TMS THERAPY
FDA-cleared, non-medication depression treatment
Understanding The Pros and Cons of TMS Therapy
Daniel Hageman
You've been dealing with a mental health issue for a while. You've tried a few therapies and medications, but nothing seems to be working. Now, you're weighing the advantages and disadvantages of transcranial magnetic stimulation (TMS), and, like many others, aren't sure if you have all the information you need to make a confident decision. Here's a look at the pros and cons of TMS therapy to help you decide how to move forward on your journey to wellness.
The Pros of TMS Therapy
The most common use for TMS is to treat depression symptoms, but TMS can be used to treat other conditions, including obsessive-compulsive disorder (OCD) and smoking cessation. TMS is a rapidly evolving medical field that will likely be used to treat many other conditions in the future, but more research needs to be done to gain further understanding, FDA clearance, and insurance coverage.
TMS Works When Other Treatments Don't
TMS therapy is FDA-cleared to treat major depressive disorder (MDD) in patients who have failed to respond to one antidepressant (though insurance companies generally cover TMS only after a patient hasn't responded to at least two antidepressants). The TMS success rate is promising; one prominent multicenter study found that 70 percent of TMS patients experienced reduced symptoms, and 40 percent experienced full remission. These numbers reflect results solely among people who found medication ineffective, meaning TMS has proven successful among the majority of people with treatment-resistant depression (TRD).
For many people with TRD, TMS therapy succeeds where medication has failed. Among patients with MDD who have received TMS, three out of four have reported a reduction in depression symptoms after completing the acute phase of the procedure. Others may find the side effects of antidepressants intolerable, making TMS therapy a desirable option.
TMS Side Effects Are Minimal
TMS is generally well tolerated with few adverse consequences. The only side effect that is greater than a 5% risk is transient headache or site pain with initiating treatment. On the other hand, medications travel thru the body thus individuals are vulnerable to systemic side effects. For example, some antidepressants are known to cause weight gain, constipation, anxiety, blurred vision, nausea, sedation or insomnia and sexual dysfunction making compliance with antidepressant medication a challenge.
TMS Is an Opportunity for Self-Care
Some patients balk at the time commitment for TMS therapy—patients will have 30-36 sessions over six to nine weeks. However, many patients find the appointments to be relaxing, a scheduled time dedicated to attending to their own needs. When coming in for a treatment, you'll sit in a comfortable chair while the TMS therapy device is situated on your head. The device, which can be adjusted to your comfort, will deliver gentle magnetic pulses to the brain regions known to be directly associated with mood regulation. After a 20-minute treatment session, you can immediately return to your normal routine.
The technicians do everything they can to ensure you have a comfortable and relaxing experience. "I had wonderful technicians who were so good at explaining everything to me," says Josie, a Greenbrook TMS patient. "They were kind and entertaining, making every 20-minute session go by quickly. I felt like we were a team."
The Cons of TMS Therapy:
TMS is a lifeline to many people who feel like they are out of options, but not everyone has an easy time with TMS therapy. Hurdles like insurance, contraindications, and barriers to access can be frustrating for patients who might otherwise enjoy the benefits of TMS.
Insurance Can Be Tricky
TMS therapy is covered by most major insurance companies for MDD if you have tried and failed at least two antidepressants. Because TMS is more expensive than most antidepressants, insurance companies typically won't authorize payment if TMS is the first-line therapy.
That being said, Greenbrook helps manage the insurance process for you. Throughout the process, you'll work with a patient consultant to find the status of your insurance requests. You'll know what your benefits inquiry is when you start so your payments are predictable, and this allows you to make an informed choice about what's best for you. If your insurance does not cover TMS, Greenbrook can help you find third-party financing.
TMS Isn't Recommended For Everyone
TMS may be complicated or contraindicated for people with certain conditions. TMS's use of magnetic fields can have negative consequences for people with metal implanted above their neckline. The magnetic field won't pass through metal, and it can also cause the metal to get hot. Other things that could complicate TMS include brain tumors, implanted devices, and a history of seizures. Many of these issues can be accommodated, so be sure to see an experienced TMS provider who may be able to work around your specific case before you decide that TMS won't work for you.
Some Face Accessibility Issues
Behavioral health care in rural areas remains a problem in the United States. Because TMS is a relatively new treatment, even if you are not in a rural area, you may have trouble finding a treatment center near you.
Greenbrook providers recognize that TMS therapy needs to be convenient, so they've established centers where it's easier for people to visit. The goal is to avoid causing someone to drive hours to receive TMS therapy for depression. Greenbrook is constantly expanding to bring TMS therapy to those who need it. Patients can go to the website, which has a location finder, to can find the center nearest to your home.
Learn More about TMS Therapy
No matter your situation, it's a smart idea to weigh the pros and cons of TMS therapy and seek the treatment that works best for you. If you're interested in learning more about the advantages and disadvantages of TMS for your specific situation, you can set up a free consultation, and a patient consultant will discuss any questions you may have.
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. 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Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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