FAQs

Both medications and TMS affect the electrochemical signaling between neurons in the brain, however the mechanism by which they do so differs. One of the most obvious differences is that medications are chemicals and must be taken by mouth and must travel through the bloodstream in order to reach the brain. Along the way, they must travel through every part of the body, which is why they can often cause side effects. Some medications work by disrupting process by which neurons reabsorb the neurotransmitters (which all neurons need to communicate with one another), thereby allowing the neurotransmitters additional time to reach the receptor sites of the next neuron. Other medications work by encouraging the creation and release of more neurotransmitters. TMS works by stimulating brain cells in the prefrontal cortex of the brain, inciting the electrical signal to travel through the neuron to its synapse and trigger the release of neurotransmitters across the synaptic cleft. With more neurotransmitters released into the synaptic cleft, the more receptor sites are needed on the receiving synapse. As a result, neurons begin to develop more connections with each other. As the stimulation is repeated, the rate of electrical signaling increases and this neuronal activity eventually becomes self-sustained.

Since TMS does not circulate through the body, it causes none of the side effects that medications cause, such as dry mouth, upset stomach, dizziness, drowsiness, weight gain, or sexual dysfunction. TMS does cause a tingling sensation on the scalp, but most people quickly get used to this and it’s not unusual for someone to doze off during a treatment.

Currently, TMS is used primarily for the treatment of Major Depression, which is the indication approved by the FDA. But because TMS can be used to stimulate different regions of the brain in different ways, TMS is also used as a treatment for Bipolar Depression, Anxiety, Obsessive Compulsive Disorder, Migraine, Fibromyalgia, Auditory Hallucinations, and Tinnitus.

The only reason why someone should absolutely cannot have TMS is if they have a metal object, like a surgical clip, somewhere in the head. Pacemakers and defibrillators are not usually a problem since they lie outside the magnetic field. TMS has also been safely used in women who are pregnant. It can be safely used in the elderly as well as adolescents. There is an extremely low risk of having a seizure–about 1 in 10,000–but if a person has ever had a seizure in the past, special precautions may be necessary.

There is no evidence that TMS can make depression worse, unlike antidepressants, all of which carry a “black box warning” on the label. Antidepressants have been known to make some people, especially adolescents, feel worse or even suicidal.

TMS was invented in 1985 and was originally used for research, and it has been used to treat depression since the late 1990s. In 2008, the FDA approved a new type of TMS device, known as the NeuroStar® TMS Therapy System, which is designed especially for the clinical treatment of depression.

The long term effects of TMS are the result of changes in the actual physical structure of the brain. This process is called “neuroplasticity.” These changes take time and depend upon repeated, frequent administration of TMS. Although TMS does require a time commitment, because it does not require anesthesia, a person can drive themselves to and from treatment and it is usually not necessary to take off much, if any, time from work or school.

Many people notice temporary improvement in the first week or two due to the activation of existing neurocircuits. Longer lasting improvement occurs several weeks later when new circuits are formed. Maximum improvement, however, may not be achieved until about 4 to 6 weeks of treatment.

Depression is a syndrome that can have many different symptoms and not every with depression has the same symptoms, therefore responses to TMS vary from patient to patient. However, many people report thinking more clearly and improvements in sleep pattern, energy level, and appetite during the first week or two of treatment. Many times these symptoms improve before a person’s mood.

Clinical studies have shown that TMS is effective about 75% of the time, which means that it is twice as effective as antidepressant medications and almost as effective as electroconvulsive therapy (ECT). Half of those who respond to TMS experience significant improvement in the first four weeks of treatment.

Everyone’s depression is different, however 90% of patients who respond to TMS continue to do well a year after treatment. Some people may require periodic or “maintenance” TMS, which often consists of just one or two treatments every few weeks or months. Some people also begin do well on medications, even if they did not help before TMS treatment, which helps maintain the long term therapeutic benefit of TMS Therapy.

Our TMS treatment plan also includes working with our patients to develop healthy sleeping, eating, activity, and relaxation habits in order to equip them with skills to cope with any “triggers,” which they may encounter after their course of TMS Therapy.

At the present time, insurance coverage is generally available on a case by case basis. In most cases, insurance approval has come only after a person has received TMS treatment and has gotten better as a result of their treatment. The TMS Center of New England works closely with the NeuroStar® Care Connection Program to help patients submit claims to their insurance companies, guide them through, and complete the majority of the letters and documentation necessary to the appeal process. To date, about 75% of patients who use the NeuroStar® Care Connection Program from start to finish have received reimbursement for TMS Therapy. We strive to provide an easy and relatively effortless appeal process for our patients so that they may fully focus on getting well.

Most major insurance companies and plan have covered TMS Therapy for depression including, but not limited to:

Aetna, Alliance BH, Allied National, Anthem, BCBS Federal, BCBS of MA, CIGNA, Harvard Pilgrim, Health New England, Humana, Magellan BH, Oxford Healthcare, Self Insured Employers, and United Healthcare (UBH)

In the event that your insurance plan does not have an established coverage policy for TMS Therapy, out of pocket expenses may be necessary to receive treatment while we work to secure insurance coverage. Since the cost of treatment can vary based on a number of factors, including the total number of treatments, it is our policy not to quote specific costs. We offer several financing options to off set any out of pocket expenses so that you may receive treatment when you require it, rather than when insurance plan determines its coverage for TMS Therapy. Please contact our office to inquire further about cost and financing.

Since the initial consultation is a comprehensive consultation with a complete mental health assessment, complex medical decision making, communication with your other treatment providers and a detailed introduction to TMS Therapy, how it works, and how it may or may not benefit you, there is a fee for the initial consultation. Most of this cost should be reimbursed by most insurance plans. Although the TMS Center of New England specializes in TMS Therapy, it may not be the right treatment for everyone. As a specialist in treatment resistant depression, Dr. Lanocha can also discuss other treatments which may be more appropriate or just as effective as TMS Therapy. Whenever this is the case, we will tell you and in most cases we will be able to provide treatment for you.