Frequently Asked Questions About TMS
Transcranial Magnetic Stimulation, or TMS, is a non-invasive depression and OCD treatment. It uses an electromagnetic coil placed against the head to target brain regions that are implicated in the disease of depression to stimulate the brain. Targeted magnetic pulses are painlessly delivered to neuronal circuits while the patient is awake. TMS devices are FDA approved for the treatment of patients who have failed or cannot tolerate other depression or OCD treatments. TMS can be used alone although many patients will continue their medication while receiving TMS. Depression is a debilitating and painful illness and TMS can help.
Dr. Kim provides consultations to help you decide if TMS is an option for you. Evolving research continues to inform us about individual treatment response. About 50% of patients show significant improvement in their depression after 36 treatments and over 60% with 44 treatments. Dr. Kim will evaluate your personal depression or OCD course to design a protocol that is right for you. In general, treatment should not be done if you have metal implants in or around your head (except for standard dental fillings) or if you have a seizure disorder. Our patients tell us that it is not scary or painful and that they feel comfortable in our offices. A trained technician is always with you. Before OCD treatment can start, there is an additional session with Dr. Kim to develop a personalized provocation protocol. (I wouldn’t worry if nobody knows what this means – we just want them to know they have 2 sessions) No mental health treatment works for everyone but we will do our best to make sure you see results. This includes giving you information on how to maximize your treatment success.
Our center provides a type of TMS called deep TMS. The targeted electromagnetic pulses reach deeper and wider into the brain. This is likely an important part of the success of TMS. Brainsway TMS is the only approved device for OCD.
TMS has few side effects and they are not long lasting. Patients are awake and able to interact throughout the treatment. It is loud so we provide ear plugs. Sometimes after the first few sessions headaches or jaw pain have been reported. We recommend wearing a mouth guard if you notice teeth clenching or jaw pain. Headaches are usually mild and are unusual after the first week of treatment. We will screen you for medications, illnesses or issues that may need to be addressed before you can start TMS. If you have a seizure disorder, TMS is generally avoided.
Some antidepressants cause weight gain, gastrointestinal problems, increased anxiety, changes in sleep and dream quality, changes in sexual functioning, and/or sweating. Electroconvulsive therapy (ECT) requires anesthesia and can have effects on cognition and memory. While both medications and ECT are important depression treatments, TMS does not have these side effects.
Each session is 20 minutes. We start with 36 daily treatments Monday-Friday. After those are completed, we taper to two sessions per week for 8-12 weeks and then one session per week for 8-12 weeks. After the taper is completed, you and your doctor will decide on a maintenance schedule – usually once per month. This regimen has been shown to be effective for long term results. Of course, you can stop the treatments at any time. Investing in continuing TMS past the 36 initial treatments has given our patients the best results and we want you to know this before you start. Insurance will not cover the weekly safety and progress checks nor will it cover taper and maintenance TMS. Therefore, we do not work with your health insurance – we want you to get well and stay well.
TMS is a financial investment in your long-term mental health. An initial 60-minute consultation with Dr. Kim is $250 (less than half her usual fee). If you are interested in treatment for OCD there is an additional 60-minute appointment for provocation development.
Acute Treatments –
TMS is done as a series of treatments. An acute course of 36 treatments is $9300 which includes 5 free treatments. Mainline TMS does not accept medical insurance. We give you documentation that you can give to your insurance company for any out of network mental health benefits you may have. If your insurance company requires prior authorization for out of network reimbursement Dr. Kim will do that after the treatment plan has been developed for you. Every insurance plan has different criteria for prior authorization. You can ask your insurance whether you meet the prior authorization standards or whether you have out of network mental health benefits by calling them directly. We suggest you do this before you call us if you are interested in getting reimbursed by your insurance.
We understand that you may chose to seek a provider that accepts insurance. Your insurance can provide you with those options directly, you do not need to choose to get your TMS at Mainline TMS.
Why Choose Mainline TMS and Follow Up Care –
Patients choose Mainline TMS because Dr. Kim is a clinical leader in the field and makes sure that each treatment is done safely and expertly. Treatment at Mainline TMS is hands on and Dr. Kim creates a treatment plan based on each patients’ unique needs. This increases your chance of success. Insurance does not pay for taper and maintenance sessions which Dr. Kim believes is a very important key to long-term success with TMS.
During your first treatment, Dr. Kim will perform a test to identify the minimal amount of electromagnetic field necessary to stimulate your brain. Each treatment is 100% customized to each patient, so we can deliver the correct treatment dose the specific area of your brain. Once the treatment starts, you will feel like TMS is tapping on your scalp. You may notice some painless facial twitching during the treatment. This is normal and will not continue once the TMS session is over. Over the course of the first few sessions, we gently increase the power so that you can accommodate over time. You can resume your normal activities immediately after each session.