small risk of a seizure occurring during treatment (.01% of patients). This risk is no greater than what has been observed with oral antidepressant medications. No side effects such as weight gain, sexual problems, stomach problems, sleepiness, or dry mouth were seen during trials. There were no negative effects on memory or the ability to concentrate.
Patients should notify their doctor if they experience worsening depression symptoms, signs or symptoms of suicidal behavior and/or unusual behavior. Family members and support individuals should also be aware of the need to observe patients and notify their treatment provider if they observe worsening symptoms.
TMS Therapy can be a life changing treatment for patients suffering from the most severe depression symptoms. Benefits of TMS include a reduction in anxiety & depressed mood, normalized appetite & sleep, reduction in body aches, and an increase in overall mood, energy and concentration/focus. Many patients who achieve remission may also eventually taper off of their antidepressant medications.
Many people notice temporary improvement in the first week or two due to the activation of existing neuro-circuits. Longer lasting improvement occurs several weeks later when new circuits are formed. 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. In the clinical setting, 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.
Not necessarily. Your TMS psychiatrists will work with your other doctors to make decisions about whether or not to continue medications and any dose adjustments that might be recommended.
No. TMS therapy is non-invasive and drug-free. The patient remains awake and alert during treatment and can go back to his or her normal routine right after the treatment is complete.
Your doctor will recommend a schedule of sessions based on your individual needs and response to treatment. The ability for TMS to provide relief of symptoms varies greatly from person, but typically patients receive 20-30 treatments over a 4-6 week period.Treatments are usually performed five days a week (Monday through Friday) and each procedure lasts approximately 30-45 minutes. In addition, you will meet regularly with your TMS psychiatrist to track your progress and address any issues throughout the course of treatment.
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 around their head (like surgical clips) are not appropriate candidates for TMS Therapy. It also should not be used in patients with implanted devices that are controlled by physiological signals such as pacemakers.
TMS has been safely used in women who are pregnant. It can also be safely used in the elderly as well as adolescents. There is an extremely low risk of having a seizure – about 1 in 10,000 – but if you have had a seizure in the past, special precautions may be necessary. To determine if TMS Therapy may be right for you, your TMS prescribing psychiatrist or doctor will carefully screen for the presence of medical conditions or metal objects which may make TMS harmful.
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, or patients who wish to seek an alternative to antidepressants.
If you or a loved one has been diagnosed with clinical depression or Major Depressive Disorder, then TMS Therapy may be able to help. Contact your local TMS provider to find out if TMS therapy is right for you.
Each treatment involves the placement of the TMS coil against the patient’s head over the prefrontal cortex area of the brain.. Over a 30-40 minute period, pulses from the TMS coil are delivered in 20-30 second intervals. These pulses feel like tapping on the scalp. The pulses may be strong or uncomfortable at first, but patients usually adjust to the sensation within the first few treatments. The technician can also make further adjustments if the patient continues to experience discomfort. TMS therapy also produces a loud clicking sound so earplugs are provided for each treatment.
This non-invasive therapy stimulates nerve cells in the area of the brain responsible for mood regulation (the dorsolateral prefrontal cortex). Through a treatment coil, the TMS Therapy system generates highly concentrated magnetic fields which turn on and off rapidly to stimulate regions of the brain that are thought to be linked to emotion. These magnetic fields are the same type and strength as those produced by a magnetic resonance imaging (MRI) machine. They do not directly affect the whole brain, as they only reach a few centimeters into the brain directly beneath the treatment coil.
TMS stimulates brain cells in this prefrontal cortex area of the brain (the area of the brain responsible for mood regulation), inciting the electrical signal to travel through the neurons to their synapse and trigger the release of neurotransmitters (like serotonin, norepinephrine, and dopamine) across the synaptic cleft. With more neurotransmitters released into the synaptic cleft, the more receptor sites are needed on the receiving synapse. As a result, neurons begin to develop more connections with each other. As the stimulation is repeated, the rate of electrical signaling increases and this neuronal activity eventually becomes self-sustained. With increased activation in this area of the brain, patients symptoms diminish and patients may achieve remission of their depression.
During treatment, the patient hears a clicking sound and feels a tapping sensation on the head. The most common side effect is generally mild-to-moderate pain or discomfort at or near the treatment area during the session. When this occurs it is temporary, and typically occurs only during the first week of treatment. The patient remains awake and alert throughout the treatment, and each treatment takes about 30-45 minutes per day. TMS is administered five days a week, for up to four to six weeks. Patients can drive themselves to and from their treatment sessions.
First used in 1985, Transcranial Magnetic Stimulation has been used by researchers around the world to help understand the function of different parts of the brain. They have utilized TMS to study the nerve fibers that carry information about movements from the brain to the spinal cord and on to the muscles. Several hundred manuscripts have been published regarding its use in stimulating select regions of the brain. In the late 1990s, physicians began to explore the therapeutic potential of TMS for the treatment of a variety of diseases, with depression being the most thoroughly studied. Since then, more than 20 randomized, controlled trials studying TMS as a treatment for depression have been published by researchers throughout the world. In 2006, the largest randomized, controlled study ever conducted with TMS Therapy was completed. TMS became a standard of practice in the United States when it was cleared by the FDA in 2008 after a decade of clinical trials. TMS Therapy was cleared as an appropriate treatment option for adult patients with Major Depressive Disorder who have failed to achieve satisfactory improvement from at least one prior antidepressant medication at or above the adequately effective dose over an adequate duration.
TMS is a non-invasive form of neuromodulation, which stimulates neurons in the prefrontal cortex by delivering highly focused MRI-strength magnetic pulses. TMS was FDA cleared in 2008 for the treatment of depression in patients who have not benefited from prior antidepressant medication. Patients undergo treatment five times weekly for 4-6 weeks, and remain awake and alert throughout the treatment. Because it is a non-systemic & non-invasive, it is virtually free of adverse effect except transient discomfort and a minimal risk of seizure.
For more information, visit About TMS (Link to About TMS) & About Depression (Link to About Depression)