Four of the most frequently asked questions from depression sufferers about TMS Therapy are:
1) Is TMS Therapy right for me?
2) What happens next?
3) What should I expect?
4) When will I start to see results?
TMS Co-founder and Patient Advocate Christopher Blackburn answers these questions in this blog.
1) Is TMS right for me?In a patient’s initial phone consultation, our staff will determine if they are a TMS candidate. There are several qualifying questions that each potential TMS patient will be asked. These questions aid in qualifying you under general Health Insurance and Medicare requirements, and help determine any individual health contraindications that may exist, things like neurological conditions and metal implants for example.
2) OK, so it seems like TMS Therapy might help with your depression, and you appear to meet initial qualifications, "What happens next?"
Three easy steps in the process to see if you qualify to beginning TMS Therapy:
- Once we have determined the patient is most likely a TMS candidate, a more comprehensive overall review will be performed. We require all new potential patients to complete a Patient Packet of qualifying paperwork. We have four ways for you to fill out your Patient Packet, all of which get your information to your Patient Advocate.
- Fastest (recommended): Fill out your forms online. We email a link to you that allows you to create an account and fill out the forms online. (This step is different than creating a Patient Portal account in Kareo, explained below). As a live web page, you can use your computer, tablet, or phone—just make sure you have your contact and health information ready. This is also the quickest way for you to fill out your information, because the forms are combined, saving you from inputting the same information on different pages.
- Fast, Fillable PDF Forms: This option also begins with a link emailed to you. You can use Adobe software to open the PDF file, fill in the six forms on your computer, save them, and then email the PDF file back to the Patient Advocate.
- Slow: You can download the six pages of PDFs to your computer and print them out. After you have completed the forms, you can scan them and email them. Or, you may mail the completed paperwork back to us.
- Slowest: Physical paper forms, which we mail to you. Fill out the six forms by hand and place them in an envelope to return to us by mail.
- Once your paperwork is received, our staff will conduct a review, or initial assessment, which is a comprehensive review of the patient’s medical history Each patient’s review is handled individually and reviewed on a case-by-case basis. After your initial assessment is complete, you’ll receive an invitation by email to create a user-friendly Patient Portal account in Kareo. There you will be able to see the progress of your Benefits Investigation, the progress of your prior authorization, and patient approval. You may want to explore the convenient features in Kareo and use it as a reference tool for your care. All communication through your Patient Portal is HIPAA-secure.
- Prior to your first appointment, our team will create an individualized treatment plan, determining your start date and the best treatment for you. You’ll receive a phone call from your Certified TMS Technician to schedule your first TMS appointment at the location closest to you. This appointment will be with the TMS Physician and the Certified TMS Technician.
Medication and TMS:
Medication management is not part of TMS therapy. TMS Solutions' role is to administer TMS Therapy. Any changes in a patient’s medication management is at the discretion of the referring physician. TMS Solutions’ Chief Medical Officer is open to collaboration with referring physicians to provide the best care for each patient.
3) What should I expect when I begin treatment?
A) Your First Day of Treatment:
One of the most frequently asked questions by patients is what they should expect from TMS treatment:
- TMS treatment is basically painless for most people and the overall experience is very positive. Some patients experience pain in the form of a headache at the site of treatment. This usually only occurs during the first few sessions and goes away as the body adapts to the pulses.
- Patients can drive themselves to and from their treatment sessions. They are awake and can interact with their technician throughout the session.
- There are no long-term side effects from TMS.
B) Your First Treatment: the Mapping Session:
The purpose of TMS is to stimulate brain cells along the neural pathways in the brain. 30 years of research and ten years of clinical practice have shown that stimulating pathways in the brain enough times daily over a set period of time causes treatment-resistant depression to get better at a significantly higher rate than with antidepressants.
There is a portion of the brain called the homunculus that runs across the head from ear to ear. We refer to it as the motor strip, and it controls your movement on the opposite side of your body. Figure 1 above illustrates the part of the brain associated with movement in various body regions, beginning with the foot and knee at the top of the brain and progressing towards the face as the strip travels downward. You can see that the area of the thumb and fingers are about a third of the way down the side of the strip. Scientists have found that a magnetic pulse administered to this region on the left side of the head causes a response in the right thumb and fingers in the form of a twitch—like a reflex when the doctor taps your knee. The mapping session entails finding this area of your motor strip by administering single magnetic pulses of increased strength until there is a twitch in the thumb or fingers. We refer to this as your motor threshold.
C) “Hunting” for the Treatment Area:
Once the motor threshold is determined, the doctor moves the magnetic coil forward of the motor strip in five centimeter increments, which we refer to as “the hunt”. At each stop, a pulse is emitted to stimulate the fingers on the right hand. The strength of the finger twitch, or lack thereof, determines if the location is correct or not. Once the strongest response is observed, the location is recorded so treatment can be administered in that exact spot in every treatment session moving forward. As stated before, the patient is alert and interacts with the technician during this mapping session. There is no pain during this process, only the tapping sensation that accompanies the magnetic pulse.
The area of the brain we are hunting for is called the left dorsolateral prefrontal cortex; is a nexus of nerve cells involved in depression. Think of this area as a trailhead for your limbic system. By stimulating this portion of the brain, the magnetic pulses stimulate neurons along neural pathways, stimulating deeper brain structures involved with depression.
Years of research show this treatment is effective in treating most people with depression. Unfortunately, no medical treatment is completely successful—about 10-20% of patients do not respond to TMS treatment. We are currently implementing the use of a therapeutic workbook that TMS technicians will use to guide patients through several exercises aimed at improving their response to treatment.
4) When will I start to see results?
Patients respond at different rates and times to TMS therapy. After providing thousands of treatments, we have observed three general response patterns:
- Some patients see improvement soon after beginning treatment, with improvement continuing throughout treatment.
- Others tend to notice little to no difference for the first four to five weeks, only to show significant improvement in the last remaining weeks or days.
- For some, there is no response over the entire six weeks of treatment.
"It's about the number of pulses"
Dr. Robert Sammons, Chief Medical Officer, Co-Founder of TMS Solutions
With the increasing amount of TMS literature on the Internet, some patients read about a possible “dip” in depression around the second week of treatment, where their symptoms seem to get worse. As our Chief Medical Officer Dr. Sammons noted (after returning from nine days of two back-to-back TMS and Brain Stimulation conferences) there was not a single mention of this supposed slump in either formal meetings or informal discussions. This means that this dip is a low frequency behavior, and there is no scientific data suggesting this slump is a side effect.
Try to think of TMS treatment as a sports game where the outcome at the end of the game is the most import result. In this analogy, we want our team to get ahead early and continue getting more points, staying in the lead throughout the game. But it’s not unusual for a team to be in the lead, only to fall behind the other team by a large margin, then come from behind for the win. While no one enjoys seeing their team fall behind, it’s the final score that matters. While it is possible to have a depressive slump during treatment, it shouldn’t be expected, and treatment will continue either way.
TMS treatment involves the patient driving themselves to and from treatment, being awake and engaged during treatment that is generally painless and has no side effects outside of treatment. Fortunately, the majority of patients have a successful treatment.
TMS Solutions currently has offices in Colorado and Washington. If you live in these state and would like to find out if you're a candidate for TMS Therapy, consider scheduling time with a TMS Patient Advocate by clicking the link below to get started on the road to remission from your depression.