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TMS FAQs

Frequently Asked Questions about TMS Therapy

What is TMS?

TMS stands for Transcranial Magnetic Stimulation. TMS is non-invasive, meaning that it does not involve surgery and does not require any anesthesia or sedation. Patients remain fully awake and alert during TMS therapy sessions.

TMS is non-systemic, meaning that it does not enter the bloodstream nor affect other areas of the body like medications can.

How Does TMS work?

TMS refers to a medical treatment which is delivered by a device that generates changing magnetic fields. TMS Therapy system generates highly concentrated magnetic fields which are rapidly switched on and off. These magnetic fields do not directly affect the whole brain; they only reach about 2-3 centimeters into the brain.

The device is positioned over the prefrontal cortex – the area of the brain which is being targeted when treating depression. These magnetic fields can create electrical activity in the nerve cells. It is well accepted by researchers and clinicians that the magnetic stimulation affects not only the targeted area (e.g. the prefrontal cortex), but also other areas of the brain connected to the prefrontal cortex, including the cingulate, hypothalamus, and thalamus.

There are many devices which can be used by clinicians. In this office, we utilize the Magstim Rapid2 Therapy System and the MagVenture Express TMS System.

Does TMS have side effects?

The most common side effects of TMS include dizziness, headache, and minor scalp pain.

There is a risk of seizure with the use of Transcranial Magnetic Stimulation. Patients who have had a seizure or who have a medical condition which could increase the risk of having a seizure should share that information with Dr. St. John at their initial consultation.

TMS treatment systems create a magnetic field that could cause metal objects near the stimulation area to move or heat up. Patients with non-removable magnetic-sensitive metals or metallic devices implanted in their head or in body parts during stimulation could experience adverse effects from the treatment and should not receive TMS therapy. Types of non-removable devices include cochlear implants, deep brain stimulators, aneurysm clips or coils, and stents.

How well does TMS work?

Current literature indicates that approximately 50% of all treated patients who meet criteria for TMS (i.e. are considered treatment-resistant) respond to the treatment by bettering their score on a standardized rating scale by 50% or more. Approximately one-third of treated patients are so-called remitters, bettering their scores so much that they are considered depression-free.

To put these statistics in perspective, it is important to note that the patient population undergoing treatment with TMS Therapy is often excluded from new antidepressant development research studies.

In addition, the STAR*D study demonstrated that patients are likely to experience a poorer response to each new medication tried following successive treatment failures. For example, after the first medication attempt, about 30% of patients achieve remission. By the time the patient has attempted three different medications without improvement, the likelihood of the 4th medication leading to remission falls below 10%.

St. John Mental Health Clinic of Houston has used TMS in the fight against treatment-resistant depression since 2013. Since then, a response rate of 76% and a remission rate of 58% of the patient population was observed. This means that more than three-quarters of their patients cut their symptoms of depression in half, and almost two-thirds were symptom-free of their depression after completing a full course of TMS treatment in our Houston office.

Is TMS performed differently for OCD than for depression?

Yes.  When treating OCD, we do not target the PFC (prefrontal cortex) as we do in the treatment of depression.  Instead, we target parts of the brain called the mPFC (medial prefrontal cortex) and ACC (anterior cingulate cortex).  Research has shown these structures to be hyperactivated in OCD patients.

How long do treatment sessions last?

The treatment protocol selected by Dr. St John will determine length of treatment.  Most insurance companies cover theta burst stimulation for MDD, which lasts only three minutes.  We also treat depression and all OCD patients with a 19-minute protocol.  Treatments can occasionally take up to 45 minutes.

Your protocol will be selected and explained to your prior to your first treatment session.

Completion of any necessary paperwork and getting situated in the treatment chair can add up to an additional 10 minutes each day.

How many sessions will I need?

The typical protocol is 36 treatment sessions: five sessions a week on weekdays for six weeks, followed by a six-session taper over an additional three weeks.

Taking on this commitment can seem overwhelming to many patients, but the high success rate of TMS compared to continued medication management and the ability to drive oneself to and from treatments helps to offset the time requirement.

The three-minute duration of theta burst TMS also makes it possible to come in before or after work, or during a lunch break for our working patients.

Some patients even find having a treatment daily helps create structure and a reason to get up, dress, and get out of the house.

Finally, some insurance companies are now covering more than one treatment a daily.  In that event, TMS can be condensed into fewer weeks, sometimes into as short as five days.  This is referred to accelerated TMS.

When will I start feeling better?

We expect patients to start noticing a difference in their mood as soon as their second or third week of treatment.

How do I know which protocol is right for me?

Dr. St John will discuss FDA-cleared protocols with you during your consultation and which one is recommended for you.  She will also consult your insurance plan’s rules to determine which options are covered by your specific insurance plan.

Will my insurance company cover TMS Therapy?

Every insurance plan we are currently in network with, covers TMS Therapy for depression (Major Depression Disorder).  Some cover TMS Therapy for OCD (Obsessive Compulsive Disorder) as well.  Coverage guidelines vary from one insurance plan to another in terms of how many prior medications a patient must have tried, over what time frame a patient must have tried them, and whether psychotherapy must have been tried.

During your initial consultation, Dr. St John will obtain your medical and psychiatric history in order to determine whether she feels you are a candidate for TMS Therapy, and whether she believes your insurance company will authorize coverage.