TMS (Transcranial Magnetic Stimulation)

TMS is a safe and effective treatment that is approved by the FDA for patients with depression, anxious depression (anxiety symptoms in patients with depression), and obsessive-compulsive disorder (OCD). I have been treating patients with TMS in my practice since 2018. It is a completely non-invasive outpatient procedure. Many patients who undergo TMS in my office have been referred by their psychiatrist, while others have been referred by their therapist or found me online. If you are currently seeing a psychiatrist and have not been referred to me, I encourage you to discuss with them their opinion regarding whether or not TMS is appropriate for you.

The Brainsway device used in my practice administers dTMS (deep TMS). It delivers pulsed magnetic fields through a cushioned helmet. The magnetic pulses stimulate neurons (brain cells) in parts of the brain that play a role in the occurrence of depression or anxiety. When these neurons are activated, they release serotonin, norepinephrine, and dopamine, the chemicals created in the brain that are involved in depression and anxiety.

TMS treatments take about twenty minutes, and are given in my office by a TMS technician, under my supervision. They are given five times a week for six weeks, and may be followed by several “maintenance” treatments. These treatments may be recommended in order to achieve maximum improvement.

For additional information about TMS—how it’s administered, how it works, and how patients who have TMS describe their experience—I recommend that you visit www.brainsway.com/knowledge-center/tms-therapy-an-overview-for-those-seeking-info-and-treatment/.

Frequently asked questions

Is TMS the same as ECT (electroconvulsive therapy, sometimes called “shock therapy?”) TMS is completely different from ECT. TMS involves creating a magnetic field outside the skull. It is performed in my office, and patients can drive themselves to the office for treatment. Since it does not require anesthesia, patients can return to school, work, or home right after treatment. It does not cause memory loss. ECT involves sending electric currents directly into the brain to activate neurons and induce seizures.  It is performed in a hospital and requires general anesthesia. Patients cannot drive themselves to and from the hospital, or go to school or work, following ECT treatments. Patients often experience confusion after ECT treatment , and typically stay in the ECT suite for up to two hours after treatment. Short-term and long-term memory loss are not uncommon with TMS.

Is it effective? Studies have shown that up to 80% of patients with depression will improve with TMS, and up to 60% of patients will fully recover from depression. Approximately 50 to 60% of patients with OCD will improve with TMS. Patients often find that their medications are more effective once they undergo TMS. As is the case with all treatments for depression and OCD, it is not effective for every patient.

Is it safe? Yes. It does not injure the brain, nor does it affect any other part of the body.

Will it cause a seizure? Before the first treatment, we locate the part of the brain that controls motor activity, and we carefully position the treatment helmet to avoid stimulating it. Seizures with TMS are extremely rare.

 Is it painful? You may experience scalp discomfort at the treatment site during the actual treatments. The strength of the pulses can be adjusted to help make treatments more comfortable. Some patients experience headaches after the treatments, and you may take over-the-counter pain medications such as Tylenol or Advil if they occur. TMS produces loud clicks with each magnetic pulse. They are far less uncomfortable that the noises patients experience during an MRI, and foam earplugs are worn during each treatment to prevent any hearing loss.

Does it cause memory loss? No. Unlike ECT, it never causes memory loss.

Is it expensive? All major insurance companies, as well as Medicare, cover a significant portion of the cost of TMS, provided that it is being used to treat major depression, anxious depression, or OCD. Each insurance company has its own criteria for approving TMS. For example, some insurers require that patients have not responded to two courses of antidepressants, some require a history of non-response to four courses, and others do not require any history of antidepressant medications at all. Before your initial TMS consultation, my office will obtain your insurance information, contact your insurance company to determine if we need to obtain prior authorization, and determine how much your insurance will cover.

Are there patients who cannot receive TMS? Patients who have magnetic-sensitive metal in the head or within 12 inches of the magnetic coil cannot receive TMS. This includes aneurysm clips or coils, stents in the brain, implanted stimulators, metallic implants in the ears or eye, bullet fragments, or any other metal devices or objects implanted in the head. This does not include dental fillings.

Will I continue to take medication during a course of TMS? Some patients are more likely to respond if they remain on medication while undergoing TMS.

Will it still be necessary to take medication once TMS is completed? Although some patients find that is unnecessary to do so, the majority of patients who respond to TMS will be prescribed medication to help prevent a relapse.

How long will it take to respond? Many patients who benefit from TMS will experience results by the third week of treatment. Some patients may experience results in less time, while others may take longer.

Is there anything that I need to do or should avoid on the days that I have TMS? If you have ear piercings or wear earrings, they must be removed before each treatment, as well as makeup that contains traces of any metals. You should not take medications used to treat anxiety symptoms, such as Xanax, Ativan, Klonopin, or Valium, for at least eight hours before each treatment. There is no need to stop eating or drinking before each treatment.

Is TMS limited to patients with depression or OCD? The FDA has approved TMS for patients with depression, anxious depression, OCD, and smoking cessation. Insurance carriers will not cover it for any other illnesses, and some insurers will not cover it for smoking cessation. However, there is evidence supporting its use for a number of other conditions, including Alzheimer’s disease, autism, bipolar disorder, chronic pain, multiple sclerosis (MS), Parkinson’s disease, post-stroke rehabilitation, post-traumatic stress disorder, and schizophrenia. It is used abroad for these and other illnesses.