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The Transcranial Magnetic Stimulation (TMS) Clinical Service at Massachusetts General Hospital is dedicated to caring for patients suffering from treatment resistant depression. Our service uses transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) to treat severe depression, particularly for people who have not had a therapeutic response from antidepressant medications or who experience side effects.
Learn more about TMS: TMS Offers New Hope for Patients Suffering from Depression
The Transcranial Magnetic Stimulation Clinical Service at Massachusetts General Hospital provides non-invasive treatment for patients with major depressive disorder using two techniques: transcranial magnetic stimulation and transcranial direct current stimulation.
Transcranial magnetic stimulation (TMS) uses magnetic impulses to stimulate neurons in targeted regions of the brain. These pulses are delivered through a magnetic coil that is placed against the front of your scalp over the prefrontal cortex (the region of the brain associated with regulating mood). The procedure typically lasts 45 minutes, during which patients are comfortably seated, awake and alert. TMS is completely non-invasive and does not require any anesthesia or sedation. Since no medications are administered, there are no cognitive or systemic after-effects, allowing patients to immediately return to regular activity.
A TMS treatment course typically consists of 30 treatment sessions over a six-week period (five sessions per week), followed by a taper phase of six additional sessions. However, treatment courses vary according to each individual patient. Patients undergo an initial evaluation to determine the appropriate therapeutic dose of the magnetic pulse and the exact area of the brain to target. Throughout the treatment course, patients are closely followed by a clinician who will periodically re-evaluate the dose level and coil placement. Each patient’s symptoms are also tracked through standardized questionnaires to monitor the effectiveness of the treatment.
Transcranial direct current stimulation (tDCS) is another form of neurostimulation that uses a constant, low direct electrical current to stimulate neurons. The electrical current is delivered through saline-soaked sponges or electrophysiological gel that is applied onto the scalp and attached to a machine that sends currents through the brain. This results in a temporary change in brain activity, which leads to longer-lasting therapeutic changes over time. Similar to TMS, tDCS is completely non-invasive and does not require any anesthesia or sedation.
tDCS has been approved by the Massachusetts General Hospital Executive Credentials Committee for off-label treatment of emotional, behavioral and cognitive difficulties, including depression or executive difficulties. Off-label treatments using tDCS are usually not covered by insurances and come with an out-of-pocket-cost. Please check with your insurance carrier to understand your out-of-pocket costs.
Off-label treatments are types of treatments that have not been approved by the U.S. Federal Drug Administration (FDA). While off-label treatments are clinically safe and effective, they are not typically covered by insurances.
TMS therapy has been approved by the U.S. Federal Drug Administration (FDA) to treat depression in patients who have not responded to one or more antidepressants. Clinical and research literature also support using TMS to treat other conditions listed here.
However, because the FDA has not yet approved the use of TMS to treat other conditions like OCD and generalized anxiety disorder, these applications are considered “off-label.” While off-label treatments are clinically safe and effective, they are not typically covered by insurances.
A depressive disorder is a whole-body illness, involving the body, mood, and thoughts, and affects the way a person eats and sleeps, feels about himself or herself, and thinks about things.
Generalized anxiety disorder (GAD) causes its sufferers chronic and exaggerated worry and tension that seem to have no substantial cause.
Obsessive-compulsive disorder is an anxiety disorder in which a person has an unreasonable thought, fear, or worry that he or she tries to manage through a ritualized activity to reduce the anxiety.
Accepting New Patients
Yes. Numerous studies have proven TMS to be more effective than medication for treating depression in patients who have had an inadequate response to one or more antidepressants. While response and remission rates can vary, a course of TMS treatment can keep patients symptom-free for up to a year or more.
This visit typically lasts 90 minutes. You doctor will follow this protocol:
After your first treatment, we will know how strong of a dose to use and the proper coil target. Once the coil is placed on the correct part of your scalp, the TMS machine will give a series of pulses to your head. You will be awake and alert during the treatment. Each of these follow-up visits last 30-45 minutes.
Most patients get treatment every day for five days over a six-week period, with six addition taper sessions (for a total of 36 treatment sessions). However, some patients need more than 36 treatments to get the best results. Your doctor will determine the appropriate number of sessions for you.
As a non-invasive procedure using magnetic pulses, TMS is mostly free from side effects, much like an MRI. The most common side effects include scalp discomfort and headaches, but these usually improve shortly after the treatment session is finished.
There is also a rare risk of seizure. However, the risk of seizure is thoroughly evaluated and discussed during your initial consultation.
No. While some TMS patients sometimes report mild headaches and scalp discomfort after the first treatment, any minor discomfort usually subsides after a few sessions. Since TMS is non-convulsive and non-invasive, the only thing you might feel is a small tap on your head.
Each tDCS session will take about 20-30 minutes. During treatment, your technician will:
tDCS is administered by trained technicians under the supervision of attending physicians from the Department of Psychiatry at Mass General. These technicians have followed an internal training and certification process under the supervision of the chief of the TMS Clinical Service.
Most patients receive treatment five days a week, for two to six weeks (a total of 10-30 treatments). Some patients will need more than 10 treatments to get the best results. The number of sessions will be decided with your care team according to your clinical progress.
There is very little risk in tDCS. Side effects are usually mild and will only occur during the course of stimulation. These side effects may include itching under the electrode and skin irritation. Rare side effects include headache and dizziness.
No. tDCS patients sometimes report a mild tingling or itching sensation during stimulation, but this usually fades away shortly after stimulation.
For further information on the TMS Clinical Service, please contact our administrative coordinator: 617-726-5340.
Referring clinicians should fill out the TMS Referral Form so we can determine whether the program is a good fit for the individual and gather relevant clinical information. A completed referral form is required prior to treatment. Please send completed referral forms to firstname.lastname@example.org.
Coverage for TMS by public and private insurers varies greatly. While Massachusetts General Hospital accepts Medicare, MassHealth and many private insurance and managed care plans, it is best to contact us or your insurance provider to determine TMS coverage. Precertification according to eligibility criteria is required in most cases.
See the Billing, Insurance & Financial Assistance page for more information on insurance providers accepted by Mass General and our financial assistance policy.
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