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Psychiatric Neurotherapeutics Program (PNP)
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 therapy for treating severe depression, as well as electroconvulsive therapy (ECT), an effective conventional therapy for chronic depression, mania, catatonia and schizophrenia. TMS and ECT are the first in a line of clinical neurotherapeutic services to be offered through the program.
With components in clinical care, research and education, the Psychiatric Neurotherapeutics Program is dedicated to improving the quality of life for individuals with depression and a broad range of other psychiatric illnesses. Our 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.
Transcranial Magnetic Stimulation (TMS)
What is Transcranial Magnetic Stimulation (TMS)
Transcranial magnetic stimulation (TMS) is a non-invasive treatment for adults with major depression that uses magnetic stimulation of the brain to help modulate 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 depression from one course of pharmacotherapy (medication). For this reason, transcranial magnetic stimulation (TMS) is particularly helpful for people with depression who have not experienced significant relief from antidepressant medications or have difficulty with side effects.
McLean uses the NeuroStar TMS Therapy® system developed by Neuronetics, Inc., a medical device company focused on developing non-invasive therapies for psychiatric disorders such as depression using MRI-strength magnetic field pulses.
How does Transcranial Magnetic Stimulation (TMS) work?
Transcranial magnetic stimulation (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 wire coil encased in plastic against one side of a patient’s scalp. An electric wire links the coil to a box containing one or more large capacitors (a device used to hold an electric charge). The capacitors are charged by a power source; electricity is discharged through the coil when the device is triggered.
The magnetic impulses are generated by the 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, transcranial magnetic stimulation (TMS) helps restore balance and relieve the symptoms of depression.
The Advantages of Transcranial Magnetic Stimulation (TMS)
Transcranial magnetic stimulation (TMS) is non-invasive and requires no anesthesia or sedation. The procedure typically lasts an hour during which time patients are awake, alert and comfortable. There are no restrictions on work or other activity before the treatment. Because no medications are administered, there are no systemic effects or cognitive after-effects (memory difficulty or ability to concentrate), therefore patients can return immediately to regular activity.
Treatment for Depression
Patients typically receive 20 to 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. A headset is applied to deliver the magnetic stimulation. Ear plugs are also provided to decrease the loud clicks associated with each magnetic pulse. Patients are given the option to watch television, listen to music or simply relax during the treatment session. During treatment the patient is monitored continuously to ensure correct coil positioning and comfort level.
Are There Risks and Side Effects with Transcranial Magnetic Stimulation (TMS)?
More than 10,000 treatments were safely performed during clinical trials. Patients 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.
Transcranial magnetic stimulation (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 Transcranial Magnetic Stimulation (TMS) covered by insurance?
There has been some limited coverage of TMS treatments by both private insurers (i.e., commercial indemnity and managed care plans) and public insurers (i.e., Medicare and Medicaid).
Medicare is now covering TMS treatment under certain conditions. McLean will bill Medicare for TMS treatment with the understanding that there are some coverage limitations. Patients work directly with their insurers to receive approval for TMS coverage. Once coverage has been determined, patients should contact the McLean Patient Accounts department to set up a payment schedule and to obtain information for applying to their insurers for reimbursement for out-of-pocket expenses.
For further information on McLean’s transcranial magnetic stimulation (TMS) treatment services for depression or a referral for consultation, please call 617-855-2360 or e-mail email@example.com.
About McLean Hospital
U.S. News & World Report named McLean America's #1 Hospital for Psychiatry in 2013 . McLean Hospital is the largest psychiatric facility of Harvard Medical School, an affiliate of the Massachusetts General Hospital and a member of Partners HealthCare. For more information about McLean visit us on www.facebook.com/ McLeanHospital or follow the hospital on Twitter@McLeanHospital.