Why TMS for depression works
TMS stands for Transcranial Magnetic Stimulation. In order to talk, walk, think, and feel, our bodies need to send signals from one area of the body to another. This is done via electrical signals amongst neurons (nerve cells in the nervous system). For some reason in depressed people, the area of the brain responsible for depression is not as electrically active as it should be. TMS technology is able to focus on that specific area of the brain and increase the electrical signaling. The more activity in that area of the brain, the less depressed a person might feel.
How TMS limits side effects
By targeting the TMS machine at the surface of the left dorsolateral prefrontal cortex (LDLPFC), electrical signals will travel into the deeper structures of the brain on their own. TMS is designed for the signaling to start as close to the surface as possible. This minimizes side effects. The electrical signals travel down to connect to the amygdala, a deep brain structure associated with emotions, memory, and addiction.
If you’ve ever had an MRI scan or know someone who has, you already have great experience with TMS treatment. Magnetic Resonance Imaging (MRI) uses very similar technology. The big differences are that the TMS machine is smaller and more focused on a particular area of the brain (LDLPFC and amygdala), minimizing side effects. With medications, chemicals enter your bloodstream and potentially cause side effects all over.
This is the target location TMS for depression treatment | LDLPFC
Common Side Effects from TMS treatment:
- Headaches
- Fatigue
- Tenderness at location of treatment
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Common Side Effects from Medications:
- Headaches
- Fatigue
- Constipation
- Dizziness
- Dry mouth
- Insomnia
- Loss of sex drive
- Muscle spasms and cramps
- Nausea
- Sleepiness
- Drowsiness
- Unwanted appetite changes
- Nervousness
- Night Sweats
- Tremor
- Blurred vision
- Increased blood pressure
- Sweating
- Worsening symptoms
- Suicidal thoughts (black box warning)
How long are TMS treatments and how long do the effects last?
The improvements in mood usually last for 6-12 months or longer. The reason the effects last for this long is because the brain has built new neuronal communication networks. The process is very similar to how working out at the gym builds new muscle.
A full course of TMS treatment typically consists of 36 total sessions, requiring 6 weeks of Monday-Friday visits. The schedule and time commitment stand to be two of the most common barriers. You can talk to your provider about scheduling arrangements. There may be early morning or evening options that can accommodate business hours. Extended lunch breaks from work might also be a temporary option. It is very common to undergo a course of TMS treatment and still work regular hours.
Financing TMS
Does Insurance Cover the procedure?
Yes. Most insurances cover TMS treatment. They each will have different requirements to get approval for prior authorization. The typical requirements are:
- At least two antidepressant medications from two different classes
- One course of talk therapy
Will insurance cover repeat treatments?
Yes. Most insurances cover treatment in the event of a depression relapse. The patient will have to show evidence that they benefited from the previous course. Your health care provider should be able to help with that. The amount of people that respond to TMS is very high (60-80%), but there are people who are considered non-responders. Furthermore, insurance companies may require a 50% reduction in symptoms before they consider allowing for another course of treatment.
How much does TMS cost?
Due to the variability in the way that insurance companies value the procedure, the cost can vary greatly. Coverage by insurance will depend on each patient’s individual plan. Deductibles, copays, and co-insurance are factors that should be calculated before starting TMS treatment. It would be a good idea to call your insurance and ask about your insurance plan. It may also be a good idea to plan for when you want to start TMS. As an example, if you have a high deductible, maybe waiting until the end of the year is a better option for you. For most plans, the early months of the year come with new renewed deductibles. If you don’t have to worry about deductible or copay, you may only need to schedule around upcoming vacations.
If paying out of pocket, the range for treatment can be from 5000- 20,000.
Is TMS worth it?
Is TMS worth it? It depends. TMS might be a great option for you if you are someone that has tried multiple medications and engaged in talk therapy, but still not experiencing symptom improvement. TMS is something to at least consider if your symptoms are moderate to severe. This is especially in respect to the low side effect profile and high response rate (65%-80%), After completing treatment, many patients feel better than they have in years. It is at least worth a conversation with a professional. Contact your local TMS provider to discuss if you are a good candidate.
TMS for depression with The CUBE Mental Health Services
We are primarily a practice that performs TMS to treat symptoms of depression. If you have tried medications and talk therapy, but still suffer from depression, Transcranial Magnetic Stimulation might work for you. Feel free to contact us if you’d like more details.
