Login
Book

Accelerated and Traditional rTMS

TMS is one of the latest treatments for treatment resistant depression and many other mental health conditions.

What is TMS Treatment?

TMS stands for “Transcranial Magnetic Stimulation.” 

TMS treatment has been extensively researched and has been successfully used in in the treatment of a number of different conditions including depression, OCD, PTSD, neuropathic pain, fibromyalgia, amongst other conditions. 

TMS is a brain stimulation treatment that passes small electromagnetic currents through  specific areas of the brain that can be targeted by placing a specially designed coil near the patient’s scalp. The energy applied though the coil, acts to stimulate nerve cells in a particular brain region.  

There are several protocols of treatment which involve delivering pulses of stimulation at 10Hz, 50Hz, theta burst or low (1Hz)  frequencies.  

At Best Brains and Minds Specialist  Clinic, we  also specialise in the delivery of Accelerated rTMS protocols ( 5 day, 50Hz theta burst,  50 sessions of treatment).  

We also offer treatment under NeuroNavgation, using MRI brain scans to target the treatment area of the brain.  

  • Is TMS therapy like ECT?

No. TMS treatment does not require general anaesthetic or any sedation. Patients are able to return to normal activities immediately after treatment. TMS does not have any negative impact on memory or cognition.  

  • How does TMS treatment differ from taking antidepressants?

TMS is a non-systemic treatment so does not travel through the blood stream like medications. TMS is a focused brain stimulation treatment that does not have the common side effects commonly seen with some medications. 

NB: Medications have helped many people with depression and continuing with antidepressant and psychotherapy while having TMS treatment can work together towards remission.  

  • Which Protocols are used for depression?

Best Brains and Minds use well researched and published protocols for treating conditions with TMS. For depression there are a number of  established protocols that stimulate either the left or right Dorsolateral Prefrontal Cortex (DLPFC).  These protocols involve delivering pulses of stimulation at either high (10Hz) or low (1Hz) frequencies. Another protocol delivers pulses at a much more complex frequency known as theta bursts. The specialist will choose the most appropriate treatment depending on the pattern of symptoms and the specific clinical Indication for TMS. 

  • How Does it work for depression?

Depression affects the executive function of the thoughtful  part of our brain called the pre-frontal cortex. When this part of the brain is healthy, we are able to experience a range of emotions, consider many sensory and memory inputs, weigh the  pros and cons using factual information to make  decisions thoughtfully.  

When we are suffering from depression we lose the ability to be thoughtful and the negative and fearful thoughts dominate.  

Treatment with rTMS,  which is targeted  on the pre-frontal cortex, or thoughtful part of the brain, reaffirms it’s dominance and connectivity, making us feel in control, organised, and happy again.

  • How does TMS work for PTSD?

In treating PTSD, MRI-strength magnetic pulses are delivered to a region of the brain called the dorsolateral Prefrontal Cortex (DLPFC). This is one of several areas of the brain involved in mood regulation and anxiety. TMS exerts its effects via myriad of complex pathways. TMS is thought to help normalise the activity of this brain region which communicates with deeper brain regions responsible for PTSD and its symptoms.  

How does TMS work for OCD?

TMS works for obsessive compulsive disorder by delivering magnetic pulses to safely stimulate a particular region of the brain called the orbitofrontal cortex (OFC). This is one region that is involved in anxiety, and TMS treatments are thought to help normalise its activity and communications with other areas that contribute to OCD and it’s related symptoms.  

Do I need a referral for TMS?

Yes, patients need a referral in order to receive TMS treatment. A referral can be obtained from your GP, Psychiatrist or allied health professional. Referral forms can be found on the website under the “for GP’s” tab at the top of the page. Alternatively your referring health care professional can email referrals to [email protected] 

Is TMS an approved treatment?

TMS was approved by the TGA for treatment of medication-resistant depression in 2007 and is recognised by the RANZCP. Currently TMS for other conditions is an off-label treatment.   

How long does a TMS session take?

There are a number of TMS treatment protocols which are specifically related to the condition being treated and the related symptoms.  The Psychiatrist will determine and prescribe the most appropriate protocol for your condition. Standard sessions typically take approximately 15-20 mins per session. Accelerated protocols may take approximately 3-9 mins per session. Depending on the protocol prescribed, treatment may be 10 sessions daily for  5 days,  daily sessions for several weeks, or several sessions a week for several weeks. A total of 35 sessions are covered by Medicare for eligible patients. 

How long will the benefits last?

Depression, PTSD and OCD  are complex conditions and the benefits of TMS treatment can vary from person to person. Measures of improvement can include, improved mood, improvement in overall function, psychological and emotional wellbeing, improved sleep and quality of life and reduction in medication requirements.  

TMS is known to have long lasting effects, however the duration of these can vary between individuals due to personal biological and environmental factors.  Some patients have had extended periods of remission on medication alone, others may need  TMS  maintenance treatment.  

What does the treatment feel like?

Patients that have undergone TMS treatment often describe the treatment as a “tapping sensation” which occurs during the TMS machine pulse.  Occasionally this may feel uncomfortable but can be managed effectively with buffers or over the counter pain relief medication if required. The TMS machine provides a loud clicking sound when the pulses are being delivered, so patients are encouraged to wear ear plugs during their treatment.  

Questions

Everything you need to know about our treatments and clinic

Are there any possible side effects?

TMS is a well tolerated and safe treatment. Only a small number to people discontinue treatment due to side effects. Common side effects include: 

  • Headache and fatigue: these are the most common and occur in approximately half of patients  undergoing  treatment. These side effects are usually minor and generally resolve over the course of treatment. Simple over the counter pain medication is usually sufficient to treat the headache.  
  • Scalp discomfort: This is usually minor and occurs in approximately one third of patients. Adjustments can be made to the coil position on the scalp and treatment stimulation settings reduced to reduce discomfort.  
  • Seizures: Seizures are an extremely rare side effect. They are usually of short duration and self-limiting. Patients are screened prior to treatment  to ensure they do not fall into this risk category.  

All patients are carefully monitored during treatment sessions by qualified and trained clinical staff. Side effects will be managed and are reversable once treatment stops.  

The patient’s 3D Brain MRI image is the method used to determine the site for coil placement in the TMS treatment. This takes into consideration the patients individual brain structure and external navigation points. This allows the clinician to place the coil over a specified target location within millimeter of accuracy. The coils position is one of the most critical elements of a successful treatment.

An experienced TMS clinician  will conduct a thorough assessment prior to treatment to ensure safety and suitability for treatment. Generally, patients with a history of epilepsy or have metal implants in their head should not receive TMS treatment.  

This can include (not exhaustive): 

  • Metallic implants in your head, ears, eyes or neck (not including dental implants) 
  • Metal stents in the neck or brain 
  • Other metal objects around your head region 
  • Facial tattoos with metallic ink 
  • Deep brain stimulators 
  • Aneurysm clips or coils 

Yes, TMS can be conducted in an outpatient setting. There is no sedation or anaesthetic required and the patient is fully awake and can return to normal daily activities immediately after treatment.

Prior to TMS clients will be assessed to rule out any other possible organic causes for their depression. This may involve blood tests or an MRI where indicated. In most cases patients will not need to do any other specific preparation before treatment.  

Prior to treatment patients will be asked to remove any magnetic related objects such as mobile phone, jewellery, and will be offered ear plugs. The patient will be seated in a comfortable chair, with the TMS coil resting on the scalp to target the specific location of the brain. Patients will hear a series of clicking sounds during the treatment and feel a tapping sensation on the scalp under and adjacent to where the coil is placed. This produced by the TMS coil delivering the pulses of stimulation. The treatment is delivered by an experienced clinician under the supervision of a TMS specialist psychiatrist. The clinician will always be present to monitor the patient throughout treatment to ensure safety and comfort. The patient can stop treatment at any time by asking the staff member.

There  are a number of protocols of TMS for a number of conditions. Each are tailored to the conditions and symptoms we are aiming to treat. For patients who have multiple comorbid conditions, a personalized treatment plan will be determined. The duration of treatment may vary in these cases dependent upon the condition(s) being treated.  

The treatment plan will be assessed on an ongoing basis according to how the patient is responding and the treatment goals.  

NB: Each specific condition to be treated must be provided on the referral form.  

Scientific research is currently being conducted around for world for its possible use in other conditions such as treatment for pain, Alziehmer’s disease, Parkinson’s disease, ADHD, smoking addiction, Multiple Sclerosis, Stroke and more.  

At Best brains and Minds we deliver treatment for depression, PTSD and OCD. 

Patients must fulfil the following requirement to be eligible to receive Medicare benefits 

  • Be over 18 years of age 
  • Be referred with depression as their primary diagnosis 
  • Have not previously received TMS therapy 
  • Have triad at least 2 classes of antidepressants without satisfactory improvement with patient adherence to antidepressants treatment, the recommended therapeutic dose trialled for at least 3 weeks, the treatment titrated to the maximum tolerated dose (where clinically appropriate).  
  • Have undertaken psychological therapy, if clinically appropriate.  
  • Have not received a completed course of TMS previously under Medicare. (if unsure, we can assist clients to clarify this).  

Get the Support You Deserve

Please call Best Brains and Minds and discover if traditional rTMS is right for you.

Contact Us
(02) 8317 5440