TMS Treatment

Most patients starting TMS Therapy do so by first contacting us to schedule an initial assessment.

Starting TMS Therapy

Most patients starting TMS Therapy do so by first contacting us to schedule an initial assessment. 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 last about one and a half hours, but plan on two just to be safe. This is the all-important first step on your road to therapy and recovery.

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 will use the assessment to determine a diagnosis and determine the risks and benefits of TMS compared to other available treatments for your diagnosis. Your TMS prescribing psychiatrist 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 will also want details about previous treatment for your depression including counseling history, names of medications, 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.

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

Motor Threshold

At your first TMS treatment, the TMS prescribing psychiatrist or attending TMS technician will perform tests to identify your motor threshold. Measuring the motor threshold helps your TMS prescribing psychiatrist 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 the treatment and is customized for each patient to deliver the correct treatment dose.

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

Each individual has a different motor threshold need for TMS to be effective. The mapping process allows us to determine the proper magnetic field strength each person requires.

Fitting the Coil

Once the motor threshold is determined, the coil is brought forward so that it rests above the front region of the patient’s brain. Your TMS prescribing psychiatrist will make several measurements to ensure that the TMS coil is properly positioned over the patient’s head. Finally, the psychiatrist 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.

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

Are You An Ideal TMS Candidate?

TMS Therapy is an amazingly well-tolerated procedure and has little side effects, which means that most people are already good candidates to receive treatment. But while the treatment itself is well tolerated, TMS is FDA cleared for a very specific purpose. It is important to determine if you are a good candidate for TMS.

Major Depressive Disorder

While we are learning every day the great and undiscovered potential of TMS, to date the FDA has only cleared TMS for treatment in Major Depressive Disorder. If you are suffering from Major Depressive Disorder, TMS may be the right option for you.

Studies are being released every year which show that TMS could be used to alleviate symptoms stemming from Parkinson’s Disease, Fibromyalgia, and even Multiple Sclerosis. TMS has even been shown to reverse the effects of OCD and PTSD. It may be some time before your doctor can prescribe TMS for these ailments, but clinical studies are being conducted nationwide and are always looking for participants.

Medication Resistant

TMS therapy is an appropriate treatment for patients diagnosed with Major Depressive Disorder, who have failed to achieve satisfactory improvement from antidepressant medications at or above the commonly effective dose and duration. It is also for patients who cannot tolerate the side effects common with medication, or for those who do not wish to risk experiencing the side effects common with medication.

Strong clinical evidence suggests that patients who are less treatment-resistant tend to respond better to TMS than those who are high treatment-resistant. There is still much to be learned about particular variables that may impact response to TMS. For example, there is a lot of interest in evaluating whether TMS Therapy combined with antidepressant medications is more effective than TMS Therapy alone.

Who Cannot Receive TMS Therapy?

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 TMS prescribing psychiatrist will carefully screen for the presence of medical conditions or metal objects which may make TMS harmful.

Typical TMS Therapy Course

You’ve decided that TMS is worth the effort and you want to pursue treatment. Awesome! But how much effort is actually required. There’s no question about it, TMS is a commitment. But it’s a commitment to your health and that alone is worth the endeavor.

Length Of Treatment

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 according to FDA guidelines.

Who is Involved?

There is variation in who is involved with you treatment. At a private practice, your psychiatrist will often times act as the sole team leader, overseeing the total responsibility of the patient’s treatment and progress. Clinics, on the other hand, tend to utilize the team approach to TMS Therapy. They almost always operate as a team who collaborate amongst each other and relegate duties between patients.

Regardless of whether TMS Therapy is administered through a single psychiatrist or a team, you should always expect a trained TMS technician to administer the actual treatments and guide you through each session. The trained TMS technician or the TMS prescribing psychiatrist 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.

Feeling The Effects

Patients are traditionally reassessed for clinical progress by the psychiatrist after set intervals. During the course of TMS Therapy, your psychiatrist should continually reevaluate your condition and response to treatment and conduct periodic re-evaluations of the dose level as well as coil placement to ensure the most efficient treatment. Additionally, patients are assessed for side effects before and after each TMS treatment. In more intensive instances, the TMS psychiatrist will assess the patient daily.

The Dip

The Dip is a term used to refer to the effect which sometimes happens when the 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 very 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 towards the goal of alleviating their depression symptoms.

Unfortunately at this time not much is known about what causes The Dip, only that it’s effects are temporary.

Typical TMS Session

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. But there are three main elements to a TMS Treatment Session that every patient should be aware of: The Coil, The Chair, and Earplugs.

The Coil

The TMS treatment coil is gently placed on the head over the left prefrontal cortex, delivering focused magnetic stimulation directly to the area of the brain thought to be involved with regulating mood. The coil then generates highly concentrated magnetic fields which turn on and off very rapidly. These rapid pulses make loud ticking noises.

The Chair

For each TMS session, patients remain awake while sitting in a specially designed treatment chair, shaped much in the way of a dentist’s chair. The seating is relatively comfortable and reclines. During each TMS session, patients are awake, alert and may talk with the TMS technician, watch movies, listen to music, or read.

Ear Plugs

The TMS coils produce a loud clicking sound with each pulse, much like an MRI machine emits a loud tapping noise. Patients will want to bring earplugs. A lot of times earplugs are provided by the clinic. But if you are very picky about what gets shoved in your ear, then it is highly recommended you bring your own specialized plugs.