Frequently asked questions about Transcranial Magnetic Stimulation (TMS).

Jan 24th, 2019

Q: What is TMS?

A:TMS is a neuromodulation treatment, a procedure used for the treatment of major depressive disorder, anxiety disorders and obsessive compulsive disorder.

Q: How does TMS work?

A: In this procedure a magnetic field is used to direct an electric current to a very small and localized area of the brain. Depending on the condition targeted the impulses generated by the machine can be inhibitory or excitatory for the brain. 

  • In depression some areas of the brain are underactive (decreased blood flow and reduced metabolic rate of glucose in the left dorsolateral prefrontal cortex); in this case, excitatory impulses are used.
  • In anxiety, there is overactivity (hypermetabolism and hyperactivity in the right dorsolateral prefrontal cortex); in this case, inhibitory impulses over the right cortex are used.
  • In Obsessive Compulsive Disorder (OCD), excitatory impulses are delivered to an underactive anterior cingulate cortex.

Q: What is it like to have TMS?

A: TMS devices consist of a comfortable chair, a monitor and an arm connected to the monitor which contains the magnet on its distal end. While you sit on the chair the magnet is placed over your head. A psychiatrist with the help of a technician will localize the target area of the brain. There are well stablished protocols that guide this search (the search is also referred as mapping). Once the correct area is localized, the next step is to find the intensity necessary to create a stimulus. With these two measurements your treatment can begin.

Q: What is the time commitment for this treatment?

A: Each treatment session last about 20-25 minutes, usually you would receive a total of 36 daily sessions on Monday through Friday.

Q: What are the risks and potential side effects of TMS?

A: TMS is a safe, noninvasive procedure which does not require sedation or anesthesia. People usually read or watch TV during the procedure. TMS does not cause memory loss or any other cognitive problems, and you are able to return to their daily routines and activities immediately after each session (you could drive, return to school or work).

The most frequent side effects are: discomfort under the treatment area and headaches. These two progressively subside. You may also experience contraction of the muscles around the eye, lachrymation and toothaches during active treatment. The TMS devices make a loud clicking sound, therefore earplugs are required.  Not using earplugs can lead to tinnitus. Seizures occur very rarely—-incidence is 0.1%

Q: What is the average cost of treatment?  Will insurance cover the cost?

A: There is significant price variability depending on the provider.  Average cost per session is about $250-$500. Most commercial insurance will cover the cost of TMS. They usually require a past history of at least 2 failed trails (lack of benefit or inability to tolerate medications due to side effects) of medication prior to approving the procedure.

Q: Are there any contraindications for TMS?

A: Yes, if you have certain types of metal in your head (like cochlear implants, deep brain stimulators), you cannot do TMS. If you have an implantable cardioverter defibrillator (ICD), you cannot do TMS.

Q: How long does it take to see a response?

A: Some response may be seen in 2-3 weeks, but most people typically require at least 30 treatments for a more robust response.

Q: What are the changes that TMS would work?

A: Response rates (reduction of at least 50% of the symptoms) is seen in about 60% of the patients.  Remember these are patients who failed standard treatment, so 60 % is a really good number! Remission (resolution of symptoms) is seen in about 30 % of the patients.

Q: Do I have to come off my medications while receiving TMS?

A: No, most medications are safe in combination with TMS.

 

Do you have more questions about TMS? Please contact us at 919-636-5240 or office@cognitive-psychiatry.com

AUTHOR

Dr Andrea Hernandez-Gonzalez

Andrea Hernandez, MD, is a board-certified psychiatrist at Cognitive Psychiatry of Chapel Hill, North Carolina. Fluent in both English and Spanish, Dr. Hernandez treats adult patients with mental health and substance abuse disorders.

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