Treatment Requirements

Coverage Approval

For coverage approval, typically health insurers require documentation to (which may vary by insurer) include:

Adult age
A diagnosis of Major Depressive Disorder (MDD), Moderate to Severe severity
Validation and measurement of the diagnosis and depression severity using a standardized rating scale (commonly the PHQ-9, which mirrors the DSM criteria for MDD)
Failure of 3 to 4 antidepressants during the current episode, with documentation of dosages, start & stop dates, and response to each
Failure of a course of validated psychotherapy during the current episode
Prior authorization from the insurer before starting

The process for initiating rTMS treatment typically includes:

Gathering preliminary information on prior treatment trials and health status for safety and insurance approval
Having in place releases of information to communicate with all medical and mental health providers for continuity of care.
Performing an assessment to verify appropriateness and safety of treatment
Formulating a plan to manage any medical comorbidities, such as the existence of any implantable electrical devices or metal in the body
The only firm contraindication to treatment with TMS is the presence of any ferromagnetically sensitive object in the head area.
Obtaining informed consent for treatment, including a discussion of expectations and the known potential risks, side effects and benefits, including that effectiveness is not guaranteed
The most medically concerning known side effect is the possibility of inducing seizures

Treatment typically requires:

Commitment and dedication to your own recovery. Response, like many antidepressant treatments, is typically seen weeks into the stimulation.
Daily transportation.
Payment of associated fees and copays (our office will assist in clarifying this for you)
Treatment is required almost every weekday for 9 weeks. This customarily includes 6 weeks of acute treatment 5 days per week, followed by a 3-week taper of thrice weekly for 1 week, twice weekly for one week, then once the last week.
The first day of treatment lasts longer, because time must be taken to determine the motor threshold (MT) and map the appropriate treatment location
Psychotropic medications are often maintained during and after treatment, especially of there has a been a partial response
Near daily interaction with a, experienced, knowledgeable and supportive treatment team, and frequent monitoring by the administering physician, aids in safety and recovery