Ask the Doctor

TMS can be an effective treatment for certain types of headache, especially migraine headache.

TMS can be very effective for anxiety, both when it occurs as part of depression, and when it occurs as a separate condition. The treatment protocol for anxiety is a bit different than the protocol for depression.

One of the most interesting things about TMS is that it is “pro-cognitive”, that is, it improves cognitive function globally. Nearly everyone who undergoes a course of TMS reports improved concentration, longer attention span, better focus, and better memory. This improvement appears to be above and beyond the improvement that might be expected as a result of treating the depression and often precedes improvement in mood. In fact, TMS has been used experimentally in the treatment of ADHD and Alzheimer’s disease.

Our practice focuses on the treatment of depression and comorbid anxiety. While clinical studies suggest that TMS Therapy may be an effective treatment for other psychiatric and neurological disorders such as Parkinson’s, schizophrenia, and autism–to name a few–conclusive scientific evidence is not yet available. While some treatment protocols have been developed for other disorders, these have been determined with the use of several different TMS devices, which have different capabilities. We use the NeuroStar TMS Therapy System, which is currently the only TMS device FDA cleared for clinical use. This device is designed for the treatment of depression and it is not always appropriate for the treatment of other disorders, which require a very different protocol.

Studies of long-term outcomes of patients treated with TMS Therapy suggest that most patients will remain in remission for at least one year, if not indefinitely. Nevertheless, relapse remains a possibility and so in preparation for that possibility I always discuss a discharge and follow up plan with my patients.

In the event that patient begins to notice symptoms returning, I usually will recommend a “booster” treatment plan consisting of several consecutive TMS treatments over the course of a couple of weeks. In some cases, however, regular maintenance treatment may be a more appropriate choice due to a particular patient’s past history. In those cases, regularly maintenance treatments are recommended at a particular frequency (for example, one treatment per month).

TMS Therapy, when not covered by insurance, is valued at approximately $400 per treatment. This number may be considered high by some, but it is important to remember that this is a complex procedure and a number of different factors contribute to this figure. At our practice, we work with our patients to ensure that cost is not a barrier to treatment. We offer several in house and third party payment plans to allow patients to receive treatment now without worrying about how to pay for it. These different options can be discussed in more detail with our office staff.

The U.S. Food and Drug Administration approved indication states that a patient must have tried and failed at least one antidepressant trial of adequate dose and duration within the current depressive episode.

Based on your description of treatment history, TMS Therapy may be an appropriate treatment option for you. Of course, a formal evaluation of your current symptoms and details of your treatment history would be necessary in order to make a treatment recommendation. Since accessibility to TMS specialists is of concern, I think it would be appropriate to contact providers in the European region or, alternatively, the United States and Canada as some may be willing and able to conduct a teleconference.