By Cayden Antee, Synergy Strive TMS Treater (Silver Spring, MD)
Though the prevalence and effectiveness of TMS has greatly increased in recent years, it remains on the margins of public discussion, receiving little spotlight relative to medication and therapy. Because of this, many people don’t know much about TMS, and misconceptions are common. Below are several such misconceptions; we’ll discuss how they emerged, and get at what may be closer to the truth.
This is almost always one of the first things that patients ask, and it is a fair question! Both TMS and ECT treat depression and other disorders by physiologically acting on the brain, leveraging principles of neuroplasticity. This, however, is just about where the similarities end. ECT anesthetizes patients and delivers electrical currents to induce seizures, disrupting neural networks; this often leads to adverse side effects including permanent damage to the brain.
TMS is far less invasive, far safer, and has fewer (roughly zero) side effects. Instead of directing electrical current, TMS repetitively activates a magnetic field on the outside of the head, causing mood-regulating neural regions to activate as they usually would, only at a greater rate. In short, these two are optically similar, but not similar in function, mechanism, safety, or effectiveness.
Here are the facts: TMS (with us) consists of 36 brief appointments across two months. Most patients come in Monday through Friday, though we’re very flexible with scheduling around busy lives, work schedules, etc. For most patients, these sessions are 19 minutes long, and they’re in and out of the office in well under 30min.
Because of this, most everyone can work TMS into their schedules. Folks often come during lunch breaks, before work, after work, or on their weekdays off. While this may be a lot to ask at first, the brief appointment times and flexible scheduling allow all 36 sessions to be completed with minimal disruption to daily life. By the end of treatment, most patients are quite used to their new schedule and look forward to coming in!
While TMS can and does help with extreme cases of depression and OCD, it is not exclusive to them. It’s understandable to associate a magnetic brain treatment with severe conditions, but it’s actually quite efficacious to folks all across the continuum of symptomatology! We’ve had patients at all points of functionality, at all stages of suffering and grief, and at all levels of hopefulness.
Corporate executives, lawyers, university students, and school administrators (i.e., people of high functionality) have all walked through our doors for help. Additionally, some of our patients may have more mild, less global symptoms; they may not constantly feel miserable, but rather bothered by one or two symptoms (e.g., stress management, vocational motivation, etc.). These are just a few examples of the diverse set of people we work with. Using TMS, we can meet you where you’re at, whether you’re bedridden or just a little blue.
As is the case with many medical expenses, the out-of-pocket cost for TMS is, frankly, quite high. In recent years, however, insurance coverage for TMS has greatly proliferated. While 36 sessions once cost upwards of $7,000, TMS can now be fully covered depending on your health insurance plan.
At Synergy Strive, we accept the largest health insurance providers in Maryland and the DMV: CareFirst (BlueCross BlueShield), Medicare, Cigna, Aetna, and Johns Hopkins. Depending on your insurance plan and whether you’ve met your deductible, per-session copayments are usually between $0 and $25 (average is around $15/session).
While “affordable” and “expensive” are relative terms, practices like ours will work with you to attain the lowest out-of-pocket cost possible.
When you’re browsing testimonials online, there are two common stories. The first is “TMS saved my life” and the second is “TMS did not work whatsoever”. In reality, this pattern is likely attributable to social media algorithms desiring sensational content, and our minds seeking binary simplicity; it’s not necessarily reflective of the evidence.
Both in the published literature and in our practice’s data, there exists a whole range of patients between these two poles of responsiveness. Anecdotally, we’ve seen many patients improve in certain domains and not in others (e.g., improved motivation but unchanged hopefulness), thereby complicating whether they can be classified as a “responder”. This said, these two poles do exist, but rather as the two ends of a spectrum. Importantly (and fortunately), we see far more of those for whom it “fully works” than those for whom it “fully doesn’t”.
When thinking about the likelihood of improvement, make sure to talk to a clinician about what improvement actually looks like for you and others; not just how it’s categorized.
It’s hard to tell exactly what makes an individual feel better (or worse, for that matter). For TMS, we could ask ourselves: Is TMS making me feel better, or is it the expectation of improvement? Or is it rather that I have to get up earlier for my appointments? Is it because I’m now on a more consistent schedule? Or is it actually because I have a nice conversation with the technician every day?
Thankfully, a large amount of quality research has investigated these alternative explanations, finding that TMS has positive effects above and beyond any placebo. Researchers have found actual TMS recipients to improve much more than those who undergo everything else (daily appointments, technician conversations, magnet near their heads, etc.) only with fake treatment; this is called a sham control. Also, these are double-blind, meaning that even the doctors and technicians rating improvement don’t know who is receiving the treatment and who is in the sham control group.
This said, it’s also worth mentioning the genuinely beneficial effect of these “alternative explanations”. Having a regular schedule, knowing that you’re working on yourself, and conversing with a friendly face at daily appointments are all factors that can genuinely improve how you’re feeling in a meaningful way that we should not be quick to dismiss as “placebo”. Between these effects and the primary influence of TMS, we’ve been happy to see nearly all of our patients improve in some capacity.
Admittedly, this is only a half-myth: TMS is predominantly used to treat major depressive disorder. However, TMS is also approved to treat obsessive-compulsive disorder (OCD)! Many TMS providers (Synergy Strive included) have begun offering OCD services, and we’ve seen quite promising results in the reduction of compulsive behaviors. This said, receiving insurance coverage for OCD treatment can be a bit more challenging, and may at times require a comorbid depression diagnosis. Unsurprisingly, this is a leading reason as to why TMS remains more closely associated with depression (for now).
Additionally, while TMS targets depressive symptoms and requires a depression diagnosis, other areas of symptomatology and functioning can be collaterally improved. Many of our patients report reduced anxiety–both acute and chronic. Relational and occupational functioning often improve, as do many health behaviors. While TMS is usually directed toward depression on paper, it’s important to recognize that many positive effects are downstream of strengthening what we aptly call the “smart part of your brain”.
If you’re looking into TMS, we’d love to help. Fill out the contact portal on this page or give us a call and we’ll be in touch to discuss whether TMS is right for you! We offer insurance-covered NeuroStar TMS in Columbia, Towson, and Silver Spring, MD.
