FDA approved in 2008 for treatment resistant depression TMS allows us to stimulate the neurons in the left dorsolateral prefrontal cortex through electromagnetic induction. The treatment is covered by most insurance companies if you have failed at least four trials of antidepressants, and failed some form of talk therapy ie: cognitive behavioral therapy etc… You must also score at least a 17 on the PHQ 9 to meet insurance criteria for this treatment. Otherwise it is still available but off label and on a fee basis.
“Depression is a Physical Disease” Dr. Boris Kawliche
These images from the University of South Carolina were captured through Pet Scan which is a research tool that helps assess the degree of cell activity within the brain. The brain on the right has essentially shut down due to the depression that has taken over. The one on the left is a healthy functioning brain with neurons that respond properly and have oxygen flow. The goal with TMS is to restore the depressed patient’s brain functioning and get them feeling energized again. Think of it as muscle memory and TMS is the workout your brain has been needing!
HOW IS IT DONE?
During 36 sessions of 20 minutes each over 9 weeks the neurons of the left prefrontal cortex are stimulated with a small voltage 2 cm deep into the brain. Under those conditions the neurons are programmed to fire 3000 times per session. Overtime this has a healing effect on the circuits that are involved in depression and cognition. The pulses are given at 120% of the motor threshold at 10 hz for 2 seconds with a 4 second pause in between groupings of pulses called “trains” in traditional TMS.
TMS has a huge potential to become a treatment for many other medical conditions but like most things in medicine large studies are going to be needed before they may become FDA approved. The cost is always in the many millions of dollars.
For more on TMS or off label call our office and ask for James at 813.681.5880 ext#2