What is TMS?
Transcranial Magnetic Stimulation (TMS) is a noninvasive brain stimulation treatment which 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 Brainsway 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 their 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.
Should I be doing Cognitive Behavioral Therapy (CBT) prior to and during TMS?
We strongly recommend that patients that participate in CBT during TMS treatments due to the positive results seen when these treatments are combined. We also encourage patients to engage in other healthy behaviors such as exercise, healthy diet, working on creating goals and structure in their lives, and increasing social contacts as these behavioral changes can lead to a more positive treatment response.