As the public’s understanding of TMS Therapy grows, so does insurance coverage. The majority of insurance companies cover TMS Therapy. Our TMS Coordinator will communicate with your insurance carrier to determine if TMS Therapy is a covered benefit under your policy. The following insurance companies* are in-network with us:
*Please keep in mind that TMS therapy is not a covered benefit under Medi-Cal.
How long does the TMS dip last?
A small percentage of individuals, as with other types of depression medication, have a brief ‘dip’ or exacerbation of depression or anxiety symptoms. This dip usually happens three to four weeks after treatment for the few people who experience it, as the brain adjusts to new changes. Even if you have a relapse, it is critical to maintain treatment because the symptoms will fade over time.
What type of provider does TMS Therapy?
Privileges to prescribe Deep TMS vary per state in the United States, for example. While psychiatrists are the only doctors who may administer Deep TMS, several states allow other doctors, such as nurse practitioners, physician’s assistants, and prescribing clinical psychologists, to do so as well.
Similarly, various insurance carriers may establish a distinct list of healthcare practitioners who can do Deep TMS treatment (and be compensated for it). This means that healthcare practitioners interested in prescribing or providing Deep TMS therapy should check with their customers’ insurance companies to see if their plans support Deep TMS therapy and if they will be reimbursed for the treatments they offer.
Deep TMS is FDA-approved in the United States to treat Major Depressive Disorder (MDD) and Obsessive-Compulsive Disorder (OCD), and it is CE-marked in Europe to treat these and a variety of other mental health issues. Due to its expanding popularity, several insurance firms are eager to give Deep TMS to their clients. Since a result, those who are not insured for the treatment may contact their insurance company and inquire about Deep TMS coverage, as single-case agreements may be achievable in some situations.
Is TMS for depression covered by Medicare?
If you’re 65 or older and have depression, you might be wondering if TMS is covered by Medicare. Transcranial magnetic stimulation (TMS) treatments are covered by Medicare.
What is the difference between CES and TMS?
Delving into the history of mental disease treatments can be distressing. Rather of generating new treatments, psychiatrists and others in the mental-health field appear to be recycling old ones. Take, for example, therapies that use electricity to stimulate the brain. H. Lewis Jones, a physician, wrote in the Journal of Mental Science in 1901, “
“The use of electricity in medicine has gone through many vicissitudes, from being acknowledged and used in hospitals to being abandoned and left in the hands of stupid people who continue to commit the most heinous crimes in the name of electricity.
Men’s attention have been directed anew to the subject as each new key discovery in electric science has been made, and interest in its healing powers has been sparked.
Then, following excessive hopes and promises of healing, there have been failures, which have dragged this agent’s job into contempt, only to be revived and brought back into popular favor over time.”
Jones’s worries may be relevant in our time, when electro-therapies for mental illness have been “reintroduced into popular favor.” Transcranial magnetic stimulation, cranial electrotherapy stimulation, vagus-nerve stimulation, deep-brain stimulation, and electroconvulsive therapy are the five electrotherapies I briefly cover here.
Conflicts of interest frequently affect electro-cure research. As a result, I rely on the National Institute of Mental Health’s and the Cochrane Collaboration’s reviews of the clinical literature, which are both relatively objective. My goal is to get other journalists and consumers to look into electro-therapies more closely.
TMS (sometimes known as rTMS, with the “r” standing for “repetitive”) is a type of transcranial magnetic stimulation.
TMS involves using an electromagnetic coil to stimulate the brain. More than 650 physicians have treated more than 25,000 patients for depression with Neurnetics’ NeuroStar device, according to the company; the suggested treatment comprises of five 37-minute sessions per week for up to six weeks. TMS could be “the controversial therapy to lift your brain out of the darkness,” according to celebrity physician Dr. Mehmet Oz. TMS was found to be beneficial in a 2014 study published in The Journal of Clinical Psychiatry, although the study was not controlled, and 11 of the 12 authors have affiliations to Neuronetics and/or other suppliers, and three work for the company. The following is an overview of TMS from the National Institute of Mental Health: “The effectiveness of rTMS has been studied in clinical trials, although the results have been inconsistent. Some studies have revealed that rTMS is more helpful in treating patients with serious depression than a placebo or inactive (sham) treatment. Other studies, on the other hand, have revealed no difference in responsiveness between active and passive treatment.” Only 14 of the 16 trials examined in a 2009 Cochrane review of TMS for depression were “in a sufficient form for quantitative analysis.” “There is no convincing evidence for benefit from using transcranial magnetic stimulation to treat depression,” Cochrane concludes, “but the small sample sizes do not rule out the possibility of benefit.”
Vagus-nerve stimulation, unlike TMS and CES, is an intrusive treatment that was originally intended to treat epilepsy. It involves using electrodes connected to a pacemaker-like device implanted in the chest to stimulate the vagus nerve, a main neurological conduit that travels from the brain down through the neck. The National Institute of Mental Health summarizes the evidence supporting VNS treatment of depression as follows: “In 2005, the United States Food and Drug Administration (FDA) approved VNS for the treatment of major depression in particular circumstancesif the illness has lasted two years or more, is severe or recurrent, and the depression has not improved after at least four different therapies.” Despite FDA licensure, VNS remains a divisive depression treatment due to conflicting results from research examining its efficacy in treating severe depression.”
Because it requires implanting electrodes deep into the brain to treat severe depression and other diseases, DBS is undoubtedly the riskiest and most invasive of all the electro-cures. DBS has been used to treat Parkinson’s disease and other movement disorders, and the National Institute of Mental Health gives it a positive review for depression: “While there has been relatively little study done to investigate DBS for depression treatment, the few studies that have been done demonstrate that the treatment could be promising.” The National Institute of Mental Health (NIMH) needs to update its database. Helen Mayberg, a key DBS researcher, recently presented her work in Scientific American and was praised in a 2006 story in The New York Times Magazine for her “amazing” achievements. As I noted last year, a large clinical trial of Mayberg’s DBS technology was recently suspended after failing a “futility analysis,” which determines if an experimental treatment has a realistic possibility of outperforming established treatments. See also this follow-up post, in which a DBS subject discusses the pain he had as a result of the procedure.
Electroconvulsive therapy, generally known as ECT or “shock treatment,” has the best track record of all the electrotherapies. ECT, which was first used in the 1930s, involves sending electricity to the brain through external electrodes to induce seizures in sedated patients. According to the National Institute of Mental Health, ECT “has had a bad image for years, with many unfavorable depictions in popular culture.” The method, on the other hand, has substantially improved since its inception and is now both safe and effective.” ECT can provide short-term relief for many severely depressed individuals, but relapse rates are substantial, according to my 1999 book The Undiscovered Mind. According to a 2013 research published in Nature, not much has changed: “Relapse rates following ECT remain surprisingly high and appear to have grown over time.” Relapse was highest in the first 6 months among patients treated with continuous pharmacotherapy, which was the major focus of our study. Nearly 40% of ECT responders relapse in the first 6 months, and roughly 50% by the end of the first year, according to current clinical practice.”
The continuation of electro-cures reveals the shortcomings of psychopharmacology, as well as psychotherapy, as a fundamental means of treating mental disease. There is evidence that antidepressants and other drugs, while providing short-term comfort for many individuals, may do more damage than good in the long run and in aggregate, as I previously stated (see Further Reading).
Sigmund Freud and William James lived more than a century ago, and science still hasn’t come up with compelling ideas or effective therapies for mental illness. When will that scenario alter, if it ever does?
Postscript: This is not a full review. It does not include, for example, transcranial direct current stimulation, or tDCS, as discussed in a recent New Yorker article.
Addendum: I’d like to thank Walter Brown, a psychiatry professor at Brown University with whom I did a Q&A in 2013, for bringing my attention to the growing popularity of electro-cures (which he examined in 2006) and supplying me with information on the trend. He just emailed that he is “increasingly concerned” about the advertising of TMS as a depression cure. The trials that are available, some of which are sponsored by the device manufacturer, are either uncontrolled or show minimal impact, and any effect that does appear is almost certainly placebo. Nonetheless, this technique is heavily pushed.” Brown forwarded me the aforementioned 2014 TMS article from The Journal of Clinical Psychiatry, noting the authors’ conflicts of interest.
Psychiatry in Crisis: The Director of Mental Health Rejects the Psychiatric Bible and Replaces It With… Nothing
Why psychotherapies never improve: Cybertherapy, placebos, and the dodo effect
Will insurance cover a second round of TMS?
Yes, in a nutshell, but there’s more to the story. In most cases, insurance companies will not pay for a service or procedure unless it is deemed medically necessary or suitable.
Does insurance cover TMS for anxiety?
While TMS can be used to treat a variety of diseases outside depression, such as bipolar disorder, anxiety, ADHD, migraines, chronic pain, and others, most insurance coverage only cover it for individuals with moderate to severe Major Depressive Disorder (MDD). In addition to a diagnosis, you’ll need proof that you’ve taken at least two antidepressant drugs and found them to be ineffective. You’ll also need to establish that you’ve tried talking therapy to manage your depression but haven’t seen any progress as a result.
What is the success rate of TMS therapy?
TMS has a success rate of 70 percent to 80 percent, according to most TMS providers, which means that the vast majority of people have significant relief after treatment. After just one session of treatment, about half of patients report complete remission, which means that their depression symptoms have vanished.
To comprehend how effective TMS works, it’s necessary to comprehend how effective medicine is. The STAR*D research, a significant clinical trial funded by the National Institute of Mental Health, discovered that routinely prescribed drugs like selective serotonin reuptake inhibitors (SSRIs) are only effective 27.5 percent of the time. However, if the SSRI fails to function (as it does for many people with treatment-resistant depression), the medication’s success rate drops. By the time a person has tried four drugs, the likelihood of the next one working is less than 7%. We know that drug studies can take up to two months to determine whether or not an antidepressant would work for a patient. This means that many people waste 4 to 8 months trying multiple drugs when the chances of remission are slim to none. Furthermore, increased medicine use means a higher risk of harmful side effects from medications, such as:
Given this context, it is evident that people suffering from treatment-resistant depression require additional therapy alternatives. Much of the early clinical study using TMS focused on people who had a very poor chance of remission, and discovered that two-thirds of patients had a positive outcome after TMS. Researchers discovered that those who felt hopeless, suffered from anhedonia, and had tried everything else were able to get rid of their symptoms in just 6 weeks.
In mid-2020, we conducted independent study and discovered that our success rate was significantly higher than what had been previously disclosed. This could be because we specialize in both theta burst stimulation and a customized TMS method. We think that every brain is unique, and that there is no such thing as a “one-size-fits-all” approach to TMS treatment. Our most recent calculation yielded a 92.5 percent success rate.
Can TMS damage the brain?
Many people mistake TMS for ECT, or electroconvulsive therapy. These two treatments, however, are significantly different.
TMS uses brief magnetic pulses to stimulate parts of the brain that are underactive in depressed persons. These magnetic pulses cause a flow of extremely small electrical charges that the patient cannot feel. These electrical charges stimulate neurons to fire, which reactivates the targeted area and improves mood.
ECT is normally performed when the patient is under general anesthesia in a hospital setting. The method includes administering regulated electrical currents to the brain, which causes a brief seizure. Despite the fact that electroconvulsive therapy (ECT) was developed in the 1930s, doctors are still unsure how it works to alleviate depressive symptoms. They do know, however, that ECT normally works rapidly and does not cause structural harm to the brain.
TMS treatments, on the other hand, can be done as an outpatient procedure. A coil is put on the outside of the patient’s head during TMS treatment to deliver tiny magnetic pulses. The process is painless and requires no anesthetic. It also has no effect on intellect or memory, and it doesn’t cause a seizure. The patient is free to talk, listen to music, or watch television during the session.