TMS THERAPY
FDA-cleared, non-medication depression treatment
4 Questions to ask your TMS Provider Before Treatment
Mary El Grammer
Like many people, you may have sought information online before deciding to get a TMS consultation. You may also be nervous about whether you know exactly what to ask your doctor about this treatment option. We at Greenbrook TMS applaud patients who want to be informed and advocate for their health, and we firmly believe that you have a right to know about your doctor's background and the treatment at hand. No provider should be offended by your questions, and you should find a TMS doctor who is willing to answer any questions you might have.
An outdated view of the doctor-patient relationship is that the patient should do whatever their doctor tells them to, rather than the patient being informed and then agreeing with their doctor's assessment and treatment plan. In a modern doctor-patient relationship, you can participate in your health care by researching beforehand and advocating for yourself.
If you're feeling nervous about questioning your doctor, adopting this view of the doctor-patient relationship may help. After all, you are a consumer of health care, and that means you're paying money for a service. Think of choosing health care the same way you might choose a dish at a restaurant. The staff is there to guide your choice, but the decision ultimately is yours. If you're not sure what to ask your doctor, here are five questions to start the conversation.
1. Who Will Perform My Treatments?
You have a right to know who is treating you, first and foremost. You can ask where your provider went to medical school, what their specialty is, and whether they are board-certified. You can also ask how they maintain their certification for TMS and whom they go to for consultation for a question they have. You deserve to know the circumstances of your care.
At Greenbrook your doctor will perform a test to identify your motor threshold, which is how we determine your treatment intensity and location. After your first treatment, a TMS technician will treat you based on the motor threshold sequence your doctor previously determined.
2. How Long Have You Been Doing TMS?
TMS has only been more common for the last several years, so your care provider might not have been trained in TMS in medical school or residency. That’s okay, so long as they’ve had training and experience in the field. Other questions you might ask with respect to training include, "How did you train?" and "How many cases do you treat a year?" With all medical treatments, provider experience is important, and if you are only a doctor's third case, you have a right to know that.
3. What Are Your Outcomes?
You should feel comfortable asking how many of your provider's patients see improvements, face setbacks, or experience side effects, as well as how those outcomes are determined. If your provider's outcomes are generally not favorable, you should be aware of that. While unfavorable outcomes may be the result of particularly difficult cases, it could also be a red flag that prompts you to seek a second opinion.
4. Will TMS Work for Me?
You want to make sure TMS therapy is clinically appropriate for you and that you understand why your doctor is recommending TMS therapy. You can also ask how many sessions you will have, what the schedule will be, how long the treatments will last, and whether you will need to return for more treatments.
In addition to asking the questions suggested here, you may want to do your own research on TMS therapy once you find a suitable doctor so you can decide what to ask them. Apart from Greenbrook's website, you can see videos of TMS on our YouTube channel to aid in forming your own questions.
You are always welcome to bring someone with you to an appointment to advocate for you, though the pandemic may pose some restrictions, so check with your provider before you bring someone into the clinic. We at Greenbrook TMS are committed to answering your questions and supporting you on your journey to find a TMS doctor.
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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. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. 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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