Patient Questions:
How long will it take to feel better?
Can i stop taking my medication?
Should I continue with psychotherapy?
Should I Start psychotherapy?
Does insurance pay for TMS? yes
Is there anything i can do to make it work better?
See Below under (What can I do to prevent relapse?)
What about Bipolar Depression?
Right DLpfc 1 Hz (calming)
The Anxious Patient:
Right DLpfc 1 Hz (calming)
The Anxious Family:
Everything is going to be OK
(but you don’T Get to define ok)
Not Getting Better after 5 or 10 treatments?
switch to Right DLpfc 1 Hz
Whayt if still Not Getting Better after 5 or 10 treatments of that?
switch to DMpfc 10 Hz
Symptoms worse after 1 or 2 treatments
switch to Right DLpfc 10 Hz or
switch to Left DLpfc 1 Hz
Left Handed Patients:
either start as if right handed, switch if feels worse
or start with Right DLpfc 10 Hz
Do we change medications? When? How?
take the same medications for first 2-4 weeks, but:
If taking mood stabilizers or benzodiazepines in the morning:
a) schedule TMS in the morning if possible and
B) wait to take the mood stabilizers or benzos after TMS treatment
Can TMS be combined with Ketamine?
Yes
How often do patients relapse into another depressive episode?
Nationally 30% in the first year but in our clinic…
Can I do it again if that happens?
Yes
What can I do to prevent relapse?
Physical Exercise
Eat less sugar and carbohydrates
Supplements: Omega-3 4,000 mg/day (1/2 AM, 1/2 with dinner, Magnesium 250mg at bedtime
Optional supplements: SAM-E, Folic Acid(B9), Tryptophan 500mg at bedtime
CBT/DBT/IPT/ACT/Mindfulness
What is maintenance therapy?
after 30 treatments,
one week of 3 x /week.,
one week of 2 x / week
one week of 1 x / week
and possibly 1 x / month if needed
Are there other areas of the brain that can be stimulated?
Yes, that is covered in advanced topics, but
98% of the patients you see will do fine with Left DLpfc
How do you know so much about this?
or why did you add TMS to your practice?
Because I care about my patients
and want to do everything i can
to help them feel better