The Real Pros and Cons of TMS Therapy

Are you thinking about starting Transcranial Magnetic Stimulation (TMS) therapy? You’re probably weighing the pros and cons. On the one hand, becoming depression-free without dealing with medication side-effects, refills at the pharmacy, or psychiatry visits sounds pretty good. On the other hand, coming in every day sounds like a drag. Hopefully, this article will help you decide whether or not TMS is right for you.

The Cons

#1. Office Visits Every Day. This is probably the single most annoying part about TMS therapy: the actual course length. Patients must come in for 5 days per week for 6 weeks, followed by an optional (but usually recommended) 6 session “taper” consisting of 3 sessions during the 7th week, 2 sessions on the 8th week, and just one session on the 9th week. While it is not a problem to miss a couple days here and there, it is recommended to try to be as consistent as possible. The hours of your local TMS center near you may differ, but the Bespoke Treatment offices are generally open between 8:00 AM – 8:00 PM every weekday. As of 2022, the Bespoke Treatment offices are able to offer Accelerated TMS, which involves only 5 days straight of office visits—although those 5 days are comprised of 10 TMS sessions per day.

#2. Insurance Criteria. This has less to do with the actual treatment and more to do with getting your insurance company to approve you for TMS. Each insurance company has different criteria, and most insurance companies change their policies throughout each year. For instance, some insurance companies require that a patient has tried two antidepressants in the past, while other companies may require that a patient has tried four antidepressants, plus talk therapy. If you’re curious whether or not your insurance will approve you, you can always fill out our pre-approval form and our patient care coordinators will reach out to let you know the likelihood of your insurance covering TMS therapy.

#3. Discomfort. The actual treatment is not a pleasant feeling (although you’d be surprised at how many people we’ve seen fall asleep during TMS!), and most patients describe the sensation as “uncomfortable but tolerable.” Even though the device is only emitting magnetic pulses, it may feel like a tapping or knocking sensation on the scalp during stimulation. Depending on the angle that the patient reclines in the treatment chair, they may feel jaw or eyebrow movement during the stimulation. These are not permanent, and subside 100% of the time immediately after the session.

#4. Lack of Standardization. If you call 10 different TMS centers, you’ll probably hear 10 different responses regarding their respective processes and methodologies. Many providers use the exact same treatment protocols for every patient they see, and some rotate between one or two protocols. More importantly, the barrier to entry for a practice to start offering TMS is relatively low, and it’s not hard to get certified. This means that a lot of practitioners who aren’t experienced with TMS are able to buy a machine and start using it on patients without the proper education.

The Pros

#1. High Success Rate. The best part about TMS is that it’s a treatment that actually works. Traditional medication for depression has fairly low success rates, especially if the first one or two medications don’t provide adequate relief. Thousands of studies have shown that TMS has a success rate of at least 68%, compared to just 37.5% for medication. However, the most recent data analyzed from the patients in the Los Angeles Bespoke Treatment location have shown a success rate of 92.5%, meaning that 92.5% of patients who completed the TMS course have been able to at least partially relieve significant symptoms.

#2. Long-Term Results. TMS is different than any other medicine-based treatment because the results persist long after the treatment is over. This is in contrast to medications, where one must stay on them indefinitely or else they risk both relapse and discontinuation syndrome. Research shows that the benefits of TMS last for at least 24 months for 90% of people, although 35% of those individuals tend to benefit from additional Maintenance TMS sessions after the initial phase of treatment ends. For those who don’t need Maintenance TMS, the benefits persist for years.

#3. Safety/Best Side-Effect Profile. TMS is a non-invasive, targeted treatment that is statistically safer than any antidepressant medication. Medications are ingested, and therefore have diffuse and systemic reactions through the entire body, which leads to a wide range of side-effects like weight gain, fatigue and drowsiness, nausea, sexual dysfunction, memory loss, insomnia, and apathy. Although TMS isn’t necessarily “side effect free,” its noninvasive approach makes TMS safe with minimal side effects that at times include minor headache, lightheadedness, and scalp discomfort during stimulation. These effects are short-lived and last only a few minutes after the session has concluded. Unlike other treatments, there have been no long-term side effects reported after having done TMS.

#4. Theta Burst Stimulation. Advancements in technology have allowed for newer TMS machines to pulse the magnet at different frequencies that the brain can more readily adapt to. One of these frequencies is called Theta Burst Stimulation (TBS), or “Express TMS.” TBS is a 3-minute iteration that has been shown to have equal efficacy compared to older, longer (20-40 minute) protocols. Additionally, TBS allows for more affordable and accessible treatment, thus creating less of a strain on one’s daily life. For instance, patients can now pop in for a quick treatment on their lunch breaks. However, not everyone is a good candidate for Theta Burst Stimulation, and we’ve found that a Personalized TMS approach works best.

#5. Insurance Coverage. While the criteria for insurance coverage may be strict depending on the particular insurer, TMS can at times be 100% covered by insurance. If you are wondering about your particular insurance, you can always call the office anytime and ask us to verify your benefits for free.

#6. It’s Not ECT! Although treatments like electroconvulsive therapy (ECT) have shown to be effective, the improvements made are typically short term and tend to require medication to maintain the beneficial effects. Patients have reported difficulty remembering and/or retaining new information, with post-treatment side effects that include headache, nausea, confusion, and muscle aches. Patients have also reported long term memory loss, which may be referenced to the extremity of the procedural inducement of seizures and general anesthesia.

So, What Should You Do?

When considering the various treatments for depression, it’s important that each individual do their own research and decide which treatment they feel most comfortable with. When researching TMS, it’s important to highlight that TMS is:

  • Non-Systemic
  • Non-Sedating
  • Non-Invasive
  • Non-Pharmacological
  • FDA Cleared & Proven
  • Covered by Most Insurance Plans

*Paul B Fitzgerald and Zafiris J Daskalakis, The effects of repetitive transcranial magnetic stimulation in the treatment of depression, Expert Review of Medical Devices10.1586/erd.10.578, 1, (85-95), (2014).

*Malek Bajbouj, Eva-Lotta Brakemeier, Florian Schubert, Undine E. Lang, Peter Neu, Christina Schindowski and Heidi Danker-Hopfe, Repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex and cortical excitability in patients with major depressive disorder, Experimental Neurology10.1016/j.expneurol.2005.08.008196, 2, (332-338), (2005).

*Chris Baeken, Anna-Katharine Brem, Martijn Arns, Andre R. Brunoni, Igor Filipčić, Ana Ganho-Ávila, Berthold Langguth, Frank Padberg, Emmanuel Poulet, Fady Rachid, Alexander T. Sack, Marie-Anne Vanderhasselt and Djamila Bennabi, Repetitive transcranial magnetic stimulation treatment for depressive disorders, Current Opinion in Psychiatry10.1097/YCO.000000000000053332, 5, (409-415), (2019).

*Elias A. Khawam, Georgia Laurencic, Donald A. Malone JR, Side effects of antidepressants: An OverviewCleveland Journal of Medicine, vol. 73, 4, (2006).



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