If you’re considering TMS therapy as a treatment option, here are some faq to help you understand what it involves.
Is depression impacting important areas of your life?
Have you tried antidepressant medication but are still depressed?
Are you having side effects from medication and want to consider other treatment options?
Have antidepressant medicines not provided full relief from your depression?
Is depression causing other medical conditions to worsen?
Has your doctor or therapist suggested you consider TMS therapy ?
Treatments are provided while sitting in a comfortable spa type chair. The head is positioned comfortably with a pillow and a flat coil is placed at the front part of the head. During treatments, which last between 9 to 19 minutes, a clicking sound is audible as magnetic pulses are delivered. There is a tapping sensation felt underneath the coil which results from the scalp muscles responding to the stimulation. Patients are awake and alert, watching a YouTube video or talking to the staff during the treatment.
Once the treatment is over, patients are able to immediately return to normal activity and drive themselves home. The usual course of treatment is daily treatments five days a week for six weeks and then a taper for the next six treatments. This protocol will be shortened or increased based on patient response.
The TMS treatments are:
The current FDA approval for TMS therapy is for major depression, anxious depression, OCD and smoking cessation. However, at the moment, major medical insurers only cover treatment for treatment resistant major depression. This means clinical depression that is not responding to medication and counseling. Generally this means age 18 and older and a diagnosis of major depression that has not responded to 2 to 3 medications or having experienced side effects to medication. Also failure of counseling with a licensed therapist like LPC or LICSW. TMS is not approved if there are psychotic symptoms or current drug or alcohol abuse or a history of seizures. Metallic objects that are present above the neck and specific medical devices would also be a concern.
Dr Hayden has successfully treated bipolar disorder, anxiety disorder, and tinnitus with TMS , but these are “ off label” treatments since there is no specific FDA approval yet for these conditions. This treatment would not be covered by insurance.
TMS therapy feels like a tapping sensation on the scalp underneath the coil. Some patients will notice a twitching in a facial muscle like the jaw or around the eye. These sensations resolve as soon as the treatment is completed. The strength of the pulse can be adjusted down if the treatment is causing discomfort. Generally the treatment is very well tolerated and subsequent treatments become much more routine with less discomfort.
Theta Burst Stimulation (TBS) is a newer form of transcranial magnetic stimulation (TMS) that differs from the traditional 10 Hz pulse sequence.
The standard TMS treatment, established in 2008, involves delivering 10 pulses per second for four seconds, followed by a rest period. In contrast, with Theta Burst TMS, pulses are delivered in a specific pattern of "triplets," which are three closely grouped pulses. These triplets are delivered five times per second.
Studies suggest that Theta Burst may have a greater capacity to stimulate brain tissue, particularly within a reduced treatment session.
Dr. Hayden will review your current medications to determine how they might interact with TMS.
Some medications, such as antidepressants and stimulants, may enhance your response to TMS. However, other common medications could potentially reduce the positive effects of TMS.
Any changes to your medication regimen will be made in consultation with your prescribing physician and usually adjusted prior to starting treatment.
TMS therapy does not alter an individual's core personality. Depression often leads to noticeable changes in a person's demeanor, such as a loss of interest in hobbies, social withdrawal, and a reduced desire for connection. When depression is successfully treated, patients typically return to their pre-illness level of functioning and their usual disposition.
In some cases, patients may appear to have a personality change after treatment. This usually happens when depression has been suppressing the expression of their core personality traits and creativity. However, TMS therapy itself does not appear to change underlying personality characteristics.
TMS appears to be a very safe treatment option. While there is a risk of seizures, this risk is actually lower than that associated with taking an antidepressant such as Wellbutrin.
There is also a slight, though extremely small, risk of developing mania (characterized by racing thoughts, high energy, and a decreased need for sleep).
Although more studies are needed to provide reassurance about long-term safety, TMS therapy has been used to treat depression since the mid-1990s. This 30-year history, coupled with its worldwide use, , suggests that it is unlikely there are significant, as-yet-unidentified side effects.