FLORIDA TMS CLINIC

TMS therapy schedule could vary based on the indication and the protocol used. Generally it is between 20 to 36 sessions. The typical schedule of TMS therapy for depression is 30 sessions. We follow that with 6 sessions of taper off. The schedule is usually as follows: One session a day, 5 days a week for 6 weeks. Then one session a day 3 days a week in week #1. Then one session a day 2 days a week in week #2. Then one session in week #3. The typical schedule of accelerated TMS therapy for depression is 10 sessions a day for 5 days for a total of 50 sessions.

A TMS session could last anywhere from 3 minutes to 37 minutes. To be more specific, rTMS session takes 19 minutes with newer TMS devices and 37 minutes with older TMS devices dTMS session takes 20 minutes iTBS session takes 3 minutes or 9 minutes if doing SAINT accelerated TMS protocol

There are three major treatments that are currently available for TRD. 1. TMS or Transcranial Magnetic Stimulation. TMS is the most benign out of the three. 2. ECT or Electroconvulsive Therapy. Commonly referred to as shock therapy. 3. Esketamine. A derivative of the party drug; Ketamine.

Thank you for this great question. Actually, 3-minute protocol uses iTBS or intermittent Theta Burst Stimulation. iTBS uses a different frequent and pulse pattern than the old rTMS technology. To be exact, iTBS (3-minute TMS) uses 50 Hz frequency instead of 10 Hz frequency used by the old technology. This allows for the stimulation energy to be delivered in much shorter period of time. 3.09 minute to the exact. The FDA approved iTBS in 2018 based on a large trial called THREE-D. This trial showed the equivalent effectiveness of iTBS compared to rTMS. Please note that most TMS clinics in the US provide rTMS (19 minute) because they have old technology. Florida TMS Clinic has all of the TMS technologies. Including rTMS, iTBS, nTMS. The second part of the question about the frequency of the treatments per day is discussed in blog post I posted a few days ago. See this link https://www.floridatmsclinic.com/accelerated-tms Please let me know if I can answer any other questions.

Antidepressants can help depressive symptoms associated with bipolar depression. We need to be careful though not to trigger a manic episode when using antidepressants for bipolar depression. TMS therapy can help depressive symptoms in bipolar depression, but it is off label use. Like antidepressants, TMS therapy can be helpful for treating depressive episodes in bipolar as long as we watch carefully not to trigger manic symptoms.

Poor sleep and high stress can increase the chances of exacerbating mental illness in particular mood disorders like depression, anxiety... etc. Good sleep hygiene and coping skills to deal with stress are essential in improving your overall mental health. Treating depression and anxiety can also improve sleep. At FLORIDA TMS CLINIC in Wesley Chapel and Tampa, FL, we utilize TMS therapy to treat depression and anxiety. TMS is also helpful to treat sleep disorders and insomnia.

TMS is safe for most people. Patients with metal objects in their heads obviously should not get TMS because of the magnetic field interfering with the metal. Patients with an active seizure disorder shouldnt get TMS either. The only significant risk with TMS is an accidental induction of a seizure. But that is extremely rare. It is estimated to be 1/30,000 treatments. We have been doing TMS for well over a year with thousands of treatment sessions, and we never had any seizures.

There is some tapping sensation of the side of the head that patients feel when treatment is started. It goes away after a few minutes as patients get used to it. Some patients might have mild headaches during or after treatment. This gets better after a few treatment sessions as patients get used to it.

Yes. There is strong clinical evidence to justify the use of low-frequency TMS to treat anxiety. Unfortunately, it is not FDA-cleared because none of the TMS manufacturers sought after such approval. This means that insurance wouldnt cover it. At Florida TMS Clinic, we offer anxiety and PTSD treatment protocol at no extra charge to our patients receiving TMS therapy for depression.

Yes. TMS is FDA cleared to treat depression for those who dont respond to classical antidepressants. The success rate is reported to be 58% in clinical research. Our numbers are reflecting about a 70% response rate. To understand how good these numbers are, we need to know how unsuccessful medication antidepressants can be. Per STAR*D trial, the chances of someone responding to the first antidepressant is about 27%, drops to 21% for the second trial of medicine, then 16% for the third, and only 6.9% for the fourth trial antidepressant. When we take such patients with treatment-resistant depression and offer them TMS with a 58% response rate, this is a huge success.

With navigated TMS, we use 3D spatial cameras to track the positioning of the coil and the position of the patients head in real-time. This allows us to assure the most accurate positioning of the TMS coil at all times. With regular TMS, the coil is positioned and maintained in position by the naked eye. With Navigated TMS, the positioning of the coil is confirmed with the most advanced 3D tracking technology. This means that every single magnetic pulse is deprived exactly where it was intended, which increases the chances of successful TMS treatment and depression recovery for our patients.

Standard rTMS takes 19 minutes to deliver one treatment session. Theta Burst Stimulation or iTBS delivers triples pulses at 50 Hz frequency, a pulse pattern that the brain uses to communicate among its circuits. This means that we can be more efficient in delivering brain stimulation in a much shorter time. It is proven that 3 minutes of theta-burst stimulation is as effective as 19 minutes of standard rTMS. Both rTMS and iTBS are FDA-approved for the treatment of depression.

The standard course of TMS therapy consists of 30 treatment sessions in 6 weeks, followed by a taper-off course of 6 treatment sessions over three weeks.

Two out of three patients will keep their response in 6 months after the treatment. One out of three will have a recurrent depressive episode by then. So, generally speaking, if you respond well to TMS, you have a higher chance of staying well for the next six months. Those who have recurrent depressive episodes can be treated with TMS again.

TMS is very calming for most patients. We recommend that you stay awake during the treatment, as research shows that an active brain (with psychotherapy) can respond better to TMS. You can use a therapy app on your phone during the treatment. We have large screen TVs in the treatment rooms. You can watch meditation-videos, relaxation videos. Most of our patients end up catching up on their favorite shows on Netflix or Hulu.

TMS has performed in an outpatient setting using a TMS machine or device. An alternating electrical impulse is run through a coil of wires. This will produce magnetic stimulation underneath that coil. That pulsating magnetic field goes through the skull; hence the term reaches the cortex of the brain, where it activates the brain cells or neurons.

The magnetic pulses on the side of the head feel like a tapping sensation. Some of her patients describe it like a woodpecker. Some others describe it as bubble wrap. But for the most part, most of our patients don't feel anything after about a few minutes because of disability in the background because of what we call habituation, meaning that you get used to it.

During TMS treatment, The TMS therapist will welcome you into a very calming room. You will be seated In a comfortable reclining chair. A magnetic coil will be placed close to the left frontal side of the head. That magnet will produce magnetic pulses that feel like gentle tapping on the side of the head. That tapping sensation is tolerated well by almost all patients. It does not require any type of sedation. The patient can return to their normal activities after the treatment session, which means that you can drive yourself back and forth to the treatment and back and forth to work or school. Each treatment session lasts about 19 minutes; most of our patients spend their time watching their favorite shows on Netflix or Hulu.

Today, TMS is FDA approved for the treatment of depression, OCD, and smoking cessation. TMS is also helpful but not FDA cleared yet for other psychiatric disorders like anxiety and PTSD. Currently, TMS is covered by most major insurances. That being said, insurance had set different criteria For who qualifies for TMS. Usually, If a patient had failed psychotherapy and medication antidepressants, then insurance will cover the treatment.

TMS is Transcranial Magnetic Stimulation. The word Transcranial; means through the skull. The words Magnetic stimulation mean that we use a magnetic pulse to stimulate specific areas of the brain connected to the depression circuit. This brain stimulation restores the brain to normal function.

No. TMS Therapy involves a unique method of using pulsed magnetic fields for therapeutic benefit. The intensity of the magnetic field is similar to that of the magnetic fields used in magnetic resonance imaging, or MRI. These techniques differ radically from the popular use of low intensity, static magnetic fields. These products deliver weak and undirected static fields that are not capable of activating brain cells.

NeuroStar is non-systemic (does not circulate in the blood throughout the body), so it does not have side effects such as weight gain, sexual dysfunction, nausea, dry mouth, sedation, etc. The most common side effects reported during clinical trials were headache and scalp discomfort - generally mild to moderate - occurring less frequently after the first week of treatment.

You should be able to continue taking any medication you already take throughout your treatment with TMS. In fact, TMS is usually done while the patient continues to follow a pre-established medication regimen. Additionally, if your psychiatrist is not experienced with TMS or not affiliated with a TMS facility, you dont have to change psychiatrists in order to start TMS.

TMS is covered by most insurances. However, each insurance has different prerequisites for coverage. Typically, you have to have been diagnosed with Major Depressive Disorder and have had tried at least one antidepressant.

It is not uncommon for patients to report feeling nervous that their treatment is nearing completion, especially when having made improvement in their mood and quality of life. Seek guidance and support from your TMS Therapy provider, treating psychiatrist, therapist and loved ones to develop strategies that will help you navigate your feelings during this transitory period from the near ending of treatment to its conclusion and beyond. With guidance, it is also important to develop strategies that support a healthy quality of life post-treatment, such as regular exercise, healthy nutrition plan, psychotherapy (if indicated), and enriching social activities. Positive and activating lifestyle strategies will be of great benefit to you in maintaining your improvement or remission from depression.

Dips in mood and irregular sleep patterns are common among patients with depression, and while they are also common among new patients undergoing TMS Therapy, its important for you to speak with your TMS Therapy provider about any emotional or physical changes you experience throughout treatment.

While some patients may need maintenance therapy in managing their depression, a majority of patients will not. Variables such as a patients available support system, sleep patterns, diet, and exercise can all influence a patients recovery from a depressive episode. This is why [Company Name] works with each patient to help them understand their situation, recognize potential triggers, identify a support system, and find the right combination of diet and exercise to help maintain their improved mood.

Initially, most patients notice positive changes in their behavior or mood, such as getting a better nights sleep and feeling more rested in the morning, feeling good about themselves, being more social, feeling ready to go back to work, or making more independent decisions. All of these incremental changes indicate improvement, and should likely progress as treatment continuesand beyond.

The acute phase of TMS Therapy ranges from 20-30 treatments over a 4-6 week period, and since every patient is different, response time varies as well. Some patients begin noticing a reduction in depressive symptoms after week two, while others begin to feel the benefits of therapy at week 4 or 5.

While treatment varies by individual, a typical TMS Therapy treatment session is approximately 30-40 minutes. During treatment, patients relax in a treatment chair and remain awake and alert. The TMS Therapy device will deliver magnetic pulses to specific areas of the brain known to regulate mood. These pulses will feel like tapping on the scalp. The technician can make adjustments if the taping is uncomfortable. After a treatment session, patients can immediately return to their normal routine, including driving.

The definition of TRD depends on the source. In clinical trials, failure of response to one antidepressant medication is considered Treatment Resistant Depression. By CMS criteria, failure of two antidepressants is considered Treatment Resistant Depression {https://www.cms.gov/Medicare/Coverage/DeterminationProcess/downloads/id105TA.pdf}. Lastly, some insurance companies rely on outdated guidelines from 2006 to claim their own criteria for treatment resistant depression to be the failure of 4 antidepressants.

Those who don't respond to the first antidepressant can be tried on another. The chances of response drops significantly the more we try. To be more specific, it drops from 27% to 21% to 16% and finally to 6.9% by the fourth attempt. This means that about one-third of depressed patients are not going to respond to talk therapy and antidepressant medications. This is called Treatment Resident Depression.

Unfortunately, antidepressants are not very successful. The success rate of antidepressants medications is about one in three. When combining medications and therapy together we may be able to get about half the patients better from the first attempt.

The list is too long and some side effects are more common in a particular antidepressant than others. The most common side effects include stomach issues, diarrhea, dry mouth, headache, dizziness, emotional numbness (feeling like a zombie), weight gain and sexual side effects. We found that weight gain and sexual side effects to be the most common reason for patients to stop taking their medications. This could result in the worsening of the depression either because of the side effects or because of discontinuing the medication.

Mild depression is treated with psychotherapy or what is commonly referred to as talk therapy. Examples of effective psychotherapies include; Cognitive Behavioural Therapy (CBT), Interpersonal Therapy (IPT), Mindfulness-Based Cognitive Therapy (MBCT), and Acceptance and Commitment Therapy for Depression (ACT-D). Moderate to severe depression requires to be treated with psychotherapy as above in addition to medication antidepressants. Common antidepressants from the class of Selective Serotonin Reuptake Inhibitors or SSRIs are the first-line treatment. This includes medications like; Celexa, Lexapro, Paxil, Prozac, Zoloft. Other classes of medications include Serotonin and Norepinephrine reuptake Inhibitors or SNRIs like; Effexor, Pristiq, and Cymbalta. Some other antidepressants are used alone or in combination for augmentation with the above like; Wellbutrin, Remeron, Buspar. Also, we use mood stabilizers and antipsychotics for the reason of augmentation in some cases.

Yes. Women are more likely than men to experience major depressive disorder. Women are also more likely to attempt suicide than men. That being said, men are more likely to die of suicide than women.

Many depression tests had been developed over the years. The most commonly used are PHQ-9, MADRS, and HAM-D. Some of these tests are used for screening and some for follow up. Such tests are necessary to evaluate patients who could be candidates for TMS therapy. Please visit our website for a free depression test https://www.floridatmsclinic.com/schedule

Contrary to the general belief, depression has a significant impact on public health. According to the World Health Organization depression is the number one cause of disability in the world. {https://www.who.int/news-room/fact-sheets/detail/depression} Globally, more than 264 million people of all ages suffer from depression. Close to 800 000 people die due to suicide every year. Suicide is the second leading cause of death in 15-29-year-olds. Not only depression is a leading cause of disability worldwide but also it is a major contributor to the overall global burden of disease. There are interrelationships between depression and physical health. For example, cardiovascular disease can lead to depression, and depression can lead to worse outcomes of heart disease. The same can be said about diabetes, stroke, hypertension.. etc.

Depression is commonly associated with other psychiatric disorders, particularly anxiety. This warranted a subtype or a specifier of depression referred to as Major Depressive Disorder with Anxious Distress Features.

Depression is one of the worst disorders one could have. Unfortunately depression cant be diagnosed with a lab test or a brain scan. It is challenging to relate the silent suffering a depressed patient experiences on a daily basis. This adds more to the feeling of loneliness which is one of the symptoms of this disorder. The current DSM-V includes the following as criteria for major depressive disorder: To diagnose a major depressive episode, the individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure. Depressed mood most of the day, nearly every day. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day. Decreased sleep or excessive sleep. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down). Fatigue or loss of energy nearly every day. Feelings of worthlessness or excessive or inappropriate guilt nearly every day. Diminished ability to think or concentrate, or indecisiveness, nearly every day. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

Some patients may require maintenance TMS therapy after their initial or repeated treatment course. It can keep patients from relapsing again into depression after their initial treatment. Maintenance TMS therapy could be once a week for a while then once every two weeks.

TMS can be repeated again if depression returns. Generally, we would want to see a response by a decrease of depression rating scale score of 50% to consider a second treatment course. The chances of response with the second TMS therapy course of treatment is very good (78% to 84%).

About two out of three patients will maintain their response or remission 6-12 months after TMS. About one third could see a return of depressive symptoms.

The first session for the motor threshold determination and brain mapping is performed by a psychiatrist trained in TMS Therapy. The following sessions are performed by a medical assistant directly trained and supervised by the psychiatrist.

During your first session, you will be seated on a comfortable chair in a very relaxing room. The doctor will perform your brain mapping and motor threshold determination. This will specify the exact location to deliver the magnetic pulse. Also, it will specify the exact dosage (intensity of the magnetic pulse) for your treatments. To do this, the doctor will be giving one pulse at a time at the motor cortex until the spot that moves the patients thumb is identified. A few more pulses will be delivered at different intensities until the best magnetic pulse intensity is identified. This is referred to as the Motor Threshold. The next step will be determining the treatment target which is measured as 5.5 cm anterior to the spot identified in the previous step. Once thats done, you will be receiving your first TMS for the duration based on your protocol. You will notice that your first TMS session is going to be longer than the following sessions. This is because of the time needed for the mapping.

A depressed brain is hypoactive in certain areas. TMS stimulates these certain areas of the brain. This will cause a cascade of brain circuits activation that results in certain brain circuits that used to be sleepy to wake up. Obviously, the science behind it is more complicated. This novel mechanism of action is referred to as neuroplasticity. A magnetic coil is placed in contact with the patients forehead. The magnet painlessly delivers a magnetic pulse that stimulates nerve cells in the region of your brain involved in mood control and depression. More specifically, this area of the brain is called the Dorsolateral Prefrontal Cortex or DL-PFC. It's thought that the left DL-PFC is hypoactive in depressed patients and activating this regain of the brain can result in the improvement of depressive symptoms and even complete recovery in many cases.

TMS or Transcranial Magnetic Stimulation is a new treatment for depression that uses pulsating magnates to stimulate parts of the brain believed to be responsible for depression. The activation of the brain cells requires the repetition of this magnetic pulse. Hence it is sometimes called repetitive Transcranial Magnetic Stimulation or rTMS. Transcranial Magnetic Stimulation is a non-invasive outpatient treatment for depression. In TMS we use a magnetic pulse to stimulate areas of the brain connected to depression circuits.