What is Transcranial Magnetic Stimulation (TMS), and how does it help depression?
TMS is a treatment for depression that works by directly stimulating the brain. TMS activates certain parts of the brain by using electrical energy passed through a coil of wires to create a powerful magnetic field. During a TMS treatment session, energy from this magnetic field is transferred into a patient's brain when the coil device is applied to a person’s head. Magnetic energy passes easily through skin and skull, activating the brain painlessly and without surgery or sedation. TMS is applied to areas of the brain associated with mood regulation. TMS affects brain functions and chemical activity, effectively "jump -starting" mood regulation structures in the brain, resulting in dramatic improvements in depressed patients.
What does a patient experience during Transcranial Magnetic Stimulation?
During the treatment you are seated and reclined in a comfortable chair. You are fully awake and alert, and you can talk during the treatment. There are no new medications involved in a TMS treatment, though you and the doctor may decide to continue the ones you were regularly taking before you started TMS therapy. The TMS operator rests the magnet coil over the appropriate area of the scalp and determines the settings (dose parameters) before starting the session. You will need to remove any metal hair clips, hearing aids, earrings, and glasses before the treatment. Usually patients wear earplugs or listen to music during treatment to minimize the clicking sound of the equipment. A typical treatment lasts 37 minutes, during which the patient feels a series of taps on their scalp.
How long does it take to get better with TMS?
The most successful TMS treatments for depression occur when patients undergo TMS treatments every weekday for 4-6 weeks, or a total of 20-30 treatments. Often there is no noticeable mood change during the first few weeks. In the clinical trials, a small percentage of patients required more than 30 treatments to experience relief from depressive symptoms. Others noticed significant benefits from TMS at the end of the second week of TMS treatments. At Butler Hospital, TMS sessions are scheduled in 1 hour blocks, and each slot in the schedule begins at 15 minutes before the hour.
Will TMS disrupt other areas of brain functioning or change my personality?
One of the benefits of TMS, relative to other depression treatments, is the accuracy it achieves in working on the desired brain region, or “target.” TMS allows clinicians to target very specific parts of the brain, leaving other areas alone. TMS does not lead to memory difficulties or other impairments in thinking. It does not change a person’s personality, though when patients experience relief from symptoms of the depression, their ability to think and function typically improves.
Is TMS the same as ECT?
No, TMS is not the same as Electroconvulsive Therapy (ECT). ECT, commonly referred to a “shock therapy” is a different treatment for depression which involves the use of electricity to produce seizure-like activity in the brain while a patient is under anesthesia. ECT is considered the most effective treatment for severe depression, but the side effects can be substantial. TMS is similar to ECT by virtue of its direct brain stimulation method to relieve depression. However, TMS is a treatment performed in the awake/alert patient; no anesthesia or sedation is needed. Magnetic energy, rather than electricity, is applied to the scalp during TMS.
Who will be involved in my treatment?
A doctor will be involved in all three phases of your TMS therapy: (1) the pre-TMS consultation to determine if you are an appropriate candidate for the treatment, (2) the administration of TMS therapy, and (3) maintenance care of your depression after completing TMS therapy. Your outpatient psychiatrist or the primary care doctor who may be prescribing medications for your depression will remain involved during TMS and will continue to follow you after you finish TMS. Doctors at Butler Hospital trained in TMS will become a part of your treatment team while you are getting TMS, but they will not prescribe any regular medications for you. In addition, a medical technician will be present to monitor TMS under the supervision of a qualified TMS physician.
Does TMS hurt?
During the first few treatments, the tapping sensation on your scalp may be uncomfortable. Up to 50% of patients who receive TMS will experience some mild to moderate soreness on their head during the first week of treatment. Over-the-counter pain medicines such as aspirin, Tylenol. or Motrin can be used, before or after TMS sessions, to manage the discomfort. Over time, the scalp becomes less sensitive to the tapping sensation of the magnetic pulses and the treatment does not produce discomfort.
What are the risks or side effects of TMS?
TMS is relatively free of side effects, compared to other treatments for depression. Studies show that about one in five people will develop a mild to moderate headache or scalp soreness after they receive TMS especially during the first week. Throughout the NeuroStar TMS Therapy studies, more than 10,000 active TMS treatments were safely performed. There were no “body system” side effects, such as sedation, nausea, or dry mouth, no adverse effects on concentration or memory, no seizures, no interactions with medications. Fewer than 5 percent of the subjects enrolled in the TMS clinical trials dropped out due to adverse events, reflecting a high degree of tolerability of TMS compared with antidepressant medications.
Do I need to stop taking my medications to get TMS therapy?
Not necessarily. This is decided on an individual basis. During your pre-treatment consultation/evaluation, the doctor will discuss this with you, and, together, you will decide about what medications you will be on during TMS therapy at Butler Hospital.
How do I find out if I am a good candidate for TMS at Butler Hospital?
Once you have reviewed the information on this website, you may have a better idea if TMS is a treatment consideration for you. You can call and request a packet of information be sent to you in the mail (401) 455-6632. If you have learned enough about TMS and want to take the next step toward getting treatment, you can call (401) 455-6349 to arrange a consultation appointment with Dr. Carpenter.
Does Insurance pay for TMS treatment?
Since TMS is a new treatment (approved by FDA in October of 2008), most insurance providers do not yet routinely cover it, though they will consider a request on a case-by-case basis. There is a company called Care Connection that works with our patients towards processing claims, either for pre-approval or reimbursement after one has paid for TMS out of pocket. A caseworker will be assigned to help with getting all available benefits for TMS. However, at this time, each patient is responsible for payment prior to receiving TMS at Butler Hospital.
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