When we first speak with you, we will need to gather information about your psychiatric history including diagnoses, medications tried, psychotherapy/counseling history, health care professionals you have seen. We will need to secure HIPAA-compliant releases of information to other doctors and health care professionals for your records. We will also gather demographic and insurance information. Upon coming to our offices to sign releases we will furnish more information packets to you and if available you may meet with our coordinator or one of our other technicians and see the MagVenture system (unless it is in use which it typically is). After gathering information which generally takes 1-2 weeks, we will decide whether to go forward with the next step.
He’ll explain more in detail how TMS works, what it feels like and will then walk you to the TMS room to meet with Terry Chumley our coordinator. You will get to sit in the TMS chair and have a demonstration of magnetic stimulation on your arm to make your fingers twitch to simulate the motor threshold procedure.
If TMS is the right treatment for you, treatment sessions can be scheduled to begin immediately following approval by insurance company if needed.
TMS Therapy is a short outpatient procedure, performed in office under Dr. Cook’s supervision while you remain awake and alert. During treatment, you can relax in the treatment chair. Keep in mind that TMS Therapy is:
At the first treatment appointment, Dr. Cook and staff need to determine how to most effectively administer treatment and your first session could last up to an hour and a half. You will be provided and asked to wear protective earplugs—the system’s magnetic pulses make a loud clicking sound and feel like a tapping on the scalp, but do not result in more than mild discomfort.
Dr. Cook will first perform a test to identify your motor threshold (the amount of magnetic field strength that results in a movement of the fingers of your right hand). This test is important because it identifies the magnetic field strength that will be used in your treatment. This field strength is customized for each patient to deliver the correct treatment dose.
Next, 3 measurements on your head will be fed into a computer program to find the best treatment spot called the dorsolateral prefrontal cortex. We use the corrected Beam F3 equations.
The TMS team will then administer TMS Therapy over an approximately 19-minute period. In 30-second intervals, the device will deliver rapid “pulses” of the magnetic fields. These will feel like tapping on your scalp. Everyone refers to this as “the woodpecker.” If you find this tapping uncomfortable, your physician or technician may be able to make adjustments to reduce this discomfort. We always recommend taking an over-the-counter pain reliever such as Tylenol, ibuprofen, or Aleve 1 hour prior to your first 5 treatments to minimize headaches. This is rarely necessary after the first few sessions.
If necessary, you can treat this discomfort with an over-the-counter analgesic. If these side effects persist, your TMS physician can temporarily reduce the strength of the magnetic field pulses being administered in order to make treatment more comfortable.
A usual course of treatment for depression involves sessions 5 days a week for 7-8 weeks. In some cases if remission is reached earlier and is sustained for several days we will stop. As you progress through your treatment, we will regularly assess and share with you your status and determine with you the eventual number of treatments. We utilize standard depression rating scales weekly to aid in your care. We perform weekly depression testing to assess your progress.
TMS Therapy is FDA cleared for patients who have not benefited from prior antidepressant treatment. TMS Therapy is indicated for the treatment of Major Depressive Disorder in adult patients who have failed to achieve satisfactory improvement from prior antidepressant medication at or above the minimal effective dose and duration in the current episode.
TMS is the breakthrough technology for non-drug treatment of depression and promises to be the future of psychiatric treatment—providing hope for patients for whom medication treatment and psychotherapy have failed to achieve satisfactory results. At TMS of Knoxville, we have successfully treated many patients with treatment resistant depression
