Submitted Photo Kiley Andreas, PMHCNS-BC, a Psychiatric-Mental Health clinical nurse specialist, is shown with Trinity Health’s Transcranial Magnetic Stimulation system, a treatment option for patients with resistant depression.

Depression affects the lives of millions of people in the United States, and millions more around the world. It can be extremely difficult to live with the gray cloud hovering above one’s head every day.

Trinity Health Center – Riverside offers transcranial magnetic stimulation (TMS) which has helped make the lives of about 75,000 people better.

TMS in a non-invasive method of therapy, sending electromagnetic pulses through the patient’s brain via electromagnetic coils that are strategically placed. The pulses target the parts of the brain that are underactive and don’t do their job successfully. The pulses that are used are usually at a fast and high frequency to improve functionality of those areas.

The doctor administering the TMS uses brain mapping during the first appointment to assure that the coils are placed where they will be the most effective. One interesting fact about the TMS equipment is that it knows when a coil isn’t in its proper place. It beeps at the doctor and tells them which one needs to be redone.

Psychiatrist Linda Carpenter was quoted in a story by Stacey Colino, saying that TMS helps the brain “run curcuits more efficiently, make new neural connections, and restore neural rhythms.” Carpenter is also a research professor of psychiatry and human behavior at Brown University and director of the Butler Hospital TMS Clinic and Neromodulation Research Facility in Providence, R.I. “There may be some other effects, too, she says, such as improving blood flow and the functioning of the cells’ mitochondria – their energy producrers,” Colino added from Carpenter.

One of the common myths about TMS is that it’s the same as electroconvulsive therapy (ECT). They are, in fact, very different.

ECT requires the patient to be put under anesthesia while electrical currents are sent through the brain. Using the electrical current, Tonya Anderson, a nurse practitionaor at Trinity Riverside, described ECT as “intentionally giving the patient a seizure.” Some of the side effects that come with ECT are nausea, confusion and memory loss.

TMS does not have any of those side effects. The only thing that patients who receive TMS experience is mild to moderate pain at or near the treatment sites. That pain typically goes away after the first week of sessions. During their sessions, the patient stays awake and alert, watching a movie or show, or even reading a book, if they so choose.

The process of receiving TMS therapy is very thorough, only available by prescription. For those with Blue Cross Blue Shield or Medicare health insurance, the patient would have to have tried at least four antidepressants that did not work for them, go through at least two types of augmentation therapies and get a preauthorization from their insurance. The first person they would have to talk to is their primary care provider to see if TMS would be the best method of treatment for them. NeuroStar Advanced Therapy also accepts many other commercial and government insurances, including Tricare. However, Medicaid is not included in that list.

If they receive the prescription, the patient can go to the nearest TMS provider. One of the first steps in the process is filling out a patient healthcare questionnaire for depression. If their score is 20 or above, they qualify for TMS. However, if their score is under 20, they are not eligible.

Patients who qualify will typically have a total of 36 sessions, spread out over nine weeks. For the first six weeks, they must do five sessions per week. During the seventh week, they must do three sessions. Week eight consists of two sessions, and week nine is only one session. In the case where an individual’s doctor may deem it necessary, they will do more or less than the usual 36 sessions.

In order for the treatment to be effective and for insurance to continue covering it, the patient must attend their sessions. In some extenuating circumstances, like if they are sick, rescheduling a few appointments will not affect their eligibility. However, if they miss too many, insurance will no longer cover it, so that is something to be mindful of.

Trinity Riverside is the only facility in the state of North Dakota that offers transcranial magnetic stimulation through NeuroStar Advanced Therapy. Anderson said that at the moment, only Major Despressive Disorder (MDD) is covered by insurance. She also said that TMS has saved lives. Those who were struggling with their depression and suicidal thoughts or tendancies that underwent TMS saw an improvement in their mental health.

Some research is being done to see what effects TMS would have on helping indiviuals with Attention Deficit/Hyperactivity Disorder (ADHD), Obsessive Compulsive Disorder (OCD) and those that are on the Autism spectrum.

Trials have been done for individuals that have Parkinson’s Disease and stroke patients. TMS showed promise by easing the patients’ problems with movement. One woman from Ohio had a stroke in 2013 and she underwent TMS. After just six sessions, she retained enough of her fine motor skills that she could pick up BBs.

TMS could also help alleviate Post-Traumatic Stress Disorder (PTSD), anxiety and chronic pain. While depression and PTSD are targeted on the left side of the brain, anxiety is targeted on the right side. The electromagentic pulses that are used for PTSD, anxiety and chronic pain are at a lower frequency to slow activity.

Transcranial magnetic stimulation has a wide variety of uses and can help in all sorts of ways, especially mental illness. MDD is something to be taken seriously and it’s a good thing that steps are being taken to help those that desperately need it.

Those who have questions about TMS should contact their primary care provider.