Antidepressant medications and psychotherapy are the first line treatments for major depression. These treatments, however, do not work for all patients. In these instances, TMS might be used as an alternative treatment, or to augment antidepressant medications or psychotherapy. Patients who have failed to achieve an adequate response from antidepressants, or who are unable to tolerate medications, might consider and respond well to TMS therapy.

Because TMS uses magnetic pulses, before beginning a treatment, patients are asked to remove any magnetic-sensitive objects (such as jewellery, credit cards). Patients are required to wear earplugs during treatment for their comfort and hearing protection, as TMS produces a loud clicking sound with each pulse, much like an MRI machine. Patients are seated comfortably during each session of TMS.

During the first TMS session, several measurements are made to ensure that the TMS coil will be properly positioned over the patient’s head. Once this is done, the TMS coil is suspended over the patient’s scalp. The TMS technician then measures the patient’s motor threshold, by administering several brief pulses. The motor threshold is the minimum amount of power necessary to make the patient’s thumb twitch, and varies from individual to individual. Measuring the motor threshold helps the TMS Technician to personalise the treatment settings and determine the amount of energy required to stimulate brain cells.

Once the motor threshold is determined, the coil is then brought forward so that it rests above the front region of the patient’s brain. Treatment is then commenced. During the treatment, patients will hear a series of clicking sounds and will feel a tapping sensation under the treatment coil.

Motor threshold is not checked at every treatment but may be reassessed if there is concern it may have changed, for example, because of a change in medication.

At TMS Erina TMS is always prescribed by our psychiatrist Dr Mason or Dr Montanari. At TMS Erina, all TMS physicians and technicians have received training and are specifically credentialed in TMS. The initial motor threshold is always determined by a psychiatrist. The treatment itself is administered by an experienced TMS technician under the supervision of the TMS psychiatrist.

The TMS technician will monitor the patient during the treatment. The patient can stop a treatment at any time by asking the staff member present.

Each session last approximately 19 minutes using our standard protocol. There is a new treatment protocol available using Theta Burst which lasts 3 minutes, and may be suitable for certain patients if they are interested.

Patients receive TMS 5 days a week. A typical course of TMS is 4 to 6 weeks. However, this can vary depending on an individual’s response to treatment.

By treatment number 10 patients start noticing an improvement in mood. Most patients should have a good response after 20 treatments.  A more severe depression may require 30 treatments.

If you know you have a holiday or time away coming in the two to three months from starting treatment, just let your TMS technician know as the treatment has a gradual kindling effect so it is important not to miss more than a few days in the middle of your course. Your technician  can discuss with you what your best options are. We can do tapering towards the end of the treatment course if travel is essential.

Unlike ECT, TMS does not require any sedation or general anaesthesia, so patients are fully awake and aware during the treatment. There is no “recovery time”, so patients can drive home afterwards and return to their usual activities.

People undergoing TMS describe the ‘magnetic taps’ as irritating, but not painful. After a few sessions clients often get use to this feeling.

TMS is well-tolerated and associated with few side-effects and only a small percentage of patients discontinue treatment because of these. The most common side-effect, which is reported in about a fifth of patients treated with TMS, is headaches. These are mild and usually settle over the course of the treatment. Over-the-counter pain medication can be used to treat these headaches.

You may experience tingling of the forehead muscles.These too tend to diminish over the course of treatment although adjustments can be made immediately in coil positioning and stimulation settings to reduce discomfort.

The TMS machine produces a repetitive noise and because of this earplugs are given to the patient to use during the treatment. Patients with tinnitus may be more sensitive to the noise of the repetitive pulse and may require headphones in addition to earplugs. No evidence suggests these effects are permanent if earplugs are worn during the treatment.

TMS is not associated with many of the side-effects caused by antidepressant medications, such as gastrointestinal upset, dry mouth, sexual dysfunction, weight gain, or sedation.

The most serious risk of TMS is seizures. However, the risk of a seizure is exceedingly low. At TMS Erina, we follow up-to-date safety guidelines that are designed to minimise the risk of seizures. While TMS is a safe procedure, it is important to point out that because it is a new treatment, there may be unforeseeable risks that are not currently recognised. These are discussed in detail with your TMS psychiatrist prior to treatment.

TMS is non-sedating.  Patients can drive after their treatments.

TMS and ECT and both forms of brain stimulation. They use different techniques to modulate nerve functioning. Both are more effective than medication but have very different side effect profiles. ECT uses electricity. TMS is a milder treatment using magnets. TMS does not involve the use of anaesthetic or chemical treatment and the patient is awake throughout the procedure. 

Unlike ECT, TMS is not associated with memory loss.

Neurofeedback is a method that has been extensively studied in the treatment of ADHD, sleep and epilepsy. However, there is very little controlled research done on the effects of neurofeedback on depression. For this reason, Neurofeedback cannot be seen as an evidence-based approach to treat depression. TMS is extensively studied in the treatment of depression and therefore has a greater chance of treatment success.

Contraindications are: 

• Epilepsy
• Cochlear Implant
• Stroke in the past 6 months
• Retinal Detachment
• Brain Shunt
• Pacemaker (relative contraindication) 

Patients can have metal fillings or metal bridges in the mouth and still have TMS.

Download Patient Screening Form

It is hard to predict who will respond to TMS and who will not. By treatment number 10 there is a clear differentiation into 2 groups-responders and non responders. Responders show a sustained reduction in depression scores. Non responders do not show decreased depression rating scores. Approximately 50-60% of patients receiving TMS  will be responders.

There is evidence for using TMS for anxiety using right sided low frequency treatment. Medicare funded TMS is only available for depression and has a bigger evidence base. For this treatment we use the standard left sided protocol.

There is a relapse risk on stopping medication. Combining TMS with medication is likely to give better results. Once a person has been well for 6-12 months then medication could be reduced and stopped. If a person is not tolerating medication and it needs to stop, then that should be done either slowly or with a cross taper to another antidepressant to minimise withdrawal symptoms.

For Medicare subsidised TMS, the following criteria must be met: 

• A person has depression that has not responded to 2 different antidepressants or to therapy.
• If a person has tried and cannot tolerate medication this is taken into account also.  

Before TMS treatment is commenced a thorough suitability assessment is conducted by the psychiatrists at TMS Erina.

TMS is offered at TMS Erina. Before scheduling you for treatment, you must first be evaluated by one of our TMS psychiatrists to determine if TMS would be safe and appropriate for you.

You will need a GP referral or psychiatrist referral to receive TMS treatment at our clinic. 

Should your GP wish to discuss the treatment with our Psychiatrist please use our contact number 02 4314 7000 or email us at admin@tmserina.com.au

Download GP Referral Form

Referrals can be faxed to 02 4314 7007 or emailed to admin@tmserina.com.au

Yes, Medicare provides a rebate for those who meet the following eligibility criteria:

• A minimum of 18 years of age.
• Diagnosed with major depressive episode and provide a referral from a GP or psychiatrist
• Failed to experience relief of symptoms after trialling a minimum of two antidepressants
• Have also undertaken psychological therapy (unless inappropriate)
• Have not previously received TMS treatment

For more information about Medicare and TMS treatment please click here.

To find out if TMS is for you, please seek further information from your GP or psychiatrist. As stated above a referral is necessary for TMS treatment.

Patients who have their medical expenses covered by the Department of Veterans Affairs or Workcover may have the cost of TMS covered. Contact our staff to discuss your individual situation. We will arrange for an initial appointment to determine if TMS is the right treatment for you.

At this stage private health insurance companies do not cover the costs of outpatient TMS. As the legislation changes, health insurance companies are likely to provide cover for TMS treatment. We recommend that you keep in touch with TMS Erina as new updates arise.

TMS may seem expensive but it is considered to be a cost effective treatment alternative. (Please refer to the related article by Voigt, Carpenter, Leuchter “Cost effectiveness of comparing rTMS”). Not only did the article find TMS to be more cost effective than antidepressants. It also found TMS to be clinically more effective for treatment resistant depression.

Our staff will guide you through all the costs involved before you decide if TMS is right for you. It is important to us that you feel comfortable about the therapy before you start so knowledge is key. They will also provide you with the information you need to know about the treatment and how to get the most out of it. Take advantage of our initial assessment with our psychiatrist to help you decide. Is TMS is right for you? Call us on 02 4314 7000