What is transcranial magnetic stimulation (TMS)?
- Transcranial magnetic stimulation (TMS) is a safe, gentle, FDA-approved treatment for depression and OCD that can provide long-lasting relief without the side effects of medications. TMS can also help many other psychiatric conditions.
How effective is TMS for depression?
- In studies, TMS helps about 60% of patients who have failed 2 or more antidepressants. In these patients, another medication only helps about 5-10% of the time.
How effective is TMS for OCD?
- TMS seems to improve OCD symptoms in almost half of all patients.
Does it matter how severe my depression or OCD are?
- No! TMS seems to be just as effective for mild or moderate symptoms as for severe symptoms.
Can TMS cure depression or OCD?
- No. Unfortunately, there are no known cures for any psychiatric disorder, and it is possible for relapses to happen. However, TMS can provide relief lasting for years for some patients.
What does a TMS treatment course involve?
- A typical TMS treatment course involves treatment 5 days per week for 6 weeks, followed by tapered treatment, for 36 total sessions. Each treatment is about 15 minutes.
- There are occasionally reasons for shorter or longer courses. Your doctor will discuss these with you if appropriate for your care.
How does TMS work?
- TMS uses a small MRI-strength magnet to activate nerve cells in the area of the brain responsible for mood, anxiety, OCD or other disorders. By doing this repeatedly over time, TMS can change the level of activity of these areas of the brain, and improve how different parts of the brain communicate.
Does TMS hurt?
- Not typically. Most patients find the sensation of TMS to be mildly or moderately annoying, but not painful.
Is TMS safe?
- Yes! TMS is extremely safe. TMS is considered a minimal risk procedure, with no evidence of long-lasting side effects.
Is TMS used in children?
- Yes! Although there are fewer studies about children than adults, the studies that have been done show that TMS seems to be as safe and effective in children and adolescents as in adults.
Can TMS cause seizures?
- There is an extremely rare risk of seizures with TMS, about one in 60,000. Your doctor will discuss this risk, screen for anything that may increase this risk, and will help adjust treatment to ensure it is as safe as possible.
Does TMS have any side effects?
- TMS has almost no side effects for most patients. 10-20% of patients have headaches, usually mild or moderate. TMS may cause mild scalp discomfort during treatment. Ear protection is necessary during TMS treatment. However, most patients have no side effects, and in studies, TMS is just as gentle as placebo TMS.
Are there any restrictions while receiving TMS?
- None at all! Patients can work, go to school, drive, and do anything else they like before or after TMS treatments.
Will my insurance cover TMS? How much does TMS cost?
- Nearly all major insurances cover TMS for depression for adults, although requirements vary. Insurances determine if they cover TMS based on:
- How many antidepressants have been tried - most insurances require anywhere from 2 to 6 different antidepressants.
- Whether a patient has been in therapy.
- Some insurances will cover TMS in adolescents. Our doctors can review these details.
- Currently, insurances do not cover TMS for other conditions, including OCD, unless a patient also suffers from depression.
- Our doctors will always work to get insurance coverage for treatment if at all possible. If insurance will not cover a patient’s treatment, SeattleNTC uses a sliding scale payment plan whenever possible to minimize costs.
Does TMS treat anything other than depression and OCD?
- Absolutely! There is evidence that TMS is helpful for a variety of conditions, including:
- Post-traumatic stress disorder (PTSD)
- Pain disorders
- Bipolar depression
- Many, many others
- Because the above conditions have not been studied enough to be approved by the FDA, they are considered “off-label.” These treatments may not be covered by insurance unless a patient is also receiving treatment for depression.
How long does TMS take to work?
- Some patients improve as soon as 1-2 weeks, though it is most common to start improving after 2-4 weeks. Some patients improve during (or after) the tapered treatments.
How long do the effects of TMS last?
- Some patients stay better for years after a successful course of TMS. However, some patients only stay better for months, and for some, maintenance treatments may be needed.
What is esketamine (Spravato®)?
- Esketamine (brand name Spravato®) is a new FDA-approved nasal spray antidepressant. Esketamine is a derivative of ketamine, which has been shown to provide very rapid (within hours), profound relief of depression.
Isn’t ketamine a horse tranquilizer drug or a drug used among the nightclub crowd?
- Ketamine is a medicine used in anesthesia. More recently, it has shown potential as a new antidepressant. Like many anesthetics, ketamine is abused by some people.
How effective is esketamine for depression?
- Esketamine works in about 50-70% of depressed patients who have failed 2 or more antidepressants.
What should I expect from an esketamine treatment?
- FDA and U.S. Drug Enforcement Administration (DEA) regulations require that patients administer esketamine at a certified clinic, and then be monitored for 2 hours at the clinic for any side effects (see below).
Are there any restrictions when taking esketamine?
- FDA regulations require that patients not drive home from an esketamine treatment, and recommend that they do not drive until the next day after a restful sleep.
- There are no restrictions on non-treatment days.
What does an esketamine treatment course involve?
- Esketamine involves an initial course of 2 treatments per week for 4 weeks (8 treatments). If patients are better at the end of 8 treatments, they have the option of transitioning into maintenance treatment, which is 1 treatment every 1-2 weeks.
How does esketamine work?
- The exact mechanism of ketamine and esketamine is not completely understood, but unlike other antidepressants that tend to target serotonin, dopamine or norepinephrine, esketamine affects the glutamate (information-processing) system.
Is esketamine safe?
- Esketamine seems to be safe for use in the short- and medium-term, with current studies showing no significant lasting side effects out to 2 to 3 years. However, esketamine is a very new treatment, and longer-term safety data do not exist. While there is no evidence currently that esketamine or ketamine cause significant long-lasting problems, because of how new this treatment is, it is important to understand that there may be problems that we have not yet discovered. This risk must be considered when deciding whether to have esketamine or ketamine treatments.
Does esketamine have any side effects?
- Most patients find esketamine treatments to be very easily manageable or even pleasant. However, side effects during the 2 hours of monitoring may include: intoxication dissociation, anxiety, nausea, heart rate, blood pressure changes and others. Most of these side effects go away by the time a patient leaves the clinic – some patients may feel tired or slow for the remainder of the day. Most patients do not have side effects between treatments.
Will my insurance cover esketamine? How much does esketamine cost?
- Most insurances now cover esketamine, but specific details may vary by patient plan. Our clinic helps patients to receive the most insurance coverage possible. Some costs are not covered by insurance.
Does esketamine treat anything other than depression?
- Currently, esketamine is only well-studied for treating depression. Like ketamine, esketamine may help pain conditions as well. There is not enough evidence to tell whether esketamine helps other psychiatric conditions.
How long does esketamine take to work?
- Esketamine can provide rapid relief within the first 1-2 weeks, although some patients require the full 4-week course to see improvement.
How long do the effects of esketamine last?
- Like all ketamine treatments, esketamine seems to require maintenance treatments to stay better. Most patients require at least 1 treatment every 2 weeks to stay better.
What is ECT?
- ECT (electroconvulsive therapy) is the single most effective treatment available for severe depression. For many patients, ECT is lifesaving.
How effective is ECT for depression?
- ECT is the “gold standard” for improving severe or treatment-resistant depression, and helps around 80% of patients, even those who have failed 2 or more antidepressants. For comparison, after 2 failed antidepressants, only 5-10% improve with the next medication.
What does an ECT treatment course involve?
- ECT is generally performed 2 to 3 times a week for 10-15 treatments, followed by gradually weaning off.
How does ECT work?
- ECT is done under general anesthesia and uses a small electrical current applied through the scalp to start a controlled seizure. This seizure seems to cause the release of neurotransmitters such as serotonin, as well as the growth of branches of nerves (called “dendrites”) that help different areas of the brain talk to each other. This is thought to help reverse the effects of depression.
Does ECT hurt?
- No - ECT is done under general anesthesia (patient is fully asleep), and patients cannot feel or remember anything about the procedure.
Is ECT safe?
- ECT is very safe! It is considered a low risk procedure, and is one of the safest procedures done under general anesthesia.
Is ECT used in children?
- Although many think ECT is an “extreme” procedure just for adults with severe conditions, ECT has been studied in children as well, and seems to be just as safe and effective in children and adolescents.
Does ECT have any side effects?
- Although ECT is very safe, there are side effects to be aware of. Common physical side effects include nausea, headaches and muscle aches - these can usually be controlled by medications given during the procedure.
- ECT has temporary effects on thinking and memory, especially when receiving ECT 2 or 3 times per week. Patients may have a harder time remembering things or be more easily confused. Our doctor will review all of these side effects with patients and their family before and during ECT treatments.
- ECT usually does not cause any long-lasting side effects, and the vast majority of patients recover fully. Very rarely, patients may experience some changes in memory and thinking after the procedure, and this risk must be considered when determining whether or not you should have ECT.
Does ECT cause brain damage?
- No. There is no scientific evidence that ECT causes permanent or long-lasting brain damage.
Is ECT like I’ve seen in the movies?
- Absolutely not! Popular movies like One Flew Over the Cuckoo’s Nest show ECT as a scary procedure done while patients are awake and without any anesthesia. Modern ECT is a life-saving procedure done under general anesthesia and would make for a very boring movie. For an example of what modern ECT looks like, see the following videos:
Will my insurance cover ECT? How much does ECT cost?
- All insurances cover ECT for severe depression, particularly if a patient is suicidal, hearing or seeing things that other people don’t hear or see, or not eating or drinking enough to stay healthy. Due to the fees charged by hospital operating rooms, a full course of ECT will generally reach the out-of-pocket maximum for the year. Patients can check their insurance plan.
Does ECT treat anything other than depression?
- Yes! While ECT is most commonly used for depression, it is also effective for:
- Bipolar depression
- Other severe or treatment-resistant psychiatric conditions
How long does ECT take to work?
- Most patients notice a benefit between 2-4 weeks after starting treatment. However, some patients notice improvement within the first 2 weeks, including some after just the first treatment!
How long do the effects of ECT last?
- Improvement from ECT can last months to years after the ECT course. Weaning off of ECT slowly (instead of quitting “cold turkey”) helps improve the likelihood of staying better, as does staying on some antidepressants after ECT. Our doctors will review this information before and during the ECT course.
Does SeattleNTC only treat depression?
- No! Our doctors treat a variety of complex and hard-to-treat conditions, including OCD, bipolar disorder, PTSD, anxiety and many others.
Does SeattleNTC take my insurance?
- SeattleNTC takes nearly all commercial insurance plans and Medicare. We offer a sliding scale payment plan on a case-by-case basis when insurance does not cover our services.
Where are you located?
- SeattleNTC has offices in Seattle, Bellevue and Tacoma, with more planned in the near future!
Do you treat children?
- Yes! We treat patients of all ages for a large variety of conditions.
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