Q: Why do Brainsway Deep TMS?
A:
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.

Q: Is Brainsway approved?
A:
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 any number of previous anti- depressant medications, psychotherapies and/or electroconvulsive therapy (ECT).

Q: What should I expect in a Deep TMS session?

A: 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 will be moved to the location of the brain research suggests may be responsible for causing depression. How often a patient’s MT is re-evaluated is determined by the physician who prescribes the treatment.

The treatment session is delivered as a series of pulses that last 2 seconds, with a rest period of 20 seconds between each pulse sequence, for a total of 1,980 pulses. Treatment is targeted to the region of the brain called the dorsolateral prefrontal cortex (DLPFC), or the left frontal part of the brain. Each treatment lasts approximately 20 minutes but allow 30 minutes from start to finish. The number of Deep TMS treatments prescribed will be determined by Dr. Drell at your initial evaluation. Dr. Drell meets with each patient periodically during the course of Deep TMS treatments to answer questions and coordinate treatment. This treatment does not involve any anesthesia or sedation and patients remain awake and alert during the treatment. Patients are able to drive themselves to and from appointments. The treatments do not induce a seizures like ECT is meant to do.

Deep TMS treatments are typically administered daily, Monday through Friday over 6-9 weeks. The actual number of sessions will depend on your individual response and if Dr. Drell thinks a tapering schedule is necessary to maximize your results.

Q: Is TMS covered by my insurance plan?
A:
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 Deep TMS 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.

Q: What criteria does my insurance company use to decide if they will pay for my TMS?
A: 
To decide if you a suitable candidate for insurance to cover your TMS, see the six criteria below.

  1. My PHQ 9 score is 10 or more. (The form is located under Downloadable Forms)
  2. I am currently depressed in spite of trying several antidepressants.
  3. I have failed 4 or more antidepressants in the past.
  4. Some insurance companies also require the failure of two augmentation strategies. (Augmentation strategies mean my doctor added a second antidepressant or another medication, like Seroquel, Abilify, Rexulti, Lithium, etc. to another antidepressant).
  5. I have tried some talk therapy with my doctor or a therapist during the course of this depression.
  6. I have never tried TMS in the past or I tried it and it helped my depression, but my depression has returned.

If all the above are true, you are a suitable candidate for Deep TMS.  Insurance will likely pay for your TMS if it is a covered benefit.

If you do not use health insurance, the FDA only requires you have moderate to severe depression and have failed only one antidepressant due to ineffectiveness or side effects. If you tried regular TMS in the past and it was not as helpful as you wanted, Brainsway Deep TMS may still be worth trying. Insurance companies have a lot of unnecessary rules to limit their potential costs.

Q: If I do not meet my insurance company’s criteria for TMS, can I still do it?
A: Yes you can! 
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. Call 713-464-4455 if you have any questions. We are here to help.

Q: When should Brainsway Deep TMS not be used? 

A: Deep TMS treatment delivers a magnetic field that can cause any metal objects that are near the device to move or get hot. DTMS treatment should not be used if you have metal implants in or around your head and neck(except for standard amalgam dental fillings). This includes shrapnel, piercings, stents, staples, metal plates, implants, aneurysm clips,etc. Deep TMS treatment should not be used if you have implanted electronic devices in your body. These implants could cause serious injury or death if Deep TMS treatment is used. You should tell Dr. Drell if you have any metal devices or objects in your head or body in order to determine if those devices could be affected by Deep TMS treatment.

Unfortunately, there are a few more contraindications to  Deep TMS.

  1. You have a history of epilepsy, seizures or strokes.
  2. You have had a severe brain injury or brain surgery.
  3. You are currently at risk for self harm or suicide. TMS may reduce these risks but not immediately.
  4. You have tried Brainsway Deep TMS in the past and it did not help your depression.

If you have any of the contraindications above, please consult your current doctor or psychiatrist to discuss other treatment alternatives. Dr. Drell’s Deep TMS will not be an option for you.

Q: What is the Brainsway Deep TMS safety information?
A:
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 in patients who took part in the clinical trial. Systemic side effects such as weight gain, dry mouth, and sexual side effects were not observed. Tests of memory function during the treatment showed no change during the clinical trial. Application site pain or discomfort was reported in 25% of patients who received Deep TMS treatment. Headaches were reported in 47% of patients who received Deep TMS but 36% percent of the patients who received sham or placebo treatment also complained of headaches suggesting that the headaches were not necessarily TMS.  Some patients complained of jaw pain or muscle twitches. You should inform Dr. Drell or the TMS technician if you feel pain or discomfort during the treatment because minor adjustments can be made and most of the side effects go away at the first several treatments. Very few patients dropped out of the original studies due to side effects.

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

Q: Will I need to adjust or discontinue my currently prescribed medications before starting TMS?
A: 
Some doctors may try to taper or discontinue medications before starting TMS. Medications may be continued. The power of the magnetic field will be adjusted by Dr. Drell to take to account the various medication effects on the brain. Dr. Drell may suggest discontinuing medications that have more serious side effects such as Seroquel or Ability. Patients often prefer TMS because it does not cause medication side effect like weight gain or dry mouth.  Some medications can lower the seizure threshold and it may be beneficial to reduce them prior to TMS. Please note your current psychiatrist will need to be involved in adjusting your medications since Dr. Drell is a consultant performing Deep TMS. 

Q: If I am not interested in TMS, can I schedule a regular psychiatry appointment with Dr. Drell?
A: Yes you can, but there is a several month waiting list for psychiatric consultations. Dr. Drell only accepts patients between the ages of 13-59 into his general psychiatric practice.  Dr. Drell will see appropriate TMS referrals between the ages of 21-75 as soon as possible since he understands the frustration of depression-resistant people and wants to make Deep TMS as readily available for them as possible. Remember, Deep TMS patients will obtain the medications from their current psychiatrist or physician.

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

Q: Are there any recommendations for me prior to starting my treatments?
A:
Once treatment begins, you can take over the counter Extra Strength Tylenol (2 tablets) or up to 4- 200mg tablets of Ibuprofen 1⁄2 to 1 hour before your session. The initial treatment session will last approximately 60 minutes. Remaining treatment sessions last approximately 30 minutes. We will supply ear plugs which are required to protect your hearing.
Please be sure to bring a comb or brush to sessions since the Brainsway cap might affect your hairstyle. Do not dye your hair less than 24 hours before a treatment since the magnet might strip your hair color if it is a metallic material.

**Adapted from Winston, Jaron, Texas TMS Center, Austin TX, texastmscenter.com, Rev. 8-2017
**Brainsway Patient Manual 2015