ADULT
Psychiatric Neurotherapeutics Program (PNP)
Transcranial Magnetic Stimulation
Oscar G. Morales, M.D.
Director, Transcranial Magnetic Stimulation (TMS) Service
Associate Director, Psychiatric Neurotherapeutics Program (PNP)
Stephen J. Seiner, MD
Director, Psychiatric Neurotherapeutics Program (PNP)
Director, Electroconvulsive Therapy (ECT) Service
Paula Bolton, RN/NP/MS
Nurse Director, Psychiatric Neurotherapeutics Program (PNP)
The Psychiatric Neurotherapeutics Program (PNP) at McLean Hospital specializes in the neuromodulatory and neurostimulatory treatment of psychiatric disorders. It offers transcranial magnetic stimulation (TMS), a new and promising method for treating severe depression, as well as electroconvulsive therapy (ECT), a highly effective conventional intervention for chronic depression, mania, catatonia and schizophrenia. TMS and ECT are the first in a line of clinical services to be offered through the program.
With components in clinical care, research and education, the PNP is dedicated to improving the quality of life for individuals with a broad range of psychiatric illnesses.
Its collaborative team approach is aimed at maximizing the effectiveness of psychotherapy, medication management and psychosocial treatments already offered at McLean with emerging techniques, technologies and interventions.
What is Transcranial Magnetic Stimulation
Transcranial Magnetic Stimulation (TMS) is a non-invasive treatment for adults with major depression that uses magnetic stimulation of the brain to help control mood. The procedure was approved by the Food and Drug Administration in October 2008 after more than ten years of clinical investigation in patients who failed to achieve satisfactory improvement from one course of pharmacotherapy (medication). For this reason, TMS is particularly helpful for people who have not experienced significant relief from antidepressant medications or have difficulty with their side effects.
How does TMS work?
TMS uses focused magnetic impulses to non-invasively stimulate the brain in the pre-frontal cortex (the region of the brain associated with mood regulation). During a TMS treatment, a clinician gently places a magnetic coil against one side of a patient’s scalp.
The magnetic impulses are generated by an electric coil that is positioned on the head above the left prefrontal cortex. The magnetic fields penetrate approximately two to three centimeters beneath the coil directly into the brain to produce electrical currents. These currents activate cells within the brain that are thought to release neurotransmitters, which play a role in mood regulation. Since depression is believed to be caused by an imbalance of chemicals in the brain, TMS helps restore balance and relieve the symptoms of depression.
The Advantages of TMS
TMS is non-invasive and requires no anesthesia or sedation. The procedure typically lasts an hour during which time patients are awake and alert. Because no medications are administered, there are no systemic effects or cognitive (memory and ability to concentrate) after-effects, therefore patients can return immediately to regular activity.
Treatment
Patients typically receive 20 – 30 treatments over four to six weeks (five times per week). There may also be a taper phase. The course of treatment will vary according to each individual. An initial assessment will determine the appropriate dose of the magnetic pulse and the exact area of the brain the coil should target. As the treatment progresses,
the clinician will conduct periodic re-evaluations of the dose level and coil placement.
During a treatment session the patient sits in a comfortable reclining chair similar to that found in a dentist’s office. A headset is applied to deliver the magnetic stimulation. Ear plugs are also provided to decrease the loud clicks associated with each magnetic pulse and the patient is given the option of watching TV. During the treatment the patient is monitored continuously to ensure correct positioning and comfort level.
Are There Risks and Side Effects with TMS?
More than 10,000 treatments were safely performed during clinical trials. Patient reported no side effects like those associated with antidepressant medication (weight gain, dry mouth, drowsiness, etc.), no seizures and no cognitive side effects (memory loss, ability to concentrate). Scalp discomfort during the procedure is the most common side effect.
TMS should not be used for patients with implanted metallic devices that include metal plates in the skull or aneurysm coils, clips or stents. Special precautions are recommended for individuals with implants such as pacemakers and implantable cardioverter defibrillators.
Is TMS covered by insurance?
Both private (indemnity and managed care plans) and public (Medicare and Medicaid) insurers are determining eligibility for TMS on an individual basis. However until TMS is accepted more widely as a medically necessary treatment insurance coverage will most likely not be authorized. Patients should work directly with their insurers to receive approval for TMS. Once coverage has been determined, patients can work with a Patient Account representative to arrange payment schedules and to obtain assistance in applying for reimbursement or out-of-pocket expenses from their insurers.
Contact
For further information or a referral for consultation, please call 617-855-2355 or email tmsmclean@partners.org.About McLean Hospital
U.S. News & World Report ranked McLean Hospital first among all freestanding psychiatric hospitals. McLean Hospital is the largest psychiatric facility of Harvard Medical School, an affiliate of the Massachusetts General Hospital and a member of Partners HealthCare.