Transcranial Magnetic Stimulation
Why TMS?
NON INVASIVE
TMS therapy is non-invasive and does not use any medication.
NEW HOPE
New FDA-approved therapy for treatment-resistant depression.
NO SIDE-EFFECTS
TMS therapy is non-invasive and does not use any medication.
RESTORE BALANCE
Restore and Reclaim your old self again
Transcranial Magnetic Stimulation (TMS) is an FDA approved treatment [since 2008] for adults with treatment resistant depression, i.e. those who suffer from major depressive disorder and who have failed to find relief from anti-depressants or have side effects.
What to expect from TMS
Your doctor and you, in collaboration, will decide if TMS may be right for you. You will then meet one of our therapists who will take a full history and conduct an evaluation, which will include objective tests and scales for depression, fatigue etc. This will be done regularly during your treatment as well to monitor your progress. We will then attempt to obtain prior authorization from your insurance. Our TMS specialist and doctor will answer any questions you may have.
The Consultation:
Treatments
A doctor and TMS specialist will measure the location of treatment and determine the amount of electromagnetic pulse that will be most beneficial to you. It is done by placing the coil on your head and producing one magnetic pulse while watching for movements in the hand and fingers.
During subsequent treatments a coil will be placed on your head. The TMS machine will be set to your specific treatment measurements. You will hear a clicking noise and feel tapping on your head.
In the first few treatments patients may feel a mild headache and goes away fairly quickly.
Treatment lasts 20 minutes and are conducted daily, 5 days a week for 4-6 weeks (20-30 sessions). Some patients may benefit from maintenance therapy after their initial treatment course. Please make sure you are attend the full course of therapy to get the most benefit from treatment.
While TMS does not work for everyone, it does work for the majority of people. Results are not instantaneous and it may take 2 or more weeks to begin to notice improvement.
Results
Depression and Transcranial Magnetic Stimulation
Many of our patients are referred to our clinic after receiving a depressive disorder diagnosis that is not improving with routine treatment. Our clinic’s specialization in Transcranial Magnetic Stimulation (TMS) provides a practical alternative Acute treatment for depression when medication, such as antidepressants, proves ineffective or harmful. TMS can be considered in the special population who want to avoid taking medications(e.g. pregnancy) or in elderly or medically ill who may not tolerate multiple medication trials.
Symptoms of depression cover a wide range of warnings. Low energy, fatigue, lack of motivation or concentration, irritability, sadness, inability to enjoy activities, guilt, isolation, difficulty sleeping, increase or decrease in eating, decreased sociability, worry, suicidal ideas or intentions, and thoughts of hurting yourself or others are all very common symptoms of depressive disorders.
Treating Depression with TMS
To qualify for insurance to authorize TMS treatment, the patient must generally have “difficult to treat Depression” or Treatment-resistant Depression. After approval, the patient will undergo an average of 36 total sessions. Our patients generally notice positive changes after the first 1-3 weeks, improving consistently over the process of 4-6 weeks, when the treatment concludes. After the course of 36 sessions has ended, most people will remain well for a year or few years as the benefit of TMS is more enduring than medication. TMS therapy results in long term potentiation of Neuroplasticity and many have remained on minimal medications or none. But, there will be some “tough cases” who may relapse into depression and may need a booster round of TMS therapy within 12 months. Patients with history of frequent recurrence of severe depression may prefer a “maintenance” regimen of regular TMS therapy to prevent going back into the ‘Dark zone’: e.g., weekly once or once every 2 –4 weeks. There are no definitive guidelines on maintenance treatment.
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What should I do first if I am interested in this treatment option?Please call our office at 856-399-1010 to schedule an evaluation. Please call your insurance company and ask if treatment with Spravato (esketamine) is covered. The manufacturer of Spravato (Janssen) also provides assistance for patients in determining insurance coverage and may also be able to provide some financial support for your treatment. Please call the Janssen CarePath Program at 844-777-2828
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What is the next step if I have insurance coverage for Spravato?Our office will schedule you for a detailed evaluation to determine whether Spravato (esketamine) is the best treatment for your case of TRD and also what other treatment options should be considered for you in that regard.
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What is the next step after my evaluation ?Your first treatment session for administration of the intranasal treatment with Spravato will be scheduled promptly if Spravato (esketamine) is the right treatment for you.
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What happens at the office during my visits for Spravato (esketamine) treatment?Each visit to the office for treatment will take about two and a half hours Spravato is administered in the doctor’s office. There is a 2 hour safety monitoring period. During this time your BP will be monitored. You will also be checked for any sedation and presence of any dissociative symptoms (feeling strange, disconnected transiently) or any other side effects. After 2 hours, if you are stable then you will then be discharged home. You will need somebody to drive you home after the treatment.
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What are the common side effects with Spravato (esketamine?)These include transient sedation, a possible rise in your blood pressure and feelings of dissociation (such feeling strange, disconnected or change in sense of time). These side effects may typically be present for the first 2 hours after taking the nasal spray of ketamine. For this reason you are monitored in the doctor’s office for a period of 2 hours after your dose of Spravato (esketamine). Such side effects if they occur typically go away the same day. During this time your blood pressure will be checked periodically and you will be assessed for the presence of any specific side effects. After 2 hours the doctor will assess you clinically to make sure you are safe to be discharged home.
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How often are the treatments?For the first 4 weeks you come in twice per week, each time for a two and a half hour visit. In the second month your visits are now once per week. After that treatments for long term maintenance with Spravato (esketamine) might be once per week or twice per month depending on your clinical course.
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How is payment for this treatment handled at this practice?We will work with your insurance company to cover this service
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What is the cost of the treatment?We accept most insurances and will try to get it authorized.
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Will I be covered for Spravato (esketamine) treatment if I have bipolar depression?Unfortunately, the answer here is no. The reason for this is that the FDA approval is only for major depression based on the research that has been done to date. Insurance companies will not pay for any treatments that are not FDA approved as it treats such treatments as “off label”.
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Can I take Spravato (esketamine) at home?This is prohibited by the FDA as ketamine has the potential to be abused and therefore lead to addiction. Therefore, administration is solely at the doctor’s office.