WHAT IS TMS?
Transcranial Magnetic Stimulation (TMS) is a non-invasive, non-drug and innovative approach used to treat depression, anxiety, PTSD and other mental illnesses. TMS works by stimulating the brain by using electromagnetic fields, similar to those produced by an MRI machine, to improve overall brain function. During TMS Therapy, a magnetic field is administered in very short pulses to a targeted region of your brain.
HOW LONG IS THE TMS TREATMENT COURSE?
The typical TMS treatment program is 30 treatments delivered 5 days a week over 6 weeks. For some patients, an additional 6 TMS treatments over 3 weeks immediately after typical 30-day induction may be helpful. The daily schedule of TMS allows for a gentle and gradual process to establish lasting effects to brain function. Each appointment typically lasts about 30 minutes. The very first day will be 60 minutes where brain mapping, called an MT, will take place.
CAN TMS THERAPY BE A GOOD OPTION FOR PATIENTS EVEN IF THE INDIVIDUAL IS STILL ON ANTIDEPRESSANT MEDICATIONS?
Yes. TMS directly stimulates the brain without involving the rest of your body, which is drastically different from medications which works systemically. Medication side effects involve weight gain, sexual dysfunction, nausea, dry mouth, sedation, skin rash, gastrointestinal complications, and many other symptoms. Conversely, TMS has minimal side effects, involving only temporary headache and mild scalp discomfort. TMS has a very low risk (1/20,000) of transient seizure which is significantly lower than most psychiatric medications.
IS TMS THE SAME AS OTHER THERAPEUTIC MAGNETIC PRODUCTS?
No. TMS Therapy involves a unique method of using very powerful pulsed magnetic fields for potential 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. There is significant difference in strength, power, intensity, and biological effect.
IS TMS LIKE ELECTROCONVULSIVE THERAPY (ECT)?
No, TMS and ECT procedures are very different. While both can be effective in treating of depression and other mental illnesses, there are significant differences in safety and tolerability. During TMS, patients are siting in a reclined chair, awake, alert and engaging throughout the entire appointment. Also, TMS treatment does not involve needles, sedation, anesthesia and hospitals. There is no disruption to patient's daily activity, and patient can drive themselves to and from clinic. Conversely, ECT can cause memory loss and mild confusion. In addition, ECT is invasive requiring use of needles to deliver anesthesia into patients in a hospital or surgical center setting.
HOW IS ECT DIFFERENT FROM TMS?
The mechanism of ECT, “shock therapy,” is to intentionally cause a transient seizure using electrical stimulation, not magnetic stimulation. Patients receiving ECT must be sedated with general anesthesia and paralyzed with muscle relaxants during the treatment in a hospital setting for safety purposes. Recovery from each ECT treatment session occurs slowly, and patients are closely monitored for minutes or a few hours after a treatment. Confusion and memory loss are common short-term and/or long-term complications. Because of the significant side effects associated with ECT, caregiver support is sometimes required for certain patients.
WHAT IS A TYPICAL TMS TREATMENT SCHEDULE?
In clinical trials, patients received daily TMS, 5 times per week, for approximately 19 minute sessions over 6 weeks. Some patients may benefit from a taper TMS, which is an additional 6 treatment sessions over 3 weeks period. Based on clinical judgment, some patients may sustain benefit with a consistent maintenance TMS schedule over a 12 months period.
WHAT IS THE POTENTIAL RISK IN RECEIVING TMS TREATMENT?
TMS is well tolerated and has been proven to be safe in clinical trials and by the FDA. The most commonly reported side effects are scalp discomfort during treatment sessions and temporary headaches in the initial few sessions. In clinical trials, over 10,000 TMS treatments demonstrated its safety, with no occurrence of seizures. However, there is a minimal risk of a seizure occurring during treatment. This risk is no greater than what has been observed with oral antidepressant medications.
WHAT IS THE SUCCESS RATE OF TMS?
It is important to note each individual is different and hence response may vary dramatically amongst different person. That said, clinical data shows 1 in 2 person have above 50% response in reduced depression symptoms. And, 1 in 3 person achieve complete remission.
At LIGHTHOUSE, our results are significantly better because of our customized care and advanced TMS approach. We also offer an optional integrative TMS treatment that combines talk therapy by a licensed therapist with TMS treatments.
DOES TMS CAUSE BRAIN TUMORS?
No, TMS uses the same type and strength of magnetic fields as MRIs (magnetic resonance imaging), 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 Therapy is a small fraction of just one brain scan with an MRI.
HOW LONGS THE POSITIVE EFFECTS OF TMS LAST?
It is important to note each individual 's biology is different and thus variable results are expected. That said, according to clinical data nearly 70% maintained efficacy and durability through a 12 months period. There is still no long term data available yet because TMS has only been around since 1980s and FDA approved since 2008. That said, the scientific community is very excited about TMS and a lot of research is being conducted in expanding the application of TMS primarily due to its positive safety profile. Talk to your doctor about your long-term treatment plan and how TMS may fit into your care.
CAN I CONTINUE TO TAKE MY ANTIDEPRESSANTS DURING TMS?
Yes. TMS Therapy can be initiated with or without medications onboard. But once TMS is started, we recommend no changes to your medication prescription, as well as, how you take your medication. Any medication change can begin during the TMS taper phase, which is after the 30-session index course. Our psychiatrist will coordinate care with your prescribing doctor.
DOES INSURANCE COVER TMS?
TMS Therapy is now covered by most commercial insurance, including, but not limited to, Aetna, Anthem BC, BlueShield, BCBS, Cigna, MHN/HealthNet, Magellan, Compsych, United/UHC/UBH/Optum/UMR, BrightHealth/ACN, Ambetter, and Humana. For military/veterans, we accept TriCare, TriWest (CCN), as well as, direct referrals from VA Medical Center/Clinics. Our team will work closely with you regarding the insurance process. Most insurance will require a pre-authorization or pre-determination prior to proceeding with TMS treatment.
DOES MEDICARE COVER TMS?
Medicare is regionally managed and operated. Thus, TMS policy and criteria also vary. Please check your local area. Reimbursement rates also vary dramatically amongst the regions.
Currently, LIGHTHOUSE and its affiliate facilities do not receive Medicare reimbursement for TMS treatments.
I HAVE NO INSURANCE.
WHAT IS THE COST OF TMS?
Pricing for TMS will vary based on duration of treatment. By law, we cannot charge patients differently from what we charge insurance companies. That said, we do offer a significant discount to patients who are financially burdened and will be self-financing their treatment. Payment is required prior to start of treatment.
In addition, we work with 3rd party financing companies who offer great rates. Interest rates and terms are based on financial history and credit report.
IS BRAIN IMAGING NECESSARY PRIOR TO TMS THERAPY FOR DEPRESSION?
Brain imaging (MRI, fMRI, CT, PET scan, etc) are not necessary to determine the appropriate brain region of TMS treatment. The area of treatment known as the Dorsal Lateral Prefrontal Cortex (DLPFC) can be properly located and confirmed without the use of brain imaging scans. We use a standardized methodology to determine the location of targeted region.
It is not uncommon in academic facilities that offer TMS treatment to also offer brain imaging options. Typically, this is done fore research purposes. Please consider reaching out to your local academic medical center if you have interest in getting brain imaging prior to TMS.
WHO CANNOT UNDERGO TMS?
Individuals with ferromagnetic metal in and/or around the head, including metal plates, aneurysm coils, cochlear implants, occular implants, deep brain stimulation devices and stents. Individuals with history of head trauma leading to metal fragments, metal plates, or aneurysm clips are not a candidate for TMS. Some facial tattoos can prevent a person from being a candidate for TMS.
BESIDES DEPRESSION, CAN TMS TREAT OTHER MENTAL DISORDERS?
It is important to note mental illnesses and disorders are lifelong. The goal is to achieve remission and maintain symptom-free. TMS is used to manage many different mental illnesses, including depression, anxiety, bipolar, PTSD, OCD, ADHD, chronic pain, tinnitus, migraine, concussion/TBI, postpartum depression, schizophrenia (negative symptoms) and autism (high functioning). Results may vary by person. Outcome may vary based on which condition is being managed and treated. Beyond depression, treatments of these other conditions are considered “off-label” but are clinically applicable as an alternative treatment modality. Off-label treats are not covered by private insurance companies and Medicare.
WHAT IS THE PROCESS TO ENROLL IN TMS THERAPY AT LIGHTHOUSE?
We require an initial psychiatric consult/intake with our psychiatrist who will determine if individual is a good candidate for TMS treatment.
If individual is a good candidate for TMS and is self-financing treatment, individual can schedule treatment.
If individual is a good candidate and would like to utilize their insurance, then individual will meet with our TMS team. Our team will fill out and submit pre-authorization forms to the insurance on behalf of the patient. Turn around time range is approximately 5-20 business days depending on responsive and/or additional requests from insurance company.
For depression, patient can schedule out 30 treatment session appointments over 6 weeks. Some will need additional 6 sessions over 3 weeks.
Coordination of care with you referring and/or prescribing doctor occurs prior to starting and at end of TMS.
WHAT IS INTEGRATIVE TMS AT LIGHTHOUSE?
We offer a unique integrative TMS program, which combines TMS with customized talk therapy. This creates a synergistic effect of biological change through TMS with behavioral and cognitive change through talk therapy. The talk therapy is provided by our experienced licensed therapists. This program is completely OPTIONAL. Contact us about cost and/or insurance coverage.
OUR CLINIC IS NOT A CRISIS CENTER AND DOES NOT MANAGE CRISIS SITUATIONS
IN CASE OF EMERGENCY
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If experiencing a life-threatening EMERGENCY, please dial 9-1-1
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Central Arizona Crisis Line: (602) 222-9444 or (800) 631-1314
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National Suicide Prevention Lifeline: (800) 273-8255
CLINIC POLICY
Our providers DO NOT (1) work with court related or court ordered counseling or treatment, (2) participate in custody issues including writing reports for families, and (3) fill out disability paperwork unless the patient has been seen by our providers for a minimum of 3 scheduled appointments. In addition, a billable appointment needs to be made to complete the disability forms in person between the provider and patient.
NO SHOW/LATE CANCELLATION POLICY
For INTAKES/CONSULT appointments, a fee of $150 will be imposed and payable on rescheduled appointment or earlier.
For FOLLOW-UP appointments, a fee of $75 will be imposed and payable on next scheduled appointment or earlier.
* NOTE: 1) Fees can be waived if cancellation occurred at least 24-hours (1 business day) during working hours prior to appointment, 2) for Monday appointments, cancellation will NOT BE waived if received after Friday 12pm.
MEDICATION REFILL POLICY
Our office DO NOT accept medication refill request by phone. All refill requests must be submitted to REFILL@LHPSYCH.COM.
Our office DO NOT check emails on the weekends. Hence, any refill requests received on the weekend will be reviewed on the next available business day.
Be aware there is NO SAME DAY REFILLS, without exception. Please expect seven (7) business days to process refill requests.