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TMS Frequently Asked Questions

What is Transcranial Magnetic Stimulation (TMS)?

Transcranial Magnetic Stimulation is a non-invasive (does not involve surgery), non-medication treatment that stimulates areas of the brain which are thought to be linked to depression. TMS therapy is a generally safe procedure that does not require surgery, anesthesia or sedation. Patients are fully conscious and awake throughout the treatment. TMS therapy is a generally safe procedure that allows patients to do their usual activities during the course of treatment, such as work or driving.

How does TMS Therapy work?

During TMS therapy, a magnetic coil is placed over the scalp, which when turned on generates electromagnetic stimulation; much like those generated by MRI machines. The magnetic coil delivers a series of magnetic pulses to the head, causing stimulation in a specific area of the brain. The stimulation is believed to trigger further changes in the brain circuits responsible for depression.

What is the typical course of TMS Therapy?

TMS therapy is an outpatient treatment that requires a series of treatment sessions. The initial course of treatment typically consists of 5 treatments per week over a 6-9 week period, for an average of 36 total treatments. The actual treatment lasts approximately 40 minutes. During treatment, the patient is awake in a comfortable chair. Maintenance TMS is not well studied; however, it can be provided to prevent recurrence of symptoms with a frequency of 5 daily sessions every 4-6 weeks.

What are the benefits and risks of TMS Therapy?

Transcranial Magnetic Stimulation has been studied by researchers for 20 plus years. TMS Therapy is well tolerated and has been shown to be safe in clinical trials. When used for the treatment of depression, TMS Therapy can produce clinical benefits without the side effect of antidepressant medications such as weight gain, sexual dysfunction, nausea, dry mouth or sedation.

The most common adverse event associated with TMS therapy is scalp pain and discomfort, generally mild to moderate. The incidence of this adverse event declines markedly after the first week of treatment. In recent clinical trials, with 10,000 sessions, no seizures have been observed; however, there is a small risk of a seizure occurring during treatment. In these studies, TMS Therapy has also shown to have no negative effects on memory function. Occasional muscle twitches (during treatment) or headache may occur.

In TMS trials, 1 in 2 patients reached response and 1 in 3 patients achieved remission. While TMS Therapy is an effective treatment, not all patients will respond to this treatment. In this case, the next best treatment options will be discussed and appropriate referrals will be made for further treatment.

Why TMS Therapy may be appropriate?

TMS therapy is an appropriate treatment for adult patients with major depressive disorder who have failed to achieve satisfactory improvement from antidepressant medications at or above the commonly effective dose and duration. Eligible patients will be evaluated by one of our board certified psychiatrist for the clinical appropriateness of TMS therapy.

Who would not benefit from TMS Therapy?

Persons with a history of seizures would not be indicated for TMS Therapy. TMS Therapy is contraindicated in persons who have conductive, ferromagnetic or other magnetic sensitive metals implanted in their head or are above the shoulders. Examples include cochlear implants, implanted electrode/stimulators, aneurysm clips or coils, stents, and bullet fragments. Persons with braces and/or metal fillings are acceptable for treatment. Before the first TMS session, patients are carefully screened for the presence of medical conditions (seizure disorder or epilepsy) and any underlying risk factors that could make the administration of TMS Therapy clinically unsafe.

Why choose VCU Medical Center for TMS Therapy?

VCU Medical Center is Central Virginia’s only academic medical center allowing patients to receive the highest quality of care guided by the latest research. We are the only center in the Commonwealth offering four types of brain stimulation therapies for depression. Our TMS team consist of board certified psychiatrist and psychiatric nurse practitioners with specialized training in TMS. Treatment plans are individualized to the needs of each patient by our TMS team. As part of our treatment plan, we incorporate Cognitive Therapy techniques to help patients identify measurable goals. Weekly assessments are conducted to measure the patients’ progress and then evaluated by the TMS team. We believe this team approach enhances and optimizes patient outcomes.

What are the costs and how do I pay for TMS Therapy?

The initial psychiatric evaluation is usually covered by insurance companies; however, not all insurance companies cover TMS Therapy. Due to recent healthcare advances, several health insurance plans now offer coverage for TMS Therapy. It is recommended that patients work directly with their insurance companies to determine coverage.