What is TMS?
Transcranial Magnetic Stimulation (TMS) is a noninvasive brain stimulation treatment that applies brief magnetic pulses to the brain. The pulses are administered by passing currents through an electromagnetic coil that is placed adjacent to a patient’s scalp. The pulses induce an electric field in the underlying brain tissue. When the induced field is above a certain threshold and is directed in an appropriate orientation relative to the brain’s neuronal pathways, the neurons in the brain are activated. In the United States, TMS was cleared in 2008 for the treatment of depression that has not responded to at least one antidepressant trial. It is currently in clinical trials for several other psychiatric and neurological disorders including OCD, bipolar depression, PTSD, and smoking cessation. You might also see this treatment referred to as rTMS (meaning repetitive TMS) or dTMS (deep TMS performed with the Brainsway TMS system). Montana Psychiatry uses the MagVenture TMS system.
Do I need to be referred by a psychiatrist?
If you are not currently a patient of Dr. Amato’s, your current primary care or psychiatric provider can send a referral to Montana Psychiatry. If you do not have a provider, you can call the Montana Psychiatry New Patient Line (406-839-2985 option 4) to start the evaluation process. An Evaluation Appointment will be set up with Dr. Amato and our TMS team and they will determine if TMS may be a helpful treatment for you.
Where is the TMS treatment performed?
All treatments are performed at Montana Psychiatry on an outpatient basis in our relaxing and comfortable location.
Are the TMS treatments approved by insurance?
TMS is currently approved by the FDA for depression that has not improved after at least one antidepressant trial. TMS is a covered treatment by CIGNA, BlueCross BlueShield, Medicare, Allegiance, PacificSource, Tricare, and others. Each insurance has its own requirements for coverage and our TMS team will advocate on your behalf with your insurance company for coverage of this treatment.
What can I expect during a TMS treatment session?
TMS treatments are administered by certified TMS operators under the direction of Dr. Amato. During a TMS treatment session, the operator will place the magnetic coil (which is encased in a protective helmet) on your head using a specific set of measurements that are determined by Dr. Amato during the first treatment session. You will hear a clicking sound and feel a tapping sensation on your scalp. The treatment session is delivered as a series of pulses that last 2 seconds, with a rest period of approximately 20 seconds between each pulse sequence for a total of 1,980 pulses. Treatment is targeted over the region of your brain called the dorsolateral prefrontal cortex (DLPFC). Each treatment session lasts approximately 20 minutes. You will remain awake during the entire treatment and there are no restrictions on driving or other activities after the treatment is finished.
Is the treatment effective?
In a 2015 study conducted by Brainsway, 1 in 3 medication-resistant patients with major depression achieved remission after treatment with Deep TMS. A later study showed that after 30 Deep TMS treatments, 1 in 2 patients achieved full remission.
Are there any risks or long-term side effects with TMS?
The most common side effects reported are scalp discomfort and headache. Both side effects tend to improve and/or resolve after the first few days of treatment and can be managed with over-the-counter pain relievers. TMS should not be used in patients who have conductive, ferromagnetic, or other magnetic-sensitive metals implanted in their head or that are non-removable. There is a small risk of seizures associated with TMS, but the risk is equivalent to that seen with some common antidepressants that many of our patients have already been on prior to considering TMS. It is important that patients avoid any alcohol use during treatment as alcohol can increase the risk of having a seizure. Due to the noise produced during the TMS treatment, earplugs are used during every session.
Will my current psychiatric medications interfere with TMS treatments?
Anti-depressant medications (SSRIs, SNRIs, MAOIs, and tricyclics) do not interfere with TMS treatments. Dr. Amato will consult with you prior to the start of treatments regarding any medications you are taking. Important: You should not decrease or stop taking any prescribed medications without first consulting your prescribing physician.
TMS
by Deb (age 64)
Category: generalThe hoops I jumped through in order to be evaluated were straightforward and efficient. I met with PA Kaitlin for about an hour to discuss my history and previous medications. Then Dr. Amato joined us to further discuss my history, the TMS treatment, and answer any questions. Myrna gathered all of the information and submitted it to my health insurance company to request coverage for TMS. Fortunately, insurance approved the treatment and I was able to begin the next week. I’m sure most people have anxiety about starting a treatment like TMS. No matter how many times it’s described to you, there are many unknowns. How will I feel during treatment? Is it painful? What if this doesn’t work? What if it works for a while but then stops? In all honesty, I was very uncomfortable during the first couple of weeks of treatment. The alternating two seconds of tapping sensation caused some pain during treatment, and at the end of the first week I thought about quitting. But I had sworn to myself that TMS was a last resort and I HAD TO complete the treatment and give it a chance to work. My technician, Heather, told me that some people don’t feel the tapping at all, they only hear it. Guess I wasn’t one of those people! But as the days went by, it became easier to tolerate the treatments. During this time I also saw Lauren weekly for CBT (cognitive behavioral therapy). This is highly recommended for people undergoing TMS treatment, and it was a positive complement to my total of 100 minutes each week “under the helmet”. The weekend between weeks three and four, I started to notice subtle improvements in my mood, increased belief in my self-worth, and enthusiasm for simple things like going for walks, meeting friends for lunch, and taking on volunteer work in the community. I hesitated at first to believe that TMS was helping me. I was afraid that I was convincing myself it was working because I so desperately wanted it to! But now that I am past the treatment I can say with cert
TMS
by Barbie (age 68)
Category: generalI feel so blessed to participate in the TMS protocol at MT Psychiatry. After struggling so many years with depression and not getting significant results from medication, particularly of late, I noticed positive results in the first two weeks of treatment. TMS can literally give you back the beauty & joy in living as well as the courage to make positive life changes and improvements in your daily living situation. I heartily encourage anyone to put yourself into the hands of the amazing TMS team who so gently and graciously make this journey with you out of the black hole that is depression. It is my honor and privilege to give the TMS treatment the highest recommendation.
TMS
by Shayne (age 66)
Category: generalI am grateful for the support and caring I have received from Dr. Amato (and Heidi, Heather and Myrna) in my quest for mental health and a fuller more productive life. While the TMS results have been subtle, I feel more positive about my future and I would recommend this team absolutely. Thank you!
TMS
by Carrie (age 65)
Category: generalNot realizing how fuzzy my head was, I thought I was only going through severe anxiety and depression. Through the insight of Pat, I was able to go through TMS treatments which brought down the anxiety and depression immensely and has cleared up the fuzzy, far off substantially. All the personnel treated me with kindness and I’m sure their attitudes helped in my recovery.
TMS
by Bridget (age 47)
Category: generalThe first outcome of TMS I noted happened early in my treatment, at about the beginning of week two. I felt as though my “brain fog” had been chipped away. I wish I could report that I feel my mental health issues are in “remission”, but I can’t do so yet. My hope is that I will see improvement in the weeks to come, now that my TMS cycle has ended. I can say that my brain feels – in some way – different; I can’t explain exactly how. I continue to struggle at this point in time but sill have hope for more improvement.
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