TMS stands for transcranial magnetic stimulation, and it involves the induction of magnetic waves to a targeted area of the brain, which has been shown to increase activity in parts of the brain that have decreased activity due to different brain disorders. In MDD, this area is the left dorsolateral prefrontal cortex, which is a fancy way of referring to the frontal lobe of the left hemisphere of the brain. 

No, it should never be painful. It is a magnetic pulse being sent to your brain, which almost feels like someone is taking a finger and tickling or tapping a very small region of your brain. 

TMS has been shown to outperform antidepressant medication for the treatment of depression in research trials. Approximately 60-70% of people experience ‘response’, which is a 50% reduction in depressive symptoms. Approximately 35-40% of people experience full remission, which describes no notable symptoms remaining. 

You will have an appointment with Dr. Elliott before treatment in order to establish your current severity of symptoms, and we will track your progress throughout treatment. If you aren’t seeing progress after a few weeks, we can set up a follow-up with Dr. Elliott and re-evaluate. Symptom progress is tracked using standardized depression rating scales (PHQ-9, HAM-D) before, during, and after treatment. 

There are no systemic side effects associated with treatment. The most common side effects would be mild headache, face twitching during treatment. Ear ringing has been reported, but we limit that with earbuds and sound dampening measures in the room. Mouthguards are available to prevent any jaw/tooth pressure.  If side effects do occur, they almost always dissipate after the first week in patients who don’t have pre-existing migraines. 

TMS is much less invasive because rather than inducing a seizure, like is the case with ECT, TMS avoids the risk of a seizure by targeting the magnetic energy to a very small and localized area of the brain. A natural excitation of the brain cell is created with TMS, not a seizure. There is no confusion or memory loss that occurs with TMS. 

You will consult with Dr. Elliott prior to starting TMS and she will work with you to determine your plan for the duration of treatment. It’s important to always consult with Dr. Elliott before making any changes to your medication regimen during treatment, as different drugs have the potential to change the chemistry of the brain and how it reacts to TMS.

Individual response to TMS is varied, but some people are able to stop or decrease their antidepressants if they experience full remission of their depressive symptoms. Some folks choose to stay on their medication for fear of symptom relapse, but this is something that can be discussed thoroughly with Dr. Elliott before, during, and after treatment.

From start to finish, the treatment course lasts about 6-9 weeks, depending on individual response. The first treatment will take about an hour to determine your individual treatment location and intensity of TMS required, followed by initiating your first 20-minute treatment session. The follow up appointments will be 20 minutes, and in and out in 30 minutes. Easily able to do over lunch, before or after work. There is no waiting time or recovery time required. 

The machine has a built-in copper coil that creates a magnetic field and allows for the induction of magnetic waves to be sent into a targeted area of the brain. The coil is built into an arm that sits on top of the patient’s head while treatment is administered. The machine is programmable to a setting that fits each individual, which is determined in the initial TMS mapping/treatment.

No, you will not be restrained in any way, but your head will be kept in place with an inflatable pillow that provides support and stability. It is important that we minimize movement during treatment in order for the electrical current to reach the intended part of the brain, but you will not be strapped in or restrained.

Treatment cost will be discussed before treatment begins, so there are no surprises. Each insurance company has different requirements and coverage for TMS, so cost will be determined by how much of the cost your insurance will cover, based on deductible, out of pocket max, and coinsurance. 

In order for TMS to be covered by insurance, an individual must have an MDD diagnosis, they must have tried anywhere from 2-4 antidepressants within the current episode of depression, and they must have had approximately 8 weeks of some sort of evidence based psychotherapy to treat depression.