A total course of treatment consists of 36 sessions completed in about 7-8 weeks. The first 30 sessions are 5 days per week (Monday through Friday) and the last 6 sessions are usually tapered in a 3-2-1 fashion at Dr. Gowda’s discretion. The first appointment will be about 40 minutes in length because informed consent forms, initial brain mapping, and motor threshold must be completed before stating. Otherwise, each treatment is approximately 20-30 minutes long.
Magventure TMS machine and coil. Each patient receives their own individual treatment cap that they will wear each session.
Magventure TMS Device
Transcranial Magnetic Stimulation (TMS) is a series of brief, repetitive magnetic pulses that are used to stimulate our brain cells. MagVenture TMS is used to treat depression for patients who have had no success with medication. According to studies, approximately 58% of patients respond positively to TMS therapy. The benefits of TMS treatment are a minimal side effects, non-invasive, and has been proven as a treatment for depression. TMS treatment includes four to six treatments that take less than an hour each day, five days a week. The way the TMS machine works is the patient is fitted for a cap on their head. Short pulses of magnetic energy are focused at the limbic system structures. Then the pulses trigger electrical charges, causing neurons to become active. Once the limbic system structures change, so do your emotional and behavioral patterns! This is why we need to do these treatments so frequently.
- Magnetic stimulator
- Magnetic coil for locating the patient’s exact treatment spot and intensity level (MT determination)
- Magnetic coil for the actual TMS treatment
- Trolley for the stimulator
- Comfortable treatment chair
- Pillow that shapes around the head to support and keep the patient stable during the MagVenture TMS Therapy
- Cotton caps to facilitate easy marking of the patient’s treatment location and repositioning on the patient’s head after the initial TMS session
- Cooling unit which allows consecutive treatment sessions with no issue of the coil overheating
TMS generates its therapeutic effects via the concept of neuroplasticity. This refers to the brain’s innate ability to restructure and remodel the organization of its neuronal networks (pathways of communication between brain cells). TMS has been shown to produce changes in the neuronal activity in regions of the brain responsible for emotion and mood regulation, such as the prefrontal cortex. This causes new neurons to be generated and the connections between them and other parts of the brain to become stronger.
As each magnetic pulse passes through the skull and into the brain, this induces brief electrical activity within the brain cells underlying the treatment coil. The timing, frequency, amplitude, and wave shape of magnetic pulses delivered influences whether brain activity is enhanced or reduced by a session of TMS. Different psychiatric diagnoses require different treatment parameters, and are adjusted throughout the treatment as needed.
Antidepressant medications and psychotherapy are the first line treatments for major depression. These treatments, however, do not work for all patients. In these instances, TMS might be used as an alternative treatment, or to augment antidepressant medications or psychotherapy. Patients who have failed to achieve an adequate response from antidepressants, or who are unable to tolerate medications, might consider TMS therapy.
Patients with a history of seizures may not be eligible for TMS treatment, although this can be discussed with the doctor. Patients with any type of non-removable metal in their heads (with the exception of braces or dental fillings), should not receive TMS. Failure to follow this rule could cause the object to heat up, move, or malfunction, and result in serious injury or death. The following is a list of metal implants that can prevent a patient from receiving TMS:
- Aneurysm clips or coils
- Stents in the neck or brain
- Deep brain stimulators
- Electrodes to monitor brain activity
- Cochlear implants in your ears.
- Shrapnel or bullet fragments in or near the head
- Facial tattoos with metallic or magnetic-sensitive ink. If someone had an MRI done in past, generally they can do TMS.
TMS therapy is an FDA-approved treatment for depression and has been shown to be effective in treating a variety of other neurological conditions as well. The treatment is always performed by a trained TMS technician and under the supervision of the prescribing psychiatrist. There have been very few risks associated with the treatment and it has been proven to be the least invasive treatment option for depression as well as having the smallest number of potential side-effects.
In recent years, there has been lot more research regarding the efficacy of novel treatment protocols, such as doing multiple sessions per day. There has been no evidence of this causing any cell damage or degeneration. In fact, TMS is a neuromodulation therapy that aids in neurogenesis – the promotion of new neuronal activity and proliferation of brain cells.
While the magnetic stimulation is being administered, the TMS technician will ask you questions regarding your progress with the treatment, such that protocols can be personalized and altered as needed.
Because TMS uses magnetic pulses, before beginning a treatment, patients are asked to remove any magnetic-sensitive objects (such as jewelry, hearing aids, or hair pins). Patients are required to wear earplugs during treatment for their comfort and hearing protection, as TMS produces a loud clicking sound with each pulse, much like an MRI machine.
Virtually none. Compared to other treatments for depression, TMS is generally well tolerated. The most common side effects reported by patients are mild discomfort at the treatment site and the possible development of a slight headache during the first week of treatment. The most serious risk of TMS is seizures. However, the risk of a seizure is exceptionally low and a thorough check on a client’s medical history is conducted to rule-out this risk.
You are an ideal candidate for TMS treatment if you…
- Suffer from Major Depressive Disorder
- Have not received relief from multiple anti-depressant medications
- Are unable to tolerate anti-depressants or the side-effects caused by them
- Are not an active drug use or seizure disorder
While ECT requires the delivery of high electric charges to induce a seizure, TMS is NOT shock therapy. TMS uses strictly magnetic pulses that are used in an outpatient setting. Anesthesia is not required like it is in ECT. The patient remains awake and alert throughout the entire treatment session, and they are able to drive themselves to and from the clinic. Additionally, TMS does not prove to cause any of the undesirable side-effects as ECT such as memory loss, dizziness, insomnia, gastric issues, etc. Overall TMS is much less risky and more efficient procedure than ECT.
No. On the contrary, most patients report an enhancement in their cognitive functioning throughout the course of their treatments. As the frontal lobes are the center of executive function and thought processing, it follows that many patients experience an enhancement in memory, learning ability, and overall cognitive functioning.
Remission rates vary per patient. It is not uncommon to see many enjoy the benefits for more than 1- 3 years or more.
Most insurances cover the TMS therapy as it’s more cost effective long term and results in substantial improvement in patient quality of life/productivity. The coverage eleigibility policy varies among different carriers eg; Horizon BCBS require failure of at least 4 different types of medications and trials of psychotherapy and Pt is still very depressed. Amerihealth still considers it ‘experimental’ and does not cover it (although FDA approved in 2008 and widely used all over the world).
We currently participate in most commercial insurances including but not limited to Medicare, Aetna, Cigna, United Healthcare, and Blue Cross Blue Shield. Our staff handles all insurance authorizations for you- you are strictly here for your well-being.
Our office currently offers Free Consultations as a way for those who are interested to come in, view the machine, and become acquainted with the treatment process. You can discuss any issues with the TMS coordinator for 15-30 minutes, during which you meet the treatment team, ask questions, go over any concerns one may have. You are also given some additional information regarding the treatment such as articles, brochures, etc.
Many studies have been completed regarding the TMS treatment. Our office also provides various articles and information on the treatment at the time of the initial consultation. References will be provided on our website.
After one completes the first 30 TMS sessions, the last six are tapered out through usually a two-week period. Our office offers additional maintenance sessions two months following the final day of treatment at a discounted rate for those who have completed their full course of treatment with us.
TMS is always prescribed by a TMS physician. The initial motor threshold is always determined by a TMS physician. The treatment itself is administered by an experienced TMS technician under the supervision of the TMS physician or by the TMS physician. The TMS technician or physician will always be present to monitor the patient during the treatment. The patient can stop a treatment at any time by asking the staff member present.
TMS therapy involves a series of treatment sessions. Treatment sessions vary in length depending on the TMS coil used and the number of pulses delivered but typically last around 20 – 30 minutes. Patients receive TMS 5 days a week. A typical course of TMS is 4 to 6 weeks. However, this can vary depending on an individual’s
response to treatment. There are newer ‘Accelerated’ protocols that have been studied which are very effective which can be completed in 7-10 days (not FDA cleared).
Unlike ECT, TMS does not require any sedation or general anesthesia, so patients are fully awake and aware during the treatment. There is no “recovery time”, so patients can drive home afterwards and return to their usual activities.