Transcranial magnetic stimulation (TMS)

TMS is recommended for those who have not experienced relief from first-line treatments.

Absolutely, you can continue taking your prescription while receiving TMS treatment.  A goal is symptom resolution and many, following successful treatment, feel well enough to begin coming off of medication.

TMS dates back to the 1980s and has demonstrated in clinical research studies since that it is both safe and effective for a number of conditions.  One large post-marketing data analysis of TMS treatment for severe depression, published in Psychiatry Research  showed that TMS led to a high degree of clinical response (81.6%; response being 50% reduction in symptoms) and remission rates (65.3%; remission being resolution of symptoms) after 30 sessions.

Numerous clinical studies demonstrate the efficacy of both ketamine and TMS for depression, with both also having broader applications. The two treatments differ in terms of the experience yet their potentials for improvement of mood involve action upon the same region of the brain that is involved in mood disorders. These treatments can even work synergistically if done together.  At Thrive our clinical team will carefully review your mental health concerns and discuss if these treatments can be of benefit for you.

Achieving symptom reduction through TMS is the goal, and there are individual differences in how many treatments one may need to begin seeing significant symptom improvement.  When this improvement emerges however, research demonstrates that sustained improvement can be seen upwards of one year following treatment.  Remember, TMS improvement is correlated with treatment number, as your brain learns each treatment to establish a more mentally balanced baseline. If you hope that improvement can be better by the end of your tms course, or you experience partial symptom recurrence afterwards, research demonstrates that merely continuing can improve those stubbornly treatment resistant symptoms. This is reflected in insurance company tms policies, who if clinical conditions are met, can reauthorize for continuation of treatment, with the goal of complete symptom resolution.

TMS and ECT  are not the same treatment. ECT applies electrical currents to the brain with the goal of improving the electrochemical function of brain cells and regions  involved in the most severe, treatment resistant forms of depression. It is done with a patient under general anesthesia, as the electrical current purposely causes a temporary controlled seizure to produce its effects. Despite how it sounds it is still considered a gold standard treatment that can be effective when no other treatments work.  It can be associated with side effects (e.g. memory trouble during treatment) that kept it a treatment of last restore.  TMS on the other hand, which uses magnetic pulses instead of electricity to influence abnormal electrochemical brain cell and region function is much less invasive and tolerated, with some patients even watching television comfortable during the treatment. It is done in the outpatient office setting, with some treatments lasting less than ten minutes, and the ability to otherwise return to your day with no disruption of your daily routine.

TMS is approved by the FDA to treat major depressive disorder, OCD, and smoking cessation. TMS is also an effective treatment (off-label) for a number of other conditions. TMS is commonly administered off-label for the following conditions: Bipolar depression, schizophrenia, Parkinson’s disease, anxiety, neuropathic pain, tinnitus, post-stroke motor dysfunction, PTSD, migraines, Multiple Sclerosis Fatigue Syndrome, alcohol use disorder, cocaine use disorder, tension headaches and post-stroke aphasia. Off-label TMS is considered for those who’ve had unsatisfactory symptom relief with FDA-approved first-line treatment yet given strong research data, your clinician believes it can help your symptom concerns. We  will conduct a thorough evaluation to determine if this may be of benefit in your case.

Accelerated TMS treatment is a one-week alterative to the standard TMS treatment course.  Known as the SAINT protocol, it was  developed by researchers at Stanford University, and achieved comparable effectiveness (78.6% remission rate) as the standard treatment. During accelerated treatment, patients receive 50 TMS sessions (10 per day, with 50 minute breaks in between) over the course of 5 consecutive days. The standard treatment course involves 36 sessions administered over 8-10 weeks.

TMS’s magnetic pulses feel like taps/tug on the scalp area target by the machine. It is a subtle feeling for many, yet for some, it can take the first few treatments to fully get used to it.  For the latter, most find over-the-counter acetaminophen or ibuprofen to be helpful.

Standard TMS is FDA-cleared and accepted by most insurance carriers as long as certain clinical requirements are met (e.g. one has tried and failed first-line treatments of prior antidepressants and therapy within the last 3-5 years). Accelerated TMS comparably effective yet classified as off-label, and therefore not yet covered by insurance.

Yes.

Patients who have the following:

1. Ferrous metal implants of the head and neck.

2. Some electronic medical devices within or that must remain on your person (ask if your device is disqualifying).

3. Some seizure disorders.