TMS, a Drug Free, FDA Approved Treatment for Depression
Depression is a state of feeling stuck. Imagine your thoughts as a dog tied to a tree in your yard; it runs around in circles creating deep grooves in the grass and soil. Those deep grooves are your depression. TMS allows the dog to run free in the yard – it cuts the leash and enables the brain to create other, more healthy pathways.
Over the years, you’ve probably tried to cut that leash and ‘unstick’ yourself with therapy and medications. You’ve worked hard in therapy and tried a lot of different medicines to no avail. Sometimes, even when a drug is helpful, the side effects are intolerable. You are looking for something new and different. Something that won’t have side effects and with proven results. You are looking for TMS.
TMS stands for Transcranial Magnetic Stimulation. Transcranial means the stimulus passes through the skull or cranium. The stimulus is caused by a changing magnetic field, like in an MRI machine, which creates electrical stimulation in cells inside the brain. Magnetic stimulation non-invasively stimulates the brain without causing pain in the way direct stimulation would.
Stimulation of the brain causes neurons to release of neurotransmitters and increases BDNF (brain-derived neurotrophic factor). BDNF promotes the growth and survival of nerve cells in the brain.
At Catalyst, we use the BrainsWay TMS machine. It is referred to as “Deep” TMS because of the unique coil it uses which results in a wider area of the brain being simulated and the stimulus penetrates deeper into the brain. This is thought to to be more effective than figure eight coils offered by other TMS machine manufacturers.
The first TMS machine was invented in England in the 1970s by researchers trying to study peripheral nerves such as in arms or legs without as much discomfort as direct electrical stimulation. It wasn’t until 1985 that the same group demonstrated the first use of magnetic stimulation through the skull to stimulate central nerves.
It took almost ten years, in 1993, for someone to suggest the machine could treat depression. Several thousand studies followed. A large study run by the National Institute of Mental Health, in 2008, showed that real TMS compared to sham treatment was superior, resulting in TMS’ approval in the U.S. for treatment-resistant depression. Treatment-resistant depression occurs when someone fails to respond to two or more antidepressants of adequate dose or duration. In 2009, BrainsWay, the machine we use at Catalyst, was cleared by the FDA for use in the U.S.
In a study conducted by BrainsWay, remissions rates (meaning depression was minimal to none) for those with treatment-resistant depression were almost two-fold better than sham or fake treatment. In aftermarket observations, BrainsWay patients show a remission rate of about 50%, but 75% of others see significant improvement in their symptoms. In comparison, effectiveness of any antidepressant is about 30%.
After a typical course of 36 treatments, some patients will have remission of their depression for a year or more. More typically, however, patients often will obtain remission of their depressive symptoms for 3-12 months. Patients can return at that time for another course of treatment.
BrainsWay TMS is also approved to treat OCD and most recently smoking cessation. Please call for information regarding using TMS to treat these conditions.
You’ll arrive at the office and fill out a daily habit questionnaire. Weekly you’ll fill out a depression assessment called a PHQ-9.
You’ll sit down in a comfortable chair and place earplugs in your ears.
A targeting cap is placed over your hair, which helps us systematically find the appropriate treatment area and treatment stimulus strength.
Treatment consists of 1980 pulses given in groups of 36 pulses. Each pulse is 2 seconds with a wait time between groups of pulses of 20 seconds. The total treatment time in the chair is only about 20 min. During treatment, you can relax, read, or watch TV.
Patients describe the sensation of treatment in a variety of ways. Initially, patients describe the sensation as uncomfortable (though not painful) over the first few treatments as they get used to the feeling. The helmet can be adjusted slightly for improved comfort if needed. Patients quickly acclimate to the sensation.
A typical treatment course is five days a week for six weeks, then a taper schedule of 6 more sessions over the subsequent three weeks for a total number of treatments of 36.
The most common side effect is headache on the day of treatment. In studies, this ranged from 5-25% of patients receiving TMS treatment. Typically, the headache is mild and easily treated with over the counter pain relievers.
Neck pain can also occur, especially after the first session, when we must repeatedly adjust the helmet to find the proper treatment position.
Other side effects include temporary and mild discomfort at the treatment site (in studies, this occurred 20-40%). Jaw and tooth pain can occur, which is easily prevented or alleviated by purchasing and wearing an over the counter mouth guard during treatment. There can be a rare increase in tinnitus or mild decreased ability to hear, but these risks are minimized by wearing earplugs during treatment which is mandatory.
Lastly, there is a risk of seizure, which is less than 0.1%. We evaluate patients before each session to ensure nothing might contribute to this happening, such as excessive alcohol, caffeine, lack of sleep, or drugs that could lower the seizure threshold.
The majority of insurance companies cover TMS. A prior authorization is required. Co-pays are typically still necessary. Most insurance companies want to see the following before they approve a course of TMS;
If you choose to pay out of pocket, we offer a discounted fee. Please call for details. We accept credit cards and will charge your credit card weekly. If you do not complete the entire TMS course for whatever reason, there is no charge for treatments you do not receive.
If you have magnetic metal plates, clips or devices implanted in or around your head, including metallic fragments. If you have had brain surgery, stroke, or severe head trauma history, you likely should not undergo TMS.
If you have other implanted devices such as spinal, bladder, or heart stimulators (pacemakers), you should not have TMS.
If you have a history of seizures or an active seizure disorder, this would need to be evaluated on a case by case basis as to if TMS would be safe for you.
We are a participating provider (aka ‘in-network’) with the following insurance companies. If you have questions regarding billing, please call the office during normal business hours. At this time we are closed to Medicare, Medicare advantage plans and Oregon Health Plan.
If you would like more information about becoming a patient, please contact us by calling us or filling out this form.
Brainsway’s dTMS (Deep Transcranial Magnetic Stimulation) launched a new era in brain disorder treatment. Brainsway provides a safe, effective, non-invasive treatment for Major Depressive Disorder, bringing back hope to millions of patients and their families worldwide. Check out this video below and see all their videos to learn more about Deep TMS.