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Butler Hospital
Butler Hospital
TMS

Transcranial Magnetic Stimulation (TMS)

In October 2008, TMS was approved by the US Food and Drug Administration (FDA) for treatment of patients suffering from depression who have not achieved satisfactory improvement from prior antidepressant medications. This approval was earned following over a decade of clinical trials studying depression and other psychiatric disorders.

What is Transcranial Magnetic Stimulation?


This revolutionary technique has shown positive results in patients suffering from severe depression that did not respond to medication. Targeted magnetic pulses trigger small electrical charges that stimulate the brain in the prefrontal cortex. TMS therapy is non-invasive, and does not require anesthesia or sedation. Patients can travel independently to the clinic for once-daily treatments and remain awake and alert throughout the TMS treatment sessions. TMS therapy can be given alone, or as an adjunct to ongoing psychiatric medications.

A typical acute course of TMS therapy includes:

  • Thirty daily treatment sessions, five per week; Monday through Friday (followed by six "taper phase" treatments given over three weeks).
  • Serial assessments of symptoms/response with standardized rating scales.
  • Collaboration between the TMS team and a patient's regular outpatient care team during the course of TMS therapy: Butler TMS Patients continue to meet with their outpatient clinicians and prescribers for medication management and psychotherapy.
  • An end-of-treatment summary is sent to the patient's treating clinician to document outcome and recommendations.
  • A repeat course of TMS therapy is covered by most insurance policies for patients who showed positive response to initial acute course of TMS and experienced subsequent depression relapse.

How Does TMS Work?


TMS is non-invasive, does not involve insertion of intravenous lines or surgery and does not require any anesthesia or sedation. A small electromagnetic coil, controlled by a computer program, is used to deliver short, powerful bursts of magnetic energy focused precisely on the left side of the brain’s frontal cortex.
» Learn More About How TMS Works

TMS Therapy at Butler Hospital
We strive to make the process of referring patients with treatment resistant depression to the Butler TMS Clinic as easy and effective as possible. Most of our patients receive TMS therapy as a covered service through their health insurance policy. As such, we go the extra mile to obtain source documentation of past treatment history. Typical eligibility requirements for insurance coverage of TMS include a patient:

  • Current primary diagnosis of unipolar Major Depressive Disorder (MDD), single episode or recurrent episode without psychotic features;
  • Current episode characterized by a moderate to severe level of current depressive symptoms (standardized ratings scales are used to access severity);
  • Patient has the ability to remain safe and is sufficiently stable for treatment on an outpatient basis;
  • History of adequate trials of several antidepressant medications in the current episode, or documented intolerance to several attempted medication trials;
  • Exposure to several different pharmacological classes of medications during current and past treatment for depression (SSRI, SNRI, atypical antipsychotics, augmentation agents).

A patient may or may not have had a past trial of ECT (to date, history of past ECT is not related to TMS response).

The Butler Hospital Transcranial Magnetic Stimulation Clinic has been providing TMS therapy to patients with pharmaco-resistant and pharmaco-intolerant major depression since 2009.

Our state-of-the-art treatment facility houses multiple FDA-cleared devices for standard TMS clinical care, as well as investigational devices for research clinical trials. 

Over a thousand TMS treatments are provided to outpatients annually by a highly trained and skilled staff comprised of seven TMS-credentialed psychiatrists, a TMS nurse, and two full-time TMS technicians.

Referring a Patient


Many patients refer themselves to the TMS Clinic and inquire about the screening process. Our TMS Clinic works collaboratively with outpatient providers to offer the best integrated care for each patient. To refer a patient, call the TMS Clinic at 401-455-6632. Prescribers will be asked to provide copies of treatment records to establish details of past treatment history. Once a patient's contact information is provided, a member of the TMS team will coordinate the screening process, which includes the following steps:
  • Conducting a preliminary phone screen with the patient.
  • Sending a packet of information about TMS to the patient in the mail.
  • Collecting clinical history and determining symptom severity through interviews and completion of patient self-report forms and rating scales.
  • Scheduling an outpatient consultation evaluation with a TMS psychiatrist to review clinical information, determine eligibility, provide education, obtain informed consent, and document appropriateness for TMS therapy.
  • Processing a request for pre-authorization of insurance coverage for TMS.
  • Contacting the patient to schedule the course of therapy.

Effectiveness of TMS for Depression


In clinical trials, patients treated with the type of TMS device used at Butler Hospital, experienced great improvement with depression symptoms. The FDA determined that this device provides safe and well-tolerated treatment.
» More About TMS
» More Clinical Trial Results

TMS is Safe and Well Tolerated
Over 10,000 active TMS treatments were safely performed during clinical trials with the type of TMS device used at Butler Hospital. The most commonly reported side effect related to TMS was scalp pain or discomfort during the treatment session. This side effect was generally mild to moderate, and occurred less frequently after the first week of treatment. Less than 5% of patients treated with TMS Therapy discontinued treatment due to side effects.
» More Information

TMS FAQs


Get answers to frequently asked questions about TMS.
 TMS
TMS At Butler Hospital, Magnetic Treatment for Depression
This article appeared in the Providence Journal on June 22, 2015, and was written by Nick Gilbert, a freelance healthcare writer.
>> Read the story here

A New Way to Treat Depression at Butler

This article appeared in the Providence Journal on March 11, 2009 and was written by Felice J. Freyer, Journal Medical Writer
Patient Story: Cheryl
First feeling the effects of depression in her late teens and getting little relief with anti-depressants, Cheryl finally found the treatment that worked for her.
» Providence Journal Story

Contact the TMS Clinic at Butler Hospital

Linda L. Carpenter, MD, Service Chief
Phone: (401) 455-6632
Fax: (401) 455-6686
E-mail: lcarpenter@butler.org

The TMS program is located at:

Butler Hospital
345 Blackstone Blvd
Center House Rear, 206C
Providence, RI 02906


» Directions to Butler
  TMS in the News

TMS Receives Medicare Coverage Approval
»
Press Release

Providence Journal
» TMS-A New Way to Treat Depression (March, 2009)

» At Butler Hospital, Magnetic Treatment for Depression (June, 2015)

Butler is one of the first hospitals in the country to offer TMS.
» Press Release

Depression

Depression is a medical condition which reflects abnormalities in brain chemistry and requires medical treatment.

» Depression Homepage
  Info on Safety Efficacy for Doctors
Independent research studies have indicated that TMS can help reduce symptoms of depression with little or no side effects.

» Studies of Resistant Major Depression
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