Beejal Y. Amin MD

Frequently Asked Questions

Which brain networks are involved in depression?

The three most prominent brain networks involved in depression are the default mode network, the central executive network, and the salience network. These three networks are crucial for cognition, emotion regulation and self-control but their activity is diminished and altered when a person is depressed. All three of these networks are helped with TMS. Again by analogy, it is as if TMS wakes up the “conductor” of the brain, the dorso-lateral prefrontal cortex, to coordinate the various components of these neural networks and cause them to work optimally.

How long is TMS treatment?

Currently the US FDA has cleared two different stimulation protocols. Both are clinically equivalent in terms of safety and effectiveness in the treatment of depression. The first is a 3-4 minute, TMS treatment also known as an “Intermittent Theta Burst.” The second is a 19-37 minute, high frequency repetitive 10 Hertz TMS protocol.Both of these treatment protocols require 30 core treatments that occur 5 days a week for 6 weeks. This core treatment is followed by 6 “booster” sessions to reinforce the benefits. To be clear, you will have to be available every work-day for about 10 minutes each day for 6 weeks for the core treatment. The follow up “booster” sessions usually are one session a week for 6 weeks, but other arrangements can be made.

What happens in a TMS treatment?

The first session involves measurements that decide where to place the magnetic coil and the strength of the magnetic pulse. This usually takes no more than 20 minutes. This is immediately followed by your first treatment. The second treatment is the next day and for each week-day for 30 days. The treatment involves you sitting comfortably in a treatment chair (like a dental chair). A cap is placed on your head for hygiene. Also, a mark is placed on the cap to identify the location where your treatment will occur. This avoids marking your head. Then, the magnetic coil is placed on this mark and the treatment begins.

What can I expect during and after a TMS treatment?

Many people describe the sensation of the treatment like a pulsing on the treatment location. We have seen people come into a session crying with anxious agitation only to be smiling and relaxed just a few minutes later. Many describe the treatment as very relaxing. For a few, the initial treatment may feel too intense and they describe a pulsing behind their eye or in their temple. This is easily fixed with a simple adjustment in the strength of the pulse. There are no lasting bad effects in such cases. The scientific literature says that the benefit is seen by the 16th session. Our experience and the experience of the vast number of doctors doing TMS is that benefit is seen within the first few sessions. This is usually in the form of decreased anxiety, improved ability to manage stress and a more rapid rebound in the event they do get overwhelmed. These benefits continue to expand and deepen over time as the anti-depressant effects and the cognitive improvement benefits of TMS emerge.

What are the most common side effects of TMS?

TMS therapy is free from the most common side effects experienced with antidepressant medications such as weight gain, agitation, sedation and sexual dysfunction. The most commonly reported side effects are headache and nausea but these occur in a vanishingly small percentage of TMS patients and tends to be quite brief in duration. Having treated about 100 patients over a few years, my experience in the clinic has been that about 2% of patients have had side effects and none of these have been severe. One woman stopped treatment from a headache. Another had a headache that began a few hours after treatment but was easily treated with an over-the-counter pain reliever. The headache never returned. This compared to antidepressant medications that sees up to 80% of patients develop sexual side effects, 22% with sleep disturbance, 25% with daytime sedation, 25% with weight gain, 2-4% develop suicidal thinking. TMS has none of these.

Is TMS shock therapy?

How many people benefit from TMS and how long do the benefits last?

Nationally speaking, roughly 70-80% of people who receive TMS treatment improve. This is a very important number in that these are cases in which MEDICATION DID NOT WORK! So, these are the most difficult cases, and up to 80% of these most difficult cases receive benefit! Of these 30+% have a complete remission of their symptoms.

To understand how successful TMS is, it’s important to understand just how successful medications are. A large clinical study funded by the NIMH called the STAR*D study found that commonly prescribed medications, such as Selective Serotonin Reuptake Inhibitors (SSRIs), are only successful 27.5% of the time. However, if the SSRI doesn’t work (as is the case for many individuals with treatment-resistant depression), the success rate for subsequent trials of medication decreases. By the time an individual has tried 4 medications, the success rate for the next medication working is less than 7%. We know that medication trials can take 1-2 months to even gauge whether or not a particular antidepressant may work for a patient. This means that many individuals spend 4-8 months trying different medications when the probability of improvement is negligible. Not to mention, increased medications mean that there is an increased risk for negative side-effects from medications, such as:

- Sexual dysfunction

- Gastrointestinal discomfort

- Nausea

- Increased appetite and/or weight gain

- Insomnia (sleeping too little) or hypersomnia (sleeping too much)

- Agitation and/or irritability

This is where TMS proves to be so exciting. Even people who are beginning to feel hopeless that anything can help them can actually be helped by TMS and get their life back.

Is TMS covered by insurance?

Yes. Most insurance carriers cover TMS treatment. Be aware that my practice is not in network for either Medicare or Medicaid/Husky. This means that if you have Medicare or Medicaid I will not be able to provide TMS treatment for you. Remember that our health insurance system may require that you have already met your deductible before your insurance coverage begins, and there may be significant copays depending on your insurance policy. Be sure to speak with our billing office to help you figure out if TMS is something affordable for you. If the need is significant and your budget is limited, in some cases we can work out a payment arrangement to be sure that you get the care you need.

Do I qualify for TMS treatment?

In 2008, the FDA approved TMS treatment for “treatment-resistant depression” which is defined as having not received sufficient benefit from two or more treatments with standard antidepressants. Most insurance companies go by this same guideline although some insurance companies require three or even 4 failed medication attempts before they will approve TMS. Most insurance companies also require an effort at trying psychotherapy with insufficient results. Some special cases are also allowed by insurance companies but cannot be guaranteed to be covered. These might include TMS treatment for depression during and immediately after pregnancy; when severe side effects from medications have occurred and when the patient has not had two or more medication trials, but an emergency situation exists.

Will I still need medication if I have TMS treatment?

It depends. Some patients can have their medications lowered or even stopped as a result of TMS. Along with the other 6 levels of care I cover in my care for you, the odds of you improving are significantly increased. The odds of the benefit of the treatment lasting longer are also increased. Everyone is different and I can’t promise you that you will come off your medication if you have TMS treatment. Our first goal is to help you feel better. We want to do that with as few side-effects as possible, preferably none, and with the fewest number of medications possible.

Beejal Y. Amin MD

✆ Phone (appointments): 708-722-7483

Address: 908 North Elm Street, Suite 210, Hinsdale, IL 60521