Transcranial Magnetic Stimulation (TMS) is an FDA approved, safe treatment for adults with medication-resistant depression. TMS involves the use of a very short pulsed magnetic field to stimulate nerve cells in a part of the brain that regulates mood. This area has been found to be underactive in individuals suffering from depression, who may benefit from TMS as an alternative treatment option for those who have not found success with prior antidepressant medications.



TMS Therapy

• Non-invasive, outpatient procedure
• Patients are awake and alert during treatment
• Stimulates key areas of the brain that are underactive in patients with depression
• Free from side effects often associated with antidepressent medications

~60% of people with treatment resistant depression respond to TMS

Carpenter, 2012

How does TMS Therapy Work?

Neurotransmitters are chemicals in the brain that communicate information throughout our brain and body. For those living with depression, this essential communication has decreased or been disrupted. TMS therapy works by using electromagnetic pulses to stimulate neurons, and cause the release of more neurotransmitters. Local stimulation depolarizes neurons, which can have an effect on deeper brain regions involved in mood.


Procedure

• A typical treatment occurs 5 days a week for 4-6 weeks
• A physician is present to customize treatment dose and placement for each patient
• Daily treatment often consists of 4 seconds of rapid magnetic pulses followed by a 26 second pause and/or a single pulse-per-second protocol lasting from 30 - 60 minutes daily
• Magnetic pulses are described as feeling like a small, electronic woodpecker tapping on the scalp

Safety and Effectiveness

TMS Therapy provides relief for patients who do not adequately respond to medication or who find the adverse effects of antidepressant medication intolerable. Antidepressant medications are often accompanied by symptoms such as insomnia, weight gain, nausea, fatigue, and sexual dysfunction. In contrast, the most common side effect associated with TMS Therapy is temporary slight pain or discomfort at or near the treatment site during treatment. These events are transient and usually subside after the first week of treatment.

TMS Therapy has no adverse effect on cognition, memory, or daily functioning. Once a patient has completed their treatment for the day, they are able to drive, go to work, and carry out their normal daily routine.

Individuals may not be eligible for TMS Therapy if they have any non-removable metallic objects in or near their head, or neck or implanted devices controlled by physiological signals, such as a pacemaker, cardiovascular defibrillator (ICD), or vagus nerve stimulator (VNS). THis doe snot include dental work (e.g. fillings and implants). Those who have a history of seixure may also be disqualified from treatment on a case-by-case basis. 

Clinical Studies


TMS Therapy is backed by a large clinical data set

• Over 30,000 patients treated using TMS Therapy
• 7 major studies including 800 patients, resulting in 18 publications


TMS treatment has demonstrated durability in depression over 1 year

• Learn more about proven short- and long-term efficacy of NeuroStar TMS Therapy at www.neurostar.com

Consistent Outcomes

In a study of 307 patients undergoing an intial (“acute”) course of TMS Therapy where the majority of patients were considered severely depressed, clincians found that approximately 58% were assessed as ‘mildly ill or better’ by the end of treatment. 

Patients may see an improvement in their depressive symptoms at any time over the course of treatment. While some patients may see an improvement after the first week, it is just as common for patients to notice an improvement within their last couple weeks of treatment.

Other Clinical Applications

The use of TMS Therapy as a therapeutic tool in the mental-health industry is ever-expanding. While TMS Therapy has only been FDA-approved for the treatment of Major Depressive Disorder and Obsessive-Compulsive Disorder (OCD), numerous studies have found TMS to produce significant clinical effects for various other neurological and psychiatric conditions. Additional applications of TMS Therapy include, but are not limited to: Anxiety, PTSD, Tinnitus, Auditory Hallucinations, and Neuropathic Pain. 

If you are suffering from one of these conditions, call (425) 412 - 8133 or contact us at contact@sperohealth.net to learn more about TMS Therapy and to see if this may be an effective treatment option for you.

What is TMS Therapy?

TMS Therapy is a non-systemic (does not circulate in the bloodstream throughout the body) and non-invasive (does not involve surgery) form of neuromodulation. TMS Therapy utilizes highly focused MRI-strength magnetic pulses directly through the scalp to modulate neural activity in areas of the brain associated with various neuropsychiatric conditions. Patients being treated with TMS Therapy do not require anesthesia or sedation and remain awake and alert during the treatment session. For depression, TMS Therapy consists of a 45-minute outpatient procedure prescribed by a psychiatrist and performed in a psychiatrist’s office. The treatment is typically administered daily for 4-6 weeks. Treatment protocols for other psychiatric or neurologic conditions vary in session length and number of sessions needed.

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What happens during TMS Therapy?

During TMS Therapy for depression, pulsed magnetic fields are repetitively transmitted into the left prefrontal cortex, the part of the brain that is thought to regulate mood, in order to stimulate the firing of neurons (nerve cells). This is believed to trigger a cascade of neurochemical events, including the release of neurotransmitters (such as serotonin, norepinephrine, and dopamine) and to help normalize neurotransmitter function.

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How long does a patient undergo TMS Therapy

In clinical trials for depression, patients received TMS Therapy 5 times per week for approximately 37 minutes during each session for 4-6 weeks. Patients with depression should be treated for a minimum of four weeks with additional treatments based on clinical judgment. This standard does not apply for those seeking treatment for other neuropsychiatric disorders, such as auditory hallucinations or tinnitus, which often require much shorter treatment protocols.

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What is a daily treatment session like?

At the start of treatment, patients are seated in a comfortable chair in a slightly reclined position. The clinician will speak with the patient about any updates, medication changes, concerns, or questions the patient may have each day. During treatment, the patient may listen to music, watch a show (device not provided), read a book, practice breathing or mindfulness techniques, or sit silently with earplugs in. The patient must stay awake during treatment.

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What are the benefits of TMS?

1. TMS Therapy is a non-systemic and non-invasive depression treatment that is cleared by the FDA for depression and OCD

2. It is indicated for adult patients who did not achieve satisfactory improvement from prior antidepressant medication

3. In clinical trials, approximately 60% of patients showed a significant improvement in symptoms after 4-6 weeks of treatment

4. Since it’s non-systemic, it doesn't have side effects such as weight gain, sexual dysfunction, nausea, sedation, dry mouth, etc.

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How long does the anti-depressant effect last? Do patients need to go back for another session?

In a long-term durability study of 257 patients with Major Depressive Disorder by Dunner et al., (2014), approximately 62% of patients continued to meet response criteria a year later. However, 32% of patients experienced symptom worsening a month after completing treatment, and had to go back for additional treatment sessions. Of the patients who responded to the initial course of treatment and then experienced symptom worsening, all of those patients responded equally well to reintroduction TMS treatment the second time around.

It is important to note that these statistics vary by clinic and the neuropsychiatric condition for which you are seeking treatment. Since TMS Therapy has only been FDA approved for depression since 2008, there is no standard for how long TMS is “supposed” to last, and its effects have been found to vary from months to years depending on the individual.

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Is TMS Therapy a good alternative for patients who are fearful of side effects associated with antidepressant medications?

TMS Therapy has been cleared by the U.S. FDA for the treatment of patients with depression who have failed to achieve satisfactory improvement from prior antidepressant treatment. TMS Therapy is non-systemic, so it doesn’t have side effects such as weight gain, sexual dysfunction, nausea, dry mouth, sedation, etc. Like any treatment option, patients and clinicians should work together to find the most appropriate treatment option for each patient.

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What does TMS feel like during treatment?

TMS Therapy has been described as sounding and feeling like an electronic woodpecker tapping on the scalp. The most common adverse event related to treatment is scalp pain or discomfort at the treatment area during active treatments, which is transient and mild to moderate in severity. The incidence of this side effect declines markedly after the first week of treatment.

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What are the long-term consequences of TMS treatment?

TMS is an acute (active, but short-term) therapy. With regard to long-term safety, TMS uses the same type and strength of magnetic fields as MRIs, which have been used in tens of millions of patients around the world and have not been shown to cause long-term consequences.

The amount of magnetic field exposure for a full course of TMS Therapy is only a small fraction of one brain scan with an MRI. If a patient had multiple courses of acute TMS, the magnetic field exposure would be less than exposure from a few MRI sessions.

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What are the risks of TMS Therapy?

TMS Therapy should not be used in patients with implanted metallic devices or non-removable metallic objects in or around the head. This does not apply to dental work. It also should not be used in patients with implanted devices that are controlled by physiological signals such as pacemakers. Patients with a seizure disorder or a history of seizure should consult their physician about whether TMS is an appropriate treatment option.

Some people experience slight discomfort at the treatment site or headache during the first few treatment sessions. These usually resolve by the second week of therapy.

The risk of seizures is extremely low and is estimated to be less than 1 in 1000.

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How effective is TMS Therapy compared to drugs?

TMS Therapy is meant for patients who have already tried multiple antidepressant medications and discontinued them due to a lack of response or intolerable side effects. Due to the nature of these qualifications, TMS Therapy has been found to be a much more successful therapeutic tool compared to patients trying a third or fourth medication trial that are often accompanied by potentially severe side effects.

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Is TMS Therapy intended to replace antidepressant medications?

No, though TMS Therapy is employed to address needs unmet by medications. Currently there are few options for patients who have had an inadequate response to previous antidepressant treatments. They are often faced with choosing between a complex regimen of multiple drugs or, for more severe cases, more invasive procedures. Based on its excellent safety profile, TMS Therapy may be used earlier in the treatment protocol than antidepressant drug classes that carry a significant safety/tolerability burden.

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What is the history of TMS Therapy?

First used in 1985, TMS has been used by researchers around the world to help understand the function of different parts of the brain. Several hundred manuscripts have been published regarding its use in stimulating select regions of the brain. Since the mid 1990s, TMS has been studied as an antidepressant therapy. In 2006, Neuronetics completed the largest randomized, controlled study ever conducted with TMS Therapy. In 2008, TMS therapy was cleared by the U.S. Food and Drug Administration for the treatment of adult patients with major depressive disorder who have failed to receive satisfactory improvement from prior medication antidepressant treatment. Many clinical studies are still underway to determine the effectiveness of TMS therapy as a treatment method for other neurological and psychiatric conditions.

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Will treatment be covered by insurance and/or Medicare?

While SPERO Consulting PLLC is “out of network” for general psychiatry services, we do offer to conduct a free benefits investigation for those interested in TMS Therapy to see if TMS is covered under their specific insurance plan. For those who meet the criteria for major depressive disorder, we can file a single-case agreement with insurance companies on a case-by-case basis to provide you “in-network” coverage for TMS. Unfortunately, we do not accept Medicare insurance as we have opted-out. TMS Therapy for conditions other than Major Depressive Disorder are also cash-pay only, as they have not been approved for coverage by any insurance company at this time.

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Is TMS Therapy like ECT?

No, TMS Therapy is a completely different procedure than ECT. While they are both considered to be secondary treatment options to medication and psychotherapy, they do not treat depression in the same manner. ECT is a procedure that requires general anesthesia and purposefully triggers a brief seizure by passing electric currents through the brain. TMS, on the other hand, allows for the patient to be fully awake and alert during treatment and uses non-invasive magnetic fields to directly stimulate nerve cells in a specific area of the brain. Furthermore, TMS does not produce any of the unwanted side effects that are often associated with ECT, such as confusion, memory loss, physical side effects, and medical complications. TMS Therapy does not result in adverse effects on memory, concentration, or daily functioning.

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