TMS THERAPY
FDA-cleared, non-medication depression treatment
What to Look for in a TMS Provider
Dr. Geoffrey Grammer, Chief Medical Officer, Greenbrook TMS
Acknowledging you need mental health care isn't easy, and finding the right provider can be downright daunting. We applaud you for conducting research to find a transcranial magnetic stimulation provider, because that means you are invested in feeling better and restoring a good quality of life. While we want to be your TMS provider, our biggest hope is that you find the provider that's right for you. To aid you in your search, we'd like to offer some things to think about when choosing your TMS provider.
Do They Help You with Insurance?
The World Health Organization attributes 14 percent of the global disease burden to mental health disorders, with depression being a main cause of disability. In spite of that, insurance companies remain a burdensome hurdle to receiving quality care. The American Psychological Association recommends calling your insurance company or visiting the company's website for a list of in-network providers, asking about co-payments and your deductible upfront, and talking to your provider about whether they accept your insurance. These are all important points to determine, but struggling with insurance and wondering if you can afford good care shouldn't be obstacles between you and relief from your depression. Besides, sometimes the insurance company website won't even have up-to-date information. At Greenbrook TMS, we have a billing department to do all that research for you.
We work with major insurance providers, which means all you need is an insurance card to get coverage. A patient consultant will work with you on the status of your insurance requests, and our team will file and process claims, as well as help with appeals. We make sure payment is predictable for you, with no hidden fees, helping you to make an informed choice about whether being treated by us is best for your.
Are the Providers Experienced?
Any time you get a procedure, you should consider the experience of the physician performing the procedure. You have a right to know if you're the third case or the 100th case. Since TMS has been around for just over a decade, you may find providers who are new to it. If this is the case, you can ask how the physician was trained to perform TMS and which devices they use, as not all devices are equal in efficacy.
At Greenbrook TMS, we use a variety of devices that are all cleared by the FDA, enabling us to offer several treatment options to our patients. We have more than 100 physicians in our company, including some of the nation's most experienced TMS providers, who undergo extensive TMS training. The most experienced physicians belong to our Clinical Advisory Committee to provide on-demand advice and resources to any of the physicians at Greenbrook TMS. No matter which Greenbrook TMS center you visit, you will receive the same standard of treatment with all the benefits of our best providers.
What about Location, Convenience, and Atmosphere?
Because TMS is not as commonly employed as other mental health treatments like antidepressants and talk therapy, finding a TMS center can be challenging. Availability is certainly better now than it was 10 years ago, and the Clinical TMS Society has an interactive map to help you find a nearby provider. Unfortunately, there are some providers who aren't as focused on the patient experience and may cut corners on their overhead by neglecting things like conveniently located centers, modern offices, or comfortable TMS chairs. First and foremost, Greenbrook TMS chooses centers based on geographic proximity to people's homes and workplaces. Next, we make sure our centers are appealing, soothing, and safe for our patients, making them feel more like spas than doctors' offices. We want to be sure that when you come into our centers, you're able to relax and focus on getting better.
How Friendly and Competent Is the Care Team?
When you decide to get TMS treatments, you will have 30 to 36 sessions over six to nine weeks. After your physician determines your device's settings, most of these treatments will be administered by a TMS technician. While you may have found a provider you are comfortable with, the physicians are just one part of the care team that's working with you throughout your treatment. Your TMS experience could be an unpleasant one if the technicians don't treat you the same way your physician does or, worse, aren't trained well and therefore mishandle your treatments.
Greenbrook TMS technicians are not administrative staff who also work as technicians—their full-time job is in the administration of the TMS therapy. Our technicians undergo training that far exceeds the industry standard, and we have a formalized internal training program and continuing education training opportunities to make sure they stay up to date. Besides their competency, our technicians are always pleasant and friendly. In fact, many of our patients that one of their very favorite parts of treatment is getting to see their techs every single day and talk with them.
Choosing a TMS Provider
No matter where you choose to receive TMS therapy, we want you to feel safe, well cared for, and, ultimately, better. Because Greenbrook TMS is the largest provider of TMS in the United States, we have internal quality assurance initiatives to keep track of our clinics' and providers' performance, so we know that our patients are receiving the same standard of care across the company. Between physician peer review, technician training, and quality assurance data analysis, you can rest assured that no matter where you get your Greenbrook TMS treatment, it's going to be the best that TMS has to offer. If you're ready to take the next step in choosing a provider, we would love to hear from you.
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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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