Q&A From Our Facebook Live Event on TMS Therapy & Depression

In a Facebook Live event today, Dr. William Sauvé, Medical Director with Greenbrook, along with Jennifer Marshall of This Is My Brave, Inc. discussed all aspects of TMS Therapy as a treatment for depression.

For those of you who tuned in to our live event, there were a few questions from our viewers that we didn’t have time to answer. We have provided the answers here.

Is this a ‘permanent’ solution? As well, are there maintenance treatments after the full treatment?
While there is no permanent cure for any mental health disorder, TMS has been shown to be effective in about 70% of patients according to FDA Clinical Trials. There is peer reviewed literature showing that 1 year post TMS about 14% of patients could have some sort of relapse of symptoms varying in severity. Should those people have additional TMS (maintenance or another acute induction) greater than 90% responded the second time around.

How experienced is Greenbrook TMS and its doctors with TMS?
Greenbrook TMS was established in 2011 and has prided itself in delivering an ultimate patient experience. Led by some of the most experienced doctors, Greenbrook TMS is the largest provider of TMS Therapy in North America with over 2500 patients and over 80,000 treatments performed …-and still growing. As a leader in the industry, Greenbrook TMS is committed to patient care.

What is the ballpark cost without insurance? Or if insurance doesn’t cover.
Across the US, an acute phase of TMS which includes 30-36 sessions runs approximately $10,000-$12,000 if a patient does not have insurance. If insurance doesn’t cover, Greenbrook typically charges the applicable insurance rates which range based on demographic region. Greenbrook also offers financing plans for private pay patients as well as patients with financial need to help cover the cost of deductibles, copays, and coinsurance.

Can someone with Chiari Malformation get this treatment safely?
Per the FDA the only absolute contraindications for TMS include a history of seizure disorder and/or metallic implants in or around the head.

Can it trigger mania?
While there is not clinical trial data to confirm or deny triggering a manic episode, the TMS physician along with the patient, must determine the risk/benefit analysis. Insurance companies currently do not cover bipolar disorder as bipolar and unipolar depression are very different disease states and more clinical trials are needed to confidently answer this question. Greenbrook has successfully treated patients suffering from Bipolar II but we have exercised great caution in patients with Bipolar I.

Does United Behavioral Health cover it?
Yes, all major insurance companies cover TMS to include Medicare, Blue Cross, United, Cigna, Aetna, and Tricare.

Side effects? Anesthesia (as in ECT)?
Side effects can include headache or scalp discomfort, facial nerve twitching during pulse activation (i.e. not permanent), and a less than 1% seizure risk.
ECT requires hospitalization, anesthesia, and induces a seizure all which require significant down time and the need for a caregiver during recovery. Patients undergoing TMS are able to drive themselves in and out of their appointments and resume normal daily activities. There is no need for down time, no sedation, no systemic side effects, and no hindrance to immediately return to work, school, or take care of their families.

How soon will a patient feel relief?
Most patients can start to notice a difference in mood around session 15, or week 3. This is not applicable to all patients as each person’s response time may vary. 3-4 weeks is average. It is important to note that ups and downs in mood are to be expected while undergoing TMS and patients should relay any changes in mood and behaviors to their TMS provider.

Is anxiety treatable with TMS?
Depression and anxiety are what we call comorbid conditions and are very commonly found as dual diagnoses. Typically if TMS can alleviate depression, the anxiety component will dissipate as well. There are times where anxiety and/or panic disorder may not be a result of a unipolar depression and we have the ability to manipulate the TMS devices to include not only a stimulation effect but inhibitory pulse sequences as well. While there are many conditions TMS may be effective, the FDA and insurance companies currently state TMS is used as a treatment option for depression, although we have had success getting insurance coverage for other disease states if depression is also a component.

Can TMS be used for children too?
Currently the FDA says TMS is used for adults, however there are currently clinical trials being performed studying the adolescent population. Greenbrook has successfully treated the teenage population and found they typically respond quicker than adults, however insurance coverage is not guaranteed in this population.

Thank you for joining us and be sure to keep checking back for our next Lunch & Learn.

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