What is Transcranial Magnetic Stimulation (TMS)?

Transcranial Magnetic Stimulation (TMS) is an interventional psychiatric treatment that uses a magnetic pulse generator to produce magnetic pulses directed at specific locations of the brain. This makes for a safe, non-invasive form of brain stimulation with very minimal side effects. A typical TMS treatment lasts for approximately 20 minutes, with a newly FDA-approved version called Theta Burst Stimulation (TBS), also known as express TMS, taking less than 5 minutes per treatment.

The primary use for TMS is in patients with Treatment Resistant Depression (TRD) or Major Depressive Disorder (MDD). Research for the effectiveness and safety of TMS and TBS for treating TRD and MDD is robust, and has been well documented with over 20 randomized, placebo-controlled trials. Nearly all of these trials have concluded that both TMS and TBS exhibits strong antidepressant activity, especially for those patients that have had a difficult time tolerating the adverse effects associated with most oral antidepressant medication, or whom have had limited success with those medications.

Theta Burst Stimulation: The Latest FDA Approved Form of Transcranial Magnetic Stimulation

In late 2018, the FDA approved Theta Burst Stimulation (TBS) as a treatment for depression. TBS is simply a specific protocol of Transcranial Magnetic Stimulation (TMS), which was FDA-approved in 2008. It works to more closely resemble the natural rhythms of brain activity to produce the same antidepressant effect as TMS. The TBS protocol involves short bursts of magnetic pulses at much higher frequencies than TMS, which drastically reduces the time of the treatment compared to TMS.  Most psychiatric clinics do not have access to this new technology, and only offer TMS.

How Are TBS and TMS Different?

While TBS is a form of TMS, it works in a slightly different way than a traditional treatment. TBS relies on short bursts at high frequencies to produce a much quicker treatment than TMS. TBS delivers stimuli in three rapid bursts at 50 hz repeated every 200 milliseconds. This allows for a treatment in a much shorter amount of time, yet still remains just as effective as TMS, as shown in a recent study. TBS treatments take approximately five minutes to administer, while traditional TMS lasts between 20 and 40 minutes. Due to the short amount of time the procedure lasts, Pacific Psych is able to offer TBS at a significantly lower cost than most treatment centers that offer only TMS.  Most “TMS clinics” do not offer TBS because it is a new, more expensive technology, but at PPIWC we realized early that TBS offers a great value to patients, specifically that we can provide the same efficacy that TMS offers, but in a much shorter time, and with more flexibility (multiple treatments per day), which allows us to lower the costs to patients that are not able to access insurance.

What does a typical course of TMS and TBS look like?

Both TMS and TBS, when done according the FDA-approved protocol, take place daily (M-F) for 6 weeks for the first 30 treatments, and then a tapering protocol is started with the final 6 treatments done over a 3 week period.  The first session is done with the psychiatrist, and the treatment location and intensity is established and the first TMS or TBS treatment is administered.  Most of the remaining sessions are done by a highly trained TMS technician under the psychiatrist’s supervision.  Psychiatric evaluations are done intermittently to track the progress or lack thereof through the course of treatment.

Are TMS and TBS expensive treatments?

TBS and TMS are expensive treatments, in that the cost of TMS/TBS machine and the overhead costs of running a clinic are high.  However, because these treatments are FDA-approved, almost all private and commercial health insurance plans cover all, or most of the costs of this treatment for those that qualify.  All insurance plans have a policy for approving coverage for TMS/TBS treatment, and at Pacific Psych, we are experts in navigating this process and can usually get a decision on insurance approval in a matter of days, and can find out exactly how much out-of-pocket the patients will be responsible for (if any) prior to starting treatment.

For those that do not meet insurance criteria for whatever reason, don’t have health insurance, or choose to not use insurance, we have very reasonable “self-pay” rates, and because TBS treatments take only 3-4 minutes per treatment, we can do up to 3 treatments consecutively within a 30 minutes appointment time.  This allows us to reduce the number of treatment days required to complete a full course of TMS/TBS from 6 weeks to 3 to 4 weeks, making it a very convenient option for busy, working professionals.  Insurance companies will not cover treatments associated with this accelerated, non-FDA-approved protocol.
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How do I know if I’m a candidate?

TMS and TBS are both FDA-approved to treat “Treatment Resistant Depression (TRD),” which is defined Major Depressive Disorder that fails to improve despite treatment of 2 or more antidepressant type medications.  People that meet criteria for TRD are often good candidates for both TMS and TBS.  To find out if you are a good candidate for TBS or TMS, you should schedule a consultation with a psychiatrist or other trained mental health professional, where a thorough psychiatric evaluation can be done.  There are some non-FDA-approved uses for TMS/TBS, for conditions like anxiety, OCD, and insomnia, but these are not covered by insurance plans and must be paid 100% by the patient.

Is Transcranial Magnetic Stimulation Safe?

Many consider TBS and TMS to be among the safest options for treating Major Depressive Disorder. According to a review by the Journal of Clinical Neurophysiology, only five percent of subjects experienced any form of adverse effects. The majority of subjects who experience these adverse effects only experienced mild adverse effects such as slight discomfort around the treatment area. TMS and TBS do not carry the side effects of traditional antidepressant medications such as weight gain, sexual dysfunction, or fatigue.

Where Can I Get TMS or TBS Treatment?

Pacific Psych offers TMS and TBS treatments in Del Mar, California for anyone struggling with persistent and pervasive symptoms of depression. It can either be used as a standalone treatment or in conjunction with other interventional psychiatric treatments, such as intravenous ketamine infusion therapy, and/or in conjunction with traditional psychiatric medication management and psychotherapy. When using TBS in combination with other interventional psychiatric treatments, remission rates tend to dramatically improve.

As mentioned earlier, PPC offers TBS at a low cost, particularly for patients who cannot use their health insurance to cover traditional TMS treatment methods. On average, out of pocket expenses are less than $200, making it an affordable treatment method.

Since TBS only takes a few minutes, PPC can schedule multiple treatments over the course of a single day to shorten the overall length of treatment. It can reduce the length of treatment by as much as several weeks in comparison to traditional TMS. This makes it much easier to schedule your treatment, and speeds up the time it takes to determine if this method of treatment will work well for you.

So, either call us at 858.261.4622 or visit us at 317 14th Street, Suite A, Del Mar, California to schedule your consultation and see if TBS is right for you, or check out PPC’s TMS/TBS page to take a short quiz to see if TMS/TBS might be right for you.