What is TMS?
This revolutionary technique has shown positive results in patients suffering from severe depression that did not respond to medication. Targeted magnetic pulses trigger small electrical charges that stimulate the brain in the pre-frontal cortex. TMS therapy is non-invasive, and does not require anesthesia or sedation. Patients can travel independently to the clinic for once-daily treatments and remain awake and alert throughout the TMS treatment sessions. TMS therapy can be given alone, or as an adjunct to ongoing psychiatric medications.
To find out if you are a candidate for TMS you can begin the screening process by calling (401) 455-6632.
A typical acute course of TMS therapy includes:
- Thirty daily treatment sessions, five per week; Monday through Friday (followed by six "taper phase" treatments given over three weeks).
- Serial assessments of symptoms/response with standardized rating scales.
- Collaboration between the TMS team and a patient's regular outpatient care team during the course of TMS therapy: Butler TMS patients continue to meet with their outpatient clinicians and prescribers for medication management and psychotherapy.
- An end-of-treatment summary is sent to the patient's treating clinician to document outcome and recommendations.
- A repeat course of TMS therapy is covered by most insurance policies for patients who showed positive response to initial acute course of TMS and experienced subsequent depression relapse.
Linda Carpenter, MD | An Honest Conversation about TMS
TMS Therapy at Butler Hospital
We strive to make the process of referring patients with treatment resistant depression to the Butler TMS Clinic as easy and effective as possible. Most of our patients receive TMS therapy as a covered service through their health insurance policy. As such, we go the extra mile to obtain source documentation of past treatment history. Typical eligibility requirements for insurance coverage of TMS include a patient:
- Current primary diagnosis of unipolar major depressive disorder (MDD), single episode or recurrent episode without psychotic features.
- Current episode characterized by a moderate to severe level of current depressive symptoms (standardized ratings scales are used to access severity).
- Patient has the ability to remain safe and is sufficiently stable for treatment on an outpatient basis.
- History of adequate trials of several antidepressant medications in the current episode, or documented intolerance to several attempted medication trials.
- Exposure to several different pharmacological classes of medications during current and past treatment for depression (SSRI, SNRI, atypical antipsychotics, augmentation agents).
- A patient may or may not have had a past trial of electroconvulsive therapy (ECT). To date, history of past ECT is not related to TMS response.
The Butler Hospital Transcranial Magnetic Stimulation Clinic has been providing TMS therapy to patients with pharmacoresistant and pharmaco-intolerant major depression since 2009. Our state-of-the-art treatment facility houses multiple FDA-cleared devices for standard TMS clinical care, as well as investigational devices for research clinical trials.
What does a patient experience during transcranial magnetic stimulation?
During the treatment you are seated and reclined in a comfortable chair. You are fully awake and alert, and you can talk during the treatment. There are no new medications involved in a TMS treatment; most patients continue on the ones they were regularly taking before starting TMS therapy. The TMS doctor or staff rests the magnet coil over the appropriate area of the scalp before starting the session. You will need to remove any metal hair clips, hearing aids, earrings and glasses before the treatment. Usually patients wear earplugs or listen to music during treatment to minimize the clicking sound of the equipment. A typical treatment lasts about 40 minutes, during which time the patient feels a series of taps on their scalp.
Who will be involved in my treatment?
We have a team of doctors at Butler Hospital trained in the delivery of TMS therapy. A TMS doctor will be involved in all phases of your TMS therapy including:
- Meeting with you during a pre-TMS consultation evaluation to determine if you are an appropriate candidate for the treatment.
- Performing a brain mapping procedure and determining your TMS “dose” at the first treatment session.
- Monitoring your daily progress and overseeing the administration of your daily TMS therapy by a trained TMS staff member.
- Meeting with you as needed during the course of therapy to evaluate clinical issues that impact safe and effective delivery of TMS therapy.
TMS clinic staff at Butler participate in screening patients referred for TMS treatments, setting up and delivering daily treatment sessions as ordered by a TMS doctor, communicating with outpatient care providers. Your outpatient psychiatrist or the primary care doctor who may be prescribing medications for your depression will remain involved in your care during TMS and will continue to follow you after you finish TMS. If you are engaged in outpatient psychotherapy, you do not need to stop it during TMS. TMS doctors at Butler Hospital will not typically prescribe medications for you, but they will coordinate care with your outpatient prescribers.