In clinical trials, most patients begin to see improvement within two to four weeks of treatment. Some patients may experience results in less time, while others may take longer. FDA trials (2008) found that about one out of three of TMS patients achieve remission (90%-100% improvement), one out of three achieve between 50% and 90% improvement and the rest from 0 to 49% improvement. Our results are somewhat better: one out of two achieve remission.
A course of TMS is 30 to 36 sessions. Each session lasts about 30 minutes. These are typically given 5 days a week for 6 weeks, followed by weeks of 3, then 2, then 1/week. Improvements usually start within the first 15 to 20 sessions but, interestingly, the patient’s physician, family members and friends often notice positive changes before the patients do.
A TMS technician is with the patient at all times and the patient is never left alone.
The patient is fully awake, alert and can read, watch TV, or speak with the technician or any visiting friend or companion. Sleeping is discouraged as brain activity during TMS helps with its efficacy.
Each series of TMS session starts off by calibrating the machine to your patient’s brain. The method involves determining how much magnetic energy is required to cause the patient’s thumb to wiggle upon magnetic stimulation, which can vary widely from patient to patient.
Because the amount of magnetic energy required is impacted by the medications that a patient has in their system at any given time, we ask that such be kept constant over the course of treatment. If medication adjustments are need, we prefer these wait until one month after the full 30 sessions have been delivered. If the patient cannot wait, we can recalibrate the machine to the patient’s new brain state.
We do ask that patients refrain from the use of alcohol during treatment, avoid caffeine for several hours before each treatment, and get regular sleep, nutrition and exercise during the course of treatment. These items all affect the calibration.
Each patient is required to attend a weekly psycho-educational group with other TMS clients for support and education. Each patient is also trained in stress and anxiety reduction techniques such as “HeartMath” so anxiety can be modulated during treatments. There are no additional charges for these components of our TMS treatment program.
Each patient meets periodically with the Medical Director throughout the course of treatment so progress can be assessed and adjustments to treatment parameters can be determined.
Our team is in regular contact with TMS providers nationwide and we search for protocol modifications to enhance patient outcomes. As a result, since 2014 each patient has been required to attend a weekly psycho-educational group with other TMS clients for support and education. Patients almost uniformly report enjoyment and benefit. Each patient is also trained in stress and anxiety reduction techniques such as “Heart Math” so anxiety can be modulated during treatments. There is no additional charge for these components of our TMS treatment program.
Also, since 2015 we have required that each patient participates in weekly evidence-based psychotherapy treatments through the 6 weeks of TMS. We are confident that modalities such as CBT and DBT are probable to add both to the benefit received from TMS and to the duration of that benefit. If your patient already has a therapist, we will communicate with their provider and support and encourage them in understanding the unique issues which typically arise during TMS treatments. If your patient does not have provider, they may work with someone from our staff for those 6 weeks or we will gladly provide referrals to community CBT or DBT providers. We are also in process of developing a continuity of care program which includes a post-TMS 10-week group CBT treatment if your patient has found this helpful.
Some localized head pain is common under the coil site as the magnetic energy may stimulate scalp pain fibers. Occasionally, mild headaches may occur early in the series. Usually acetaminophen or Ibuprofen one hour prior to treatment is sufficient to address these concerns.
Many patients will feel somewhat tired after each treatment and some, especially older patients, will choose to nap. The brain is indeed working during the TMS session and this does consume energy.
A rare risk (1 in 15,000 to 30,000 treatment sessions) is the development of a seizure during treatment. There has never been a report of injury from such a development.
TMS is a focal, local treatment, with no systemic or invasive use of medications.
We recommend no medication adjustments during treatment and for one month afterward. If a patient has improved, a slow medication taper over several months may be carried out.
Our Medical Director will welcome any questions or observations from you throughout the treatment process. At the conclusion of treatment he will provide you his recommendations re. possible medication reductions or other changes and will gladly consult with you in the following months should further questions arise.