1025 Montgomery Hwy
Ste. 200, Vestavia Hills, AL 35216
(205) 637-3055
Secure HIPAA-compliant
Mon - Fri: 8AM- 5PM
Online store always open
Ste. 200, Vestavia Hills, AL 35216
Secure HIPAA-compliant
Online store always open
TMS
Non-invasive
FDA-approved
Transcranial Magnetic Stimulation (TMS) uses gentle magnetic pulses to activate underperforming areas of the brain involved in mood, focus, and energy.
You can either fill out our contact form here or call, text or email us. Then we will gather basic demographic information and ask you screening questions to make sure you don’t have any contraindications and ensure that the TMS is appropriate for your condition.
We will send you electronic intake forms to start gathering the data that insurance companies require for them to cover TMS such as documentation of past medications and therapy. We will need to get your written consent for us to get records from your psychiatrist, therapist and pharmacy. You can go ahead and ask your providers for this (and signed the needed consent forms) to expedite the process. Our pre-evaluation Q6 questionnaire is a thorough documentation of your current symptoms, functional impairment, past psychiatric history, past medical history, social and family history. Please set aside a significant amount of time to complete it.
In this session Dr. Richesin will document your symptoms, functioning, psychiatric, medical and social history and answer any questions you have about TMS.
In this session, Dr. Richesin will determine the personalized settings for your TMS, including the best placement for the magnetic coil and the appropriate power level for the magnetic pulsing. This usually takes about 30 minutes. Once you have been successfully mapped, then we proceed with the first treatment session. For most patients each treatment takes about 19 minutes. During treatment you can relax in the chair and watch TV or listen to music or an audio book. After the procedure you can immediately return to your usual daily activities including driving.
TMS (transcranial magnetic stimulation) is a non-invasive treatment for major depression. It has also been studied for many other illnesses.
A magnetic coil is placed over the skull in the targeted area and a series of rapid magnetic pulses are administered. These pulses are of the same type and strength as those used in MRI machines. The magnetic pulses pass through the skull and go a short distance into the brain. There they are thought to activate the neurons, cause chemical changes as well as induce the neurons to connect and signal more with each other. This in turn improves mood and cognition. TMS does NOT administer electricity. It administers magnetic pulses.
TMS was first approved by the FDA for treatment of adults with TRD (treatment-resistant depression) in 2008. Since then TMS has also been approved for OCD and smoking cessation. It is being investigated for many other disorders including PTSD, anxiety, bipolar disorder, fibromyalgia, tinnitus, chronic pain, autism, ADHD, Parkinson’s, post-stroke and more, but has not yet been approved by the FDA for these disorders.
With over 1.5 million treatments to 60,000 patients TMS has a long safety record. It has few risks and side-effects.
Every medical treatment has risks, benefits and side effects. The most serious risk of TMS is that it can cause a seizure. This is extremely rare. The older statistics estimated the risk at 1/30,000 treatments. Newer data show an even lower risk of 1/89,000 treatments. Therefore seizures are more common from medications than from TMS. For example, the risk of seizures with bupropion (Wellbutrin) is 4/1,000.
Seizures from TMS are usually in patients with a predisposing condition like severe head trauma, usually last less than 5 minutes and do not usually cause long-term medical complications.
While not a side effect of TMS, patients struggling with depression can have suicidal thinking or behavior. If you develop suicidal thinking and may act on it, you should call 911 or go to the ER.
As with medication and light therapy treatments for depression, TMS can cause hypomania or mania. This uncommon side effect tends to occur in patients with an underlying genetic predisposition due to a family history of manic depression (also called bipolar disorder). We will screen for this and watch for any signs of this.
Yes. Most patients continue their medications during TMS. In fact, we try to minimize medication changes during TMS for the stimulation level to remain constant. After TMS, some patients taper off some or all of their medications. This would depend on your provider’s recommendation based on your history and prognosis as well as on your response to TMS.
No. TMS is non-invasive, so there is no anesthesia and no systemic side effects.
Yes. The magnetic coil is placed far enough away so as not to cause any harm to the fetus. However, because the initial clinical trials excluded pregnant women, there is no specific FDA clearance for TMS in pregnancy. However, later trials evaluated safety and efficacy of TMS in pregnant women, and no absolute contraindication was assigned.
The most common side effect is scalp discomfort during TMS treatment in about 5-30% of patients. Some patients describe it as a tapping sensation under the coil. As the treatment progresses during the first week, most patients no longer complain of discomfort as their scalp adjusts to the sensation. We always recommend pre-treating with Tylenol or Advil 30 minutes before your TMS session for the first week or so till your scalp adjusts (unless these medications are contraindicated for you). We also turn down the intensity level in the beginning of TMS and only gradually increase it as tolerated.
Up to one half of patients report tension-type headaches after the initial TMS sessions. The headaches usually resolve in 30 minutes to two hours. They can be treated with OTC pain medications. It can also uncommonly cause light-headedness, especially in patients with postural hypotension.
Patients may also report muscle twitching during the TMS session due to stimulation of superficial nerves. If this occurs, we make adjustments to minimize this.
Because the TMS machine makes a tapping noise similar to an MRI machine, it could damage hearing. We give each patient either ear buds or foam ear plugs to protect hearing and to also lessen the risk of headache. You may bring your own noise cancelling ear buds if you prefer.
TMS does NOT cause brain damage, weight gain, sexual dysfunction, memory impairment, dry mouth, nausea, urinary retention or constipation. TMS is not addictive or habit-forming.
TMS is more effective than medication. Older studies indicate that two out of three patients get better with TMS (response) and 1 out of three patients get well with TMS (remission). Some of the newer studies show even better results. Compare this with the results of the STAR-D trial: the first antidepressant had a 27% chance of helping. By the time the patient started a fourth antidepressant, the chance of response had dropped to 6.9%.
The simple answer is cost. The initial trials evaluating TMS only included patients who had failed one or more antidepressants. Thus the FDA only approved TMS for the treatment of adult patients who had failed one of more medications (treatment resistant depression or TRD). It doesn’t mean TMS can’t work as a first line treatment for depression, only that insurance will only pay for it for TRD at this time.
Two out of three patients will maintain their response or remission 6-12 months after their course of TMS. About one third could see a return of their depressive symptoms. Thankfully, insurance usually covers another course of TMS and patients who achieved response or remission with their first course typically have a similar response or remission with the subsequent course.
Yes. All of these treatments increase the neuroplasticity (connectivity of neurons) of the brain. While insurance usually covers both TMS and Spravato® treatments, they won’t cover them concurrently. We can help you figure out which treatment you should try first. Insurance doesn’t cover Ketamine treatment, so TMS and Ketamine can be done concurrently if you want to pay out of pocket for the Ketamine. (Magnetic Hope does not prescribe Ketamine. You would have to go to another provider for it. There are some important treatment considerations, so we will help you plan for the most effective treatments if you are doing both.)
If you have been to the Apple store recently you know that cutting-edge technology is expensive. The average cost for TMS is about $300/session. For 36 sessions this works out to be almost $11,000. Thankfully, insurance now covers TMS for most insured patients with treatment-resistant major depression. In weighing a cost/benefit analysis, you have to also compare the “cost” of the depression and its effect on your life in terms of work, home-life and relationships. For our patients who have gotten their lives back, they have expressed that it was money well-spent.
Yes: Patients who have magnet-sensitive metals such as ferrous (iron) in their head or neck cannot do TMS. This would include bullet fragments, metal plates and medical devices such as a brain shunt, cochlear implant, aneurysm clips, electrodes, pumps or a deep brain stimulator. Standard amalgam dental fillings and permanent retainers are usually ok as they are not reactive to magnets.
We would love to help your patient! Please contact us to begin the process. 205-637-3055 or 205-825-HOPE or office@magnetichope.com. Also please have your staff gather your patient’s records documenting the medication and therapy trials which are needed for insurance coverage if applicable.
