Questions?
We have answers.
What is TMS?
TMS stands for Transcranial Magnetic Stimulation. TMS utilizes magnetic pulses to treat depression, anxiety, OCD, and other mental conditions. These magnetic pulses gently stimulate specific areas of the brain that have grown over or under-active allowing them to re-calibrate as needed. Specifically, TMS targets certain areas of the brain that are involved in mood regulation. TMS also encourages communication between different parts of the brain, as well as neuroplasticity, which is the brain’s ability to adapt and form new patterns. ​
What is involved in TMS therapy?
During TMS treatment, patients recline in a treatment chair and are fully awake and alert for the treatment session. Your brain will be “mapped” before the initial treatment to determine your individual treatment location and magnet intensity. The magnetic coil is then placed over the treatment area and a series of magnetic pulses are delivered to specific areas of the brain.
Am I a candidate for TMS?
If your medications haven’t made you 100% better or if you’re having side effects, TMS may be an ideal treatment modality. Patients who are struggling with depression, anxiety, or other mental conditions and have failed to respond effectively to antidepressants or psychotherapy alone are optimal candidates for TMS. If you are someone who does not want to take, cannot tolerate, or has not achieved full remission on medication, TMS therapy may be for you.
​
Contraindications for TMS treatment include if you are someone with permanent metallic implants in ears or eyes, stents in the neck or brain, and other metal devices implanted in or near the head.
What are the side effects of TMS?
TMS therapy is a well-tolerated treatment for most patients with very few, if any, side effects. Side effects are mild, and may consist of a slight headache and scalp discomfort for the first few sessions or fatigue during the first week of treatments. In general, patients acclimate to treatment quickly and side effects beyond the first week of treatment are rare. Facial or eye twitching may occur during treatment sessions and is a normal response to brain stimulation. Seizures are a very rare but serious side effect that are usually a result of predisposing factors.
Is TMS safe?
Yes, TMS is a non-invasive treatment that has been FDA approved for multiple conditions including depression, OCD, and migraine, and has been shown to be effective and safe in a myriad of additional neurological conditions.
What does TMS feel like?
Some patients describe a tapping sensation. Generally the sensations of TMS treatment are well-tolerated and subside over time as the brain grows accustomed to the magnetic pulses. Treatment can also be adjusted and tapered to ensure comfort during treatment sessions.
Is TMS therapy effective?
TMS is highly effective, with efficacy rates of more than twice that of psychiatric medications. About one-third to one-half of people become symptom-free following TMS treatment. Many TMS patients experience an increase in mood and energy, while also experiencing a reduction in anxiety. While most mental health conditions are considered chronic, like diabetes or arthritis, TMS can put depression into remission for an extended period of time. Length of remission depends on multiple factors, including lifestyle components such as diet and exercise, therapy, life stressors, and the severity of illness. Studies demonstrate 50-60% response rates and 30-50% remission rates.
How long is each TMS session and how many are required?
Exact session time varies by protocol and condition being treated, but generally each session lasts approximately 20 minutes. The sessions are typically scheduled five days a week for a duration of four to six weeks (a total of 30-36 sessions), however different treatment schedules may be possible depending on your needs and treatment protocol. A two-week tapering period may follow consisting of just a few sessions a week.
When does TMS start working?
The time to respond to TMS therapy varies from patient to patient. In most cases, people start to experience positive effects after only 10 to 15 treatment sessions, which equates to about 2 to 3 weeks of treatment. Improvements may even be seen as far out as 34 weeks following initial treatment. It is highly recommended to complete the TMS course to provide the best chance possible of achieving optimal results from the treatment.
How will I know if TMS is working for me?
We track objective rating scales for anxiety and depression, and we value our patients’ subjective reports as well to determine effectiveness of treatment sessions. We do periodic check ins throughout treatment and encourage clients to let us know if they are noticing changes during their treatment course.
Is TMS covered by my insurance?
Yes, most insurance companies cover TMS therapy for Treatment-Resistant Major Depressive Disorder and OCD. Insurance coverage can vary based on your provider. Our team will help you to investigate your policy's benefits.
Can I drive after my TMS treatments?
Yes, you can resume normal activity without impairment to functioning or lingering effects following TMS treatments.
Can TMS worsen depression or anxiety symptoms?
Overall, TMS therapy is not known to worsen symptoms, although TMS may not be effective for every patient or for certain conditions. There is a phenomenon that can occur, known colloquially as the “TMS dip”, in which some patients may see a temporary increase in depression or anxiety symptoms at around the halfway mark of their therapy. This temporary shift does not indicate that your condition is worsening nor does it predict whether or not TMS will be an effective treatment for you. Always talk with your clinician if you are experiencing any symptoms or changes in your mood during treatment!
Do I continue to take my prescribed medications during TMS treatment?
Yes! There are no medication contraindications for TMS treatment. Medication adherence may help to sustain a response after TMS is complete. In fact, TMS has been shown to improve the efficacy of psychotropic medications, including antidepressants and anti-anxiety medications. However, patients who are experiencing multiple medication-related side effects or who are on multiple medications may sometimes choose to taper medications with guidance and oversight by their psychiatrist.
Can TMS therapy be repeated?
Yes, a person can have additional maintenance sessions or courses of TMS depending on their response to initial treatment. Patients who respond well to TMS initially are more likely to continue to respond positively to TMS if needed again in the future, and patients who have had success with TMS often automatically qualify for insurance coverage for another series of treatments.
What if TMS isn't the right treatment for me right now?
In some circumstances, TMS may not be the right intervention! In the event that someone is not a current candidate for TMS or treatment is inaccessible at that time, there are many other resources and options that can help them find their treatment path. This can include scheduling a consultation with a psychiatrist or seeking therapeutic care from a licensed professional. We are happy to assist you in starting your mental health journey and finding the support that you need, please reach out if you would like to schedule a consultation with a member of our clinical team.
Does TMS cause tinnitus or hearing loss?
Studies have not shown hearing loss or tinnitus resulting from TMS treatment. In fact, research demonstrates potential efficacy for the treatment of tinnitus. Initial FDA clinical trials for TMS which included audiology testing demonstrated no hearing impairments associated with TMS. However, the coils’ airborne sound may exceed some decibel exposure limits for patients, and the current TMS safety guidelines recommend that patients wear hearing protection during treatments in order to mitigate potential risk and improve patient comfort during treatment. Ear plugs will be provided to you during your TMS session.
Can TMS be used for bipolar disorder?
TMS is currently in the research process for its use in treating bipolar disorder. It is currently not FDA-approved for bipolar disorder, but the ongoing studies are showing some positive results. Recent evidence indicates that TMS can be effective for treating bipolar depression. If you have been diagnosed with bipolar disorder, speak with the clinical director to determine if TMS may be a good fit for you.
Does TMS help with anxiety?
Yes, there is data to support the benefits of TMS for anxiety. While it is not yet FDA approved, it can be used to treat anxiety in an off-label capacity.
Can TMS cause seizures?
Seizures are a rare side effect, with a less than 0.1% risk of seizure associated with TMS, approximately the same risk as with certain antidepressant medications. The occurrence of seizures is usually due to predisposing factors, and the seizure will typically end once stimulation to the brain is stopped. If a patient has a history of seizures, or if they could be withdrawing from alcohol or a benzodiazepine, the risk may be higher and TMS treatment may not be appropriate at that time. The TMS provider should be notified of any increased risk potential prior to starting TMS treatment.
Can TMS be used in PTSD?
Yes, TMS has been used off-label to help treat PTSD, but it should always be used in conjunction with trauma therapy to prevent exacerbation of memories that can trigger symptoms.
Is TMS the same as ECT?
They are different treatments with similar goals! Electroconvulsive therapy (ECT) is a treatment that uses electrical stimulation to activate areas of the brain, whereas TMS uses magnetic pulses to achieve a similar result. ECT is a more involved treatment option, requiring general anesthesia for the treatment and an extended recovery period. With TMS treatments, patients can be seen outpatient and immediately resume activities like driving and physical exercise with no lingering effects or impairment to functioning. There are also more side effects associated with ECT in comparison to TMS, such as memory impairment, confusion, and nausea. Both treatments are FDA approved and can be life-saving to patients who receive them.
Are TMS technicians trained?
Yes. All of our staff who administer TMS therapy have attended in person training from an Apollo TMS expert as well as in depth training by the Clinical TMS Society. Each treater has been certified in the administration of TMS.
Can TMS cause memory loss or brain damage?
To date, there is no evidence that TMS causes any kind of long-term damage to the brain. In fact, recent studies have shown that TMS can help with age-related memory loss as well as possible dementia-related memory loss.