Learn About TMS

TMS Therapy is being successfully used at the Center for Family Psychiatry (CFFP) in Saline MI to treat drug resistant Major Depression and OCD.

Below, you can find additional information on TMS. We are just a phone call away at (734) 944 8300 to answer any questions that may arise as you learn more about TMS. For patient convenience we have ample parking and are easily accessible.

TMS Overview

Transcranial Magnetic Stimulation (TMS or rTMS) is a novel, noninvasive, non-pharmacological treatment being increasingly used for successfully treating medication resistant Depression and OCD. Typically, “treatment resistant” is defined as having failed at least two adequate medication trials per most mental health organizations and insurances. During TMS treatment controlled magnetic pulses are precisely delivered to stimulate the underlying nerve cells in the prefrontal parts of the brain. Repeated pulse trains of magnetic stimulation of these areas of the brain have been shown to have a mood modulating effect on patients suffering from treatment resistant MDD or OCD and an increasing list of other conditions.
TMS Therapy was approved by the FDA in 2008 for treatment resistant Depression and was recommended by the American Psychiatric Association in 2010. Studies show that up to three out of every four patients report a reduction in depression symptoms at the completion of the acute phase TMS therapy. In fact, two out of every three patients who respond have reported a reduction in depression score within the first 4-week treatment period. Additionally, one out of every three patients were able to achieve remission (absent or minimal symptoms) from TMS Therapy at the end of the course. TMS Therapy is covered by most insurances and is being provided at major hospitals and qualified mental health clinics worldwide.

At the Center for Family Psychiatry (CFFP), in Saline, MI, TMS Therapy is provided by trained and certified practitioners under the supervision of the Medical Director, Dr. Ravi S. Kirbat. In summary, TMS Therapy is:

1. FDA approved with proven effectiveness and well tolerated
2. Non-Invasive – No insertion/ingestion required
3. Non-systemic and free from common side effects of antidepressants
4. Non-sedating outpatient treatment – no anesthesia is required and patients can do normal activities before and after treatment
5. Free of cognitive effects
6. Covered by most Insurance plans – we assist patients with the reimbursement and financing process.

TMS Therapy Frequently Asked Questions

It is common and appropriate for patients considering TMS therapy to have questions. Below you will find answers to the most frequently asked questions on TMS asked by our patients. CFFP staff are available to explain this in more detail and to address any other questions you or your clinicians may have about the TMS treatments.

Transcranial magnetic stimulation, (TMS or rTMS), is being shown to be a safe, effective, and noninvasive form of brain stimulation using magnetic pulses. Approved by the US Food and Drug Administration (FDA) in 2008 for Depression treatment, the device works by generating magnetic fields to stimulate nerve cells in specific prefrontal areas of the brain to improve symptoms of depression and anxiety. TMS does not require sedation or anesthesia and patients may resume daily activities right after treatment. The CFFP clinic in Saline, MI utilizes one of the world’s most well tolerated, safe and effective equipment for TMS therapeutic treatments provided by our qualified, trained and experienced TMS team under the supervision of the Medical Director, Dr. Ravi S. Kirbat. Although TMS is being studied for a number of psychiatric and neurologic conditions and more indications are being considered by the FDA and APA, at this time the indications are specifically for treating adults who suffer from persistent, unremitting major depressive disorder and OCD. TMS does not require anesthesia and is not to be confused with ECT (Electro Convulsive Therapy).

The brain is made up of electrically conductive cells called neurons. Neurons are connected to form functional circuits through complex networks in the brain. Neural networks in particular regions of the brain work together to perform particular tasks. An example is the motor cortex area neurons controls muscle movements. Similarly, the neural networks in the prefrontal regions are understood to control moods. TMS systems deliver magnetic pulses to stimulate nerve cells in the parts of the brain controlling the mood. The TMS coil placed on the scalp allows rapid changes in the magnetic field induces a current in the cortex under the area of treatment, and if the current induced is of sufficient amplitude frequency and duration, it will excite neurons and facilitates functional and clinical changes.

If you have been diagnosed with MDD or OCD and failed to receive substantial benefit from at least two trials of medications despite adequate dosing and for adequate duration, and you are still moderately to severely symptomatic at this time, then TMS maybe a good option for you as long as you do not have other contraindications (see below). Please call us for a detailed evaluation.

Given that the patient population who seek TMS treatment have failed multiple medication trials, the response rate of about 50 to 60% is considered impressive as these rates places it just at the same range as traditional antidepressants in less resistant population. Additionally, remission (defined as clinical state of absent or minimal symptoms) rates can be in the 20 to 30% range in this resistant population. Of note, TMS is approved for adjunct treatment of MDD and OCD and so patients are encouraged to continue (if able to tolerate) medications while receiving TMS treatment. In addition, once there is a response with TMS and have reduced symptoms they are instructed to continue seeking regular long term “maintenance” therapy via traditional treatment modalities (psychotherapy and medication), to make sure the results delivered by TMS remain robust.

As TMS is a non-invasive, non-systemic procedure and as such it doesn’t have the long list of systemic side effects associated with traditional antidepressant medications. Also, since TMS does not use direct electrical current stimulation such as with ECT (electroconvulsive therapy) and so it does not have the cognitive issues such as memory loss, confusion or other side effects associated with anesthesia. More than 2 million TMS therapy treatments have been performed, and less than 5 percent of patients reported any side effects. The most common side effect is a headache right after TMS treatment, which typically goes away after the first week of treatment for most people.

TMS is well-tolerated and associated with few side-effects and only a small percentage of patients discontinue treatment because of not tolerating TMS. The most common side-effect, which may usually be reported in the first week or two in about half of patients treated with TMS, is mild headaches. These generally diminish over the first couple of weeks of the course of the treatment. Over-the-counter pain medication can be used to treat these headaches.

The most serious risk of TMS is seizures. However, the risk of a seizure is exceedingly low and within the same rate as associated with anti-depressant medications. At the Center for Family Psychiatry, we follow up-to-date safety guidelines that are designed to minimize the risk of seizures.

About one third of patients may experience painful scalp sensations or facial twitching during the treatment secondary to the TMS pulses. The discomfort from this too tends to diminish over the course of treatment although adjustments can be made immediately in coil positioning and stimulation settings to reduce discomfort.

The TMS machine produces a loud noise and because of this ear-plugs are given to the patient to use during the treatment. However, some patients may still complain of hearing problems immediately following treatment. No evidence suggests these effects are permanent if earplugs are worn during the treatment.

TMS has not been associated with any of the common side-effects caused by antidepressant medications, such as gastrointestinal upset, dry mouth, sexual dysfunction, weight gain, or sedation. While rTMS is a safe procedure, it is important to point out that because it is a relatively new treatment, there may be unforeseeable risks that might not currently recognized though all indications are this seems unlikely given the data available over the last couple of decades.

The initial process starts with an assessment of the patient being appropriate for TMS treatment and meeting specific criteria towards their individual insurance coverage and to rule out any major contraindications. After this, the patient is scheduled for a “mapping” appointment which is when the localization of the specific treatment site on the scalp is identified, and additionally the stimulus intensity is determined. During TMS treatment, patients are fully awake and do not have to undergo any form of sedation or intravenous procedures. Patients can listen to music, practice mindfulness or engage with the providers while undergoing treatment. During the treatment a magnetic coil is placed over the mapped area of the patient’s head. An electromagnetic pulse train is then delivered through the coil which generates the magnetic field changes and stimulate neuronal changes. This pulse is used to stimulate portions of the brain underneath where the coil is applied.

Treatment is without any sedation and is painless. Patients can return to work, home or school after a session. For most patients, they will undergo sessions daily, five times per week, from four to six weeks. It’s possible to see a change in symptoms within the first few TMS sessions.

The initial course of treatment typically consists of 5 treatments per week over a 6-week period, with a TMS taper adding up to total of 36 treatments. Each treatment session lasts approximately 20-40 minutes. During treatment, the patient is awake in a comfortable chair. A small, magnetized wand rests lightly on the patient’s head, delivering focused magnetic stimulation directly to the area of the brain thought to be involved in regulating mood. The location targeted is called the dorsolateral prefrontal cortex (DLPFC) and is located over the front of the brain, above the left eye, near where most people have a normal hairline. You can drive yourself to and from the clinic and do not need a driver. Many patients are able to go straight back to work or school. No dietary limitations restrictions as TMS can be done on a full stomach. No sedasleep (no anesthesia or IV), and you can take your medications all on your normal schedule.

Insurance plans are recognizing the benefits in this difficult to treat population as well as the low side effects which has allowed an increasing acceptance and coverage of TMS treatment. That said, each insurance company and plan differ in coverage, and our office will diligently verify your specific TMS benefits. Prior to engaging in treatment, we will provide the details of your coverage and estimated cost-sharing, if any, that may not be covered by your insurance.

TMS is being studied extensively across disorders and other disciplines with the hope that it will evolve into new treatments for neurological disorders, pain management, and physical rehabilitation in addition to psychiatry. There are currently large clinical trials looking at the effectiveness of TMS in conditions such as Pediatric Depression, Bipolar Disorder, Auditory Hallucinations in Schizophrenia, Negative Symptoms in Schizophrenia, Smoking Cessation, Post-Traumatic Stress Disorder (PTSD), Generalized Anxiety Disorder, Autism, Tourette Syndrome etc. Studies in TMS Therapy for these conditions are at various stages, and not yet approved by the FDA (thus are considered “off-label”). At the Center for Family Psychiatry, TMS is being used for treatment of drug resistant Depression and OCD with TMS under FDA approved guidelines.

TMS therapy is FDA approved for individuals diagnosed with Major Depressive Disorder (MDD) or Obsessive Compulsive Disorder (OCD) who have not achieved satisfactory symptom improvement from antidepressant medications and other traditional therapies such as psychotherapy. TMS treatment can also be used in individuals who are unable to tolerate side effects from antidepressant medications such as weight gain and sexual dysfunction. TMS can be used alone but the recommendation for optimal response is for to be used in conjunction with medications.

Patients with non-removable metal in their head or neck area (with the exception of braces or dental fillings) are relatively contraindicated to receive TMS as the magnetic field can cause the metal object to heat up, move, or malfunction, and result in serious injury or death. The following is a list of metal implants that can prevent a patient from receiving TMS: