TMS FAQs in Houston

Why do Brainsway Deep TMS?

Deep TMS sessions take less than 20 minutes compared to approximately 40 minutes for other TMS devices. This saves you 10 1/2 hours of time over the complete course of treatment. Research on Theta Burst treatment is showing promise with just 3-minute sessions.

Is Brainsway approved?

The Brainsway Deep TMS System is cleared by the Food and Drug Administration (FDA) for the treatment of depressive episodes in adult patients suffering from Major Depressive Disorder who have failed to achieve satisfactory improvement from previous anti-depressant medications, psychotherapies, and/or electroconvulsive therapy (ECT).

What should I expect in a Deep TMS session?

During the first Deep TMS treatment session, the technician will place the magnetic coil, which resembles a helmet, over the patient’s head. The technician will then stimulate the region of the patient’s brain that makes the thumb move. Patients hear a clicking sound and feel a tapping sensation on the scalp. The device is adjusted to give just enough energy to send electromagnetic pulses into the brain so that the thumb twitches. The intensity of stimulation that barely produces a movement is called the motor threshold (MT). Once the MT is determined, the magnetic coil is moved to the location of the brain that research suggests may be responsible for causing depression. The treatment session is delivered as a series of pulses lasting 2 seconds, with a 20-second rest period between each sequence, for a total of 1,980 pulses. Treatment is targeted to the dorsolateral prefrontal cortex (DLPFC). Each treatment lasts approximately 20 minutes, but allow 30 minutes from start to finish. Dr. Drell meets with each patient periodically during the course of treatment to answer questions and coordinate care. The treatment does not involve anesthesia or sedation, patients remain awake and alert, and they are able to drive themselves to and from appointments. Treatments are typically administered daily, Monday through Friday, over 6-9 weeks.

Is TMS covered by my insurance plan?

Prior to your initial evaluation, you will be asked to send our office a copy of the front and back of your insurance card so that we may verify your individual policy coverage for the initial Deep TMS consultation and treatments. We will contact you prior to your initial appointment to review your coverage. We will file your insurance if it is approved by your health insurance. You are ultimately responsible for payments not covered by your insurance plan, including deductibles, copayments, and denied expenses.

What criteria does my insurance company use to decide if they will pay for my TMS?

To be a suitable candidate for insurance to cover your TMS, the following generally must be true: your PHQ-9 score is 10 or more; you are currently depressed in spite of trying several antidepressants; you have failed 2 or more antidepressants during this episode of depression; some insurers also require the failure of two augmentation strategies (where your doctor added a second medication such as Seroquel, Abilify, Rexulti, or Lithium to an antidepressant); you have tried some talk therapy during this depression; and you have never tried TMS in the past, or you tried it and it helped but your depression returned. If all of these are true, you are a suitable candidate and insurance will likely pay if it is a covered benefit. If you do not use health insurance, the FDA only requires that you have moderate to severe depression and have failed one antidepressant due to ineffectiveness or side effects.

If I do not meet my insurance company’s criteria for TMS, can I still do it?

Yes. If you are a good candidate for Deep TMS and your insurance does not cover it, or if you do not have health insurance, Dr. Drell can offer competitive self-pay rates. You may also qualify for medical loans. Please contact Dr. Drell for an initial consultation to get started, or call (713) 464-4455 with any questions.

When should Brainsway Deep TMS not be used?

Deep TMS delivers a magnetic field that can cause nearby metal objects to move or get hot. Treatment should not be used if you have metal implants in or around your head and neck (except standard amalgam dental fillings), including shrapnel, piercings, stents, staples, metal plates, implants, or aneurysm clips. It should not be used if you have implanted electronic devices in your body, as these could cause serious injury or death. Tell Dr. Drell about any metal devices or objects in your head or body. Additional contraindications include a history of epilepsy, seizures, or strokes; a severe brain injury or brain surgery; current risk for self-harm or suicide; or a previous course of Brainsway Deep TMS that did not help your depression.

What is the Brainsway Deep TMS safety information?

Safety of the Brainsway Deep TMS system was demonstrated in a clinical study involving 233 patients with moderate to severe depression. There were no deaths among patients in the clinical trial. Systemic side effects such as weight gain, dry mouth, and sexual side effects were not observed, and tests of memory function showed no change. Application site pain or discomfort was reported in 25% of patients who received Deep TMS. Headaches were reported in 47% of Deep TMS patients, but 36% of patients who received sham or placebo treatment also reported headaches, suggesting the headaches were not necessarily caused by TMS. Some patients reported jaw pain or muscle twitches. You should tell Dr. Drell or the technician if you feel discomfort, since minor adjustments can be made and most side effects resolve within the first several treatments.

Is TMS a safe procedure?

TMS has been FDA approved in Canada since 2004 and in the United States since 2008, and more than 80,000 patients have been treated with TMS. There is a low incidence of seizures, and we follow protocols to reduce this risk. No lasting consequences from the rare seizure events with Brainsway TMS have been reported, no deaths have been reported in the TMS studies, and there was no evidence of memory loss or negative cognitive changes during the clinical studies.

Will I need to adjust or discontinue my currently prescribed medications before starting TMS?

Medications may be continued. Dr. Drell adjusts the power of the magnetic field to account for the effects of various medications on the brain. He may suggest discontinuing medications with more serious side effects, such as Seroquel or Abilify, and because some medications can lower the seizure threshold, it may be beneficial to reduce them prior to TMS. Patients often prefer TMS because it does not cause medication side effects like weight gain or dry mouth. Your current psychiatrist will need to be involved in adjusting your medications, since Dr. Drell is a consultant performing Deep TMS.

If I am not interested in TMS, can I schedule a regular psychiatry appointment with Dr. Drell?

Yes, but there is a several-month waiting list for psychiatric consultations. Dr. Drell accepts patients between the ages of 13 and 59 into his general psychiatric practice. He will see appropriate TMS referrals between the ages of 15 and 75 as soon as possible, since he understands the frustration of treatment-resistant depression. Deep TMS patients obtain their medications from their current psychiatrist or physician.

I am interested in TMS, but still have questions and concerns that I want to discuss with Dr. Drell. Can I schedule a consultation call?

You can schedule an appointment by calling (713) 464-4455. If you want to discuss questions or concerns, you can call the same number and speak with one of Dr. Drell’s TMS technicians, or with Dr. Drell if he is available.

Are there any recommendations for me prior to starting my treatments?

Once treatment begins, you can take over-the-counter Extra Strength Tylenol (2 tablets) or up to four 200mg tablets of Ibuprofen one half to one hour before your session. The initial session lasts approximately 60 minutes, and remaining sessions last approximately 30 minutes. We supply ear plugs, which are required to protect your hearing. Please bring a comb or brush, since the Brainsway cap might affect your hairstyle, and do not dye your hair within 24 hours before a treatment, since the magnet might strip metallic hair color.

How is TMS different from ECT?

Unlike electroconvulsive therapy (ECT), TMS does not require anesthesia, does not induce seizures, and does not cause memory loss. You remain awake during TMS and can drive yourself home afterward.

Who is a good candidate for TMS?

TMS is generally considered for adults with major depressive disorder who have tried one or more antidepressants without adequate relief. A consultation with Dr. Drell will determine whether you meet the clinical criteria.

Can I work or go to school during treatment?

Yes. TMS has no recovery time, so you can return to work, school, or daily activities immediately after each session.

How do I get started with TMS?

The first step is to schedule a consultation. Call Houston West TMS at (713) 464-4455 or request an appointment online, and our team will evaluate your eligibility and explain the process.