Frequently Asked Questions
How does TMS work?
TMS (transcranial magnetic stimulation) therapy generates focused magnetic fields which turn on and off rapidly through a treatment coil that is applied to the patient's head above the left prefrontal cortex. The magnetic fields produced are similar in type and strength as an MRI. The treatment targets the part of the brain (left prefrontal cortex), which is thought to regulate mood. The magnetic fields only target about two-three centimeters into the brain directly beneath the treatment coil. The magnetic fields move into the brain and produce very small electrical currents which activate cells within the brain which are thought to release neurotransmitters, such as serotonin, norepinephrine and dopamine.
Which patients are good candidates for TMS?
Not everyone is a good fit for TMS. Patients who either cannot tolerate medication or its side effects or those who have had failed attempts of treating depression with medication are excellent candidates to discuss TMS as a possibility.
How long does a patient undergo TMS therapy?
A typical therapy course consists of five treatments per week over a six week period, for an average of thirty total treatments. Each treatment session lasts approximately 40 minutes. Patients should be treated for a minimum of four weeks with additional treatments based on clinical judgment.
Will my insurance pay?
Many health insurance companies will reimburse for TMS. You may want to check with yours. The CPT codes are 90867 and 90868. Since we have opted out of insurance contracts, some insurances will pay in-network rates since we are the only TMS treatment office available between Memphis and Nashville. We can help you find out, submit preauthorization forms and the necessary health insurance claim forms to help you get reimbursed. Many patients receive SOME reimbursement and a few have been reimbursed at 100%. It all depends on your policy. Either way, Neurohealth Solutions, in nearly all cases, requires payment for the full treatment experience to get started and then reimbursement comes to you as the patient rather than to our office. Some limited scholarships may be available.
What should a patient expect at the first treatment session?
Each patient should allow about two hours for the first treatment. Although the treatment itself is only about forty minutes, we will take the rest of the time for you to meet with the psychiatrist and set the instrument properly. We will provide you with and are expected to wear protective earplugs (the system emits a tapping sound). Next, the psychiatrist will perform a motor threshold test. This test is important because the magnetic field strength is customized individually to deliver the correct treatment dose.
Following this step, the doctor will be able to determine the place on the head where the TMS treatment will be applied. The TMS therapy will be administered over a 40-minute period, in 30-second intervals. After the session, you can immediately return to your normal routine, including driving.
What are the benefits and risks of TMS?
TMS is the first FDA approved non-systemic, non-invasive treatment for depression.
TMS therapy is prescribed by a psychiatrist and performed right in the office, requires no anesthesia or sedation and no surgery is involved.
Patient benefits from TMS include improvements in depression symptoms, with many experiencing complete resolution of symptoms. Additionally, there are virtually no side effects such as weight gain, sexual difficulties, nausea, dry mouth, or negative effects on memory or the ability to concentrate.
The most common side effect related to treatment is mild, scalp discomfort. Patients may also experience headache at the site of stimulation. These side effects may improve upon the administration of further treatments. There is also a small risk of seizures (1 in 30,000).
Not all patients benefit from TMS. Patients will be carefully monitored for worsening symptoms of suicidal or unusual behavior. Families and caregivers should contact their treatment provider if symptoms worsen.
Will I need retreatment?
Some patients may require retreatment. This will be based on clinical judgment following the six week treatment period.
Which patients should not receive TMS?
Patients with implanted metallic devices or non-removable metallic objects should not receive TMS. It should also not be used by patients with implanted devices above the shoulders that are controlled by electrical or magnetic signals such as pacemakers.
How does TMS differ from ECT?
Unlike ECT, TMS does not require anesthesia, sedation or production of convulsion. Also different from ECT, TMS therapy does not carry any risk of adverse effects on memory or concentration.
Is TMS a good alternative for patients who are fearful of the side effects or have failed to achieve satisfactory improvement from antidepressants?
TMS has been approved by the FDA for the treatment of patients with depression who have failed to achieve satisfactory improvement from prior antidepressant treatment. TMS does not have side effects such as weight gain, sexual dysfunction, nausea or dry mouth. However, like any treatment option, patients and clinicians work together to find the most appropriate option for them.
Does TMS cause brain tumors? Are there long term consequences from TMS therapy?
No. The amount of magnetic field exposure for a full course of TMS therapy is a small fraction of just one brain scan with a MRI.