Frequently Asked Questions

 

What is TMS?

TMS stands for Transcranial Magnetic Stimulation. It is used to treat depression by stimulating the brain non-invasively using electromagnetic fields, similar to those produced by an MRI (magnetic resonance imaging) machine. During TMS, a magnetic field is administered in very short pulses to the part of the brain that research has demonstrated to be associated with depression. The typical initial course of treatment is about 10 to 24 minutes daily over 4-6 weeks.

How does TMS work?

TMS uses short pulses of magnetic fields to stimulate the area of the brain that is thought to function abnormally in patients with depression, tinnitus, bipolar disorder, obsessive compulsive disorder (OCD), or schizophrenia.. The magnetic field produces an electric current in the brain that stimulates the brain cells (neurons). This results in changes that are thought to be beneficial in the treatment of these conditions.

Is TMS covered by my insurance?

Maybe. We are an Out-Of-Network provider, meaning you pay for treatment and then seek reimbursement from your insurance carrier. Our office can assist you with this process.  Many commercial plans cover TMS by an Out-Of-Network provider.  We can call ahead of treatment so you will know the expected cost.  You can pay from a healthcare flexible spending account, as well.  At this time, Dr. Pejic has opted out of Medicare and you may not seek reimbursement.  Yet, we do employ payment plans and sliding scales on a case-by-case basis.  

Is TMS a good alternative to antidepressant medications?

Yes. TMS is non-systemic (does not circulate in the blood throughout the body), so it does not have side effects such as weight gain, sexual dysfunction, nausea, dry mouth, sedation, etc. The most common side effects reported during clinical trials were headache and scalp discomfort - generally mild to moderate - occurring less frequently after the first week of treatment.

Is TMS like other alternative therapies that use magnets?

No. TMS involves a unique method of using pulsed magnetic fields for therapeutic benefit. The intensity of the magnetic field is similar to that of the magnetic fields used in MRI. These techniques differ radically from the popular use of low intensity, static magnetic fields. These products deliver weak and undirected static fields that are not capable of activating brain cells.

Is TMS like electroconvulsive therapy (ECT)?

No, the two procedures are very different. While both are effective in the treatment of depression, there are many differences in safety and tolerability. During TMS, patients sit in a chair and are awake and alert throughout the entire procedure – no sedation is used with TMS. Patients can transport themselves to and from treatment. In over 10,000 active treatments in clinical trials, no seizures were observed. TMS was also shown to have no negative effects on memory function in these studies. In contrast, "shock therapy," or ECT, intentionally causes a seizure. Patients receiving ECT must be sedated with general anesthesia and paralyzed with muscle relaxants. Recovery from an ECT treatment session occurs slowly, and patients are usually closely monitored for minutes or a even few hours after a treatment. Short-term confusion and memory loss are common with ECT, and long-term disruptions in memory have been shown to occur and may persist indefinitely in some people. Because of the side effects associated with ECT, a significant amount of caregiver support is required.

 

What is a typical course of treatment with TMS?

A typical course of TMS Therapy is 5 times per week for 10 to 24 minutes sessions over 4-6 weeks. Any additional treatments are based on clinical judgment.

What are the potential risks of TMS?

TMS has been shown to be well tolerated and safe in clinical trials. Throughout over 10,000 active treatments performed in clinical trials, the most commonly reported side effect related to treatment was scalp discomfort during treatment sessions. This side effect was generally mild to moderate, and occurred less frequently after the first week of treatment. In clinical trials, over 10,000 TMS treatments demonstrated its safety, with no occurrence of seizures. However, there is a small risk of a seizure occurring during treatment. This risk is no greater than what has been observed with oral antidepressant medications. While TMS has been demonstrated to be effective, not all patients will benefit from it. Patients should be carefully monitored for worsening symptoms, signs or symptoms of suicidal behavior, and/or unusual behavior. Families and caregivers should also be aware of the need to observe patients and notify their treatment provider if symptoms worsen.

Can TMS cause brain tumors?

No, TMS uses the same type and strength of magnetic fields as MRIs, which have been used in tens of millions of patients around the world and have not been shown to cause tumors. The magnetic energy used in a full course of TMS is a small fraction of just one brain scan with an MRI.

Does TMS cause memory loss?

No, clinical trials have demonstrated that TMS does not result in any negative effects on memory or concentration.

Is TMS uncomfortable?

No, the most common side effect related to treatment was scalp discomfort during treatment sessions. This side effect was generally mild to moderate, and occurred less frequently after the first week of treatment. If necessary, you can treat this discomfort with an over-the-counter analgesic. If these side effects persist, your doctor can temporarily reduce the strength of the magnetic field pulses being administered in order to make treatment more comfortable. In clinical trials, less than 5% of patients treated with TMS discontinued treatment due to side effects.

How long does the antidepressant effect last? 

In most patients, the clinical benefit of TMS Therapy was maintained through 6 to 12 months.  If depression re-emerges after many months, a shorter course of TMS often helps.  This is part of your maintenance plan that Dr. Pejic will develop with you.

Can I also take antidepressant(s) if I am receiving TMS?

Yes. In clinical trials, TMS was safely administered with and without other antidepressant medications.