New Options to Treat Depression

There are new options to treat depression other than the standard options of medications and psychotherapy (also known as talk therapy, counseling, or just therapy). If medication were not effective and therapy was not effective, ECT (Electroconvulsive therapy) was often used. However, this has side effects which most people find unacceptable (memory loss which can be permanent). The patient also has to undergo anesthesia, and it is very disruptive to both the patient’s life and the life of family members (who need to take the patient to ECT treatment and drive them home).

TMS (Transcranial magnetic stimulation) is a new option to treat depression. It doesn’t have the unacceptable side effects of ECT. It doesn’t have the side effects of memory loss, there is no anesthesia, and the patient can work and drive right after the procedure. These make TMS a great new option to treat depression for those patients that haven’t responded to traditional treatment for depression and want a safe, efficacious, with minimal side effect treatment. For those curious how the treatment works, you first would have your “mapping session” where you would “map” out to find the “depression center” of your brain known as the dorsolateral prefrontal cortex. This is done by taking measurements of your head and using a computer program to measure the correct distance from areas measured.

Once the spot is identified, this will be the treatment area. The next thing to do is to find the motor threshold. This is done by stimulating the motor cortex in the area that will make the patient’s thumb twitch. You try to find the lowest strength that will make the right thumb twitch. When this is found, the treatment is ready to begin, and the treatment can be delivered.

If this is something that you feel would be beneficial, you can contact Dr. Tanner’s office here to setup an appointment.

My Zoloft isn’t working, now what?

This is a common concern. The number needed to treat for Zoloft (sertraline) ranges from 4-14 (4 for severe depression and 14 for mild depression). Assuming the best of medications, that means out of 4 people only 1 of those 4 people would have a positive effect above placebo. That’s not great odds. So, if you are depressed, assuming the best of the medication, more likely than not the medication is not going to work for you. You can switch to a new medication, you can augment with another medication, or you can try other things.

Okay, so what happens after that if nothing has worked? Well, if your still not getting benefit from medications, then TMS (Transcranial magnetic stimulation) also known as rTMS (repetitive Transcranial Magnetic Stimulation) is a good alternative. It is FDA cleared for the treatment of major depressive disorder and can help those who are either drug-resistant (drugs are not effective) or drug intolerant (drugs have too many side effects to be taken) to standard anti-depressant treatments.

rTMS/TMS is a good tool to help answer the questions about what to do when your current anti-depressant stops working. The treatment for depression with TMS is 30-36 sessions of repetitive magnetic stimulation. The repetitive magnetic pulses stimulate the hypofunctioning (low functioning) area of the brain known as the “depression center” or medically known as the dorsolateral prefrontal cortex. fMRIs will show that after TMS, the activity in the depression center has gone up significantly which is associated with relief from depression.

If you are interested in TMS, we invite you to set up an Appointment with Dr. Tanner by going to our contact page located here. You can discuss with Dr. Tanner all of your questions about TMS and see if TMS is a good fit for you.

TMS and Anthem Blue Cross Blue Shield

A commonly asked question is whether Anthem Blue Cross Blue Shield will cover TMS (transcranial magnetic stimulation) treatment? The answer is yes provided that a prior authorization (permission from the insurance company) is obtained. Anthem Blue Cross Blue Shield states that TMS is considered “medically necessary” (a legalese term – meaning they’ll pay for it) when the following conditions are met:

#1 – Has a diagnosis of severe major depressive disorder
#2 – The individual has had 4 trials of psychopharmacologic agents (fancy for antidepressants) and has failed to respond to them OR unable to tolerate 4 different agents from 2 different
#3 – Of the 4 medication trials, 2 of the antidepressants have come from 2 different classes (SSRI, SNRI, Wellbutrin, Remeron, etc)
#4 – Trial has included at least 2 evidence based therapies (such as CBT)
#5 – Trial of at least 2 different augmentation strategies

Of all the insurance companies, Blue Cross Blue Shield seems to be the most rigid in terms of what they required prior to approval of TMS. However, if you are suffering with depression and have tried all of the strategies to treat your depression above, then TMS maybe a good alternative treatment for you. If you think that TMS would be a good fit for you and meet the above criteria, then the first step would be to schedule an appointment with Dr. Tanner to go over your medical and psychiatric history. You can go to our contact page here, and we’d be happy to discuss your case.

Thanks for reading.

TMS and Cigna

A frequently asked question is whether we accept Cigna insurance and if Cigna will pay for TMS (Transcranial Magnetic Stimulation). The answer is yes to both; we do accept Cigna insurance and Cigna does pay for TMS treatment provided that a prior authorization (permission from Cigna) is obtained prior to treatment. Cigna will approve TMS treatment if the following conditions are met:

#1 – The patient currently is diagnosed with major depressive disorder
#2 – Lack of clinically significant response to four trials of anti-depressants from at least 2 different classes (i.e. SSRI and SNRI or Mirtazapine or Wellbutrin, etc) OR the inability to tolerate at least 4 different medications in two different classes due to distinct side effects.

If these conditions are met, TMS and Cigna are sympatico. Cigna will most likely approve the prior authorization, and the TMS treatment can begin. A full treatment of TMS is 36 sessions (30 sessions of treatment with 6 sessions of tapering off over 3 weeks).

Many patients find TMS to be a better alternative to ECT since ECT requires anesthesia, you can’t work or drive after ECT treatment, and ECT can cause memory loss (sometimes can be permanent). These side effects are not an issue with TMS. You can drive after treatment; you can go back to work after treatment; you can get back to your normal every-day activities after your treatment. TMS is not painful and does not require anesthesia. This is a distinct advantage over ECT which is why most people find the potential side effects of ECT to be unacceptable and instead will opt for a trial of TMS treatment.

If you have any questions and TMS and Cigna, we invite you to contact us here or e-mail us at info@frontrangetms.com, and we would be happy to look into any concerns or questions that you have about TMS.

Alternative depression treatment

Many patients are frustrated with the standard treatment options for depression. The mainstay treatments are medications (antidepressants) and psychotherapy (also known as counseling, therapy, talk therapy). While these are typically successful for many patients, some patients find little to no relief from these types of treatment. Many look to the alternative depression treatments such as supplements (like St. John’s wort), blue light therapy, and for treatment resistant depression TMS (transcranial magnetic stimulation).

TMS can be a good alternative depression treatment because it is FDA-cleared, it has minimal side effects, is effective for depression, is drug-free, has no sexual side effects or weight gain typical of anti-depressants, no memory problems (like with ECT or electroconvulsive therapy). TMS treatment can be a good fit for you if you had not had successful results with other types of treatment for your depression.

Take a look at our website and the videos to see if TMS would be a good fit for you. The main drawback of TMS is having to come to the office for 30 treatments which some patients find burdensome. However, many patients when they put the time to invest in getting themselves better feel that it is well worth the time to come and get treatment. If you think that TMS is a good fit for you, you can contact us here at our contact page or you can text us or call us at 720-575-5400 or you can e-mail us at info@frontrangetms.com.

Thanks for reading about our alternative depression treatment. We hope that this was helpful for you.

TMS and Tricare

We are asked many times if Front Range TMS takes Tricare insurance and if Tricare will pay for TMS (transcranial magnetic stimulation). The answer is yes provided that prior authorization (permission) is granted from Tricare. Prior authorization will be granted provided that the following are true:

#1 – The patient is 18 years or older
#2 – The patient is experiencing a major depressive episode
#3 – It is medically necessary, and the patient has failed to respond to a less intensive form of treatment. The implication is that the patient has trialed at least 2 medications which has failed to respond and had a trial of psychotherapy.

If the patient meets this criteria than Tricare will cover the costs of TMS treatment. TMS and Tricare therefore is a good option if you are experiencing a major depressive episode and less intensive treatments have not been successful. At Front Range TMS, after we have initially met the patient and have determined that TMS is a good fit, we will send Tricare a prior authorization request. This can take from 1-10 business days depending on the responsiveness of Tricare. Once we have received approval from Tricare, we can immediately begin treatment with TMS to treat your depression.

If this seems to be a good fit for you, and you are interested in TMS treatment, you can contact us here or you can text us at 720-575-5400 or e-mail us at info@frontrangetms.com. We hope that we can be of benefit to you. Thanks for reading.

TMS and Medicare

Many patients ask if Medicare will pay for TMS (Transcranial magnetic stimulation). The answer is yes. Medicare will pay for TMS as long as the patient meets the following criteria:

#1 – Has a diagnosis of severe major depressive disorder

#2 – AND did not have a clinically significant response to a single trial of an antidepressant OR was unable to tolerate 2 different agents from 2 different classes

#3 – A trial of evidence-based psychotherapy known to be effective in the treatment of major depressive disorder was attempted without significant improvement.

If these three criteria are met, then Medicare will pay for TMS. A prior authorization is not required if the criteria are met. The first treatment (the mapping of the patient to find the dorsolateral prefrontal cortex AKA “the depression center of the brain”) is performed by a psychiatrist. All other treatments can be done by a TMS technician under the supervision of the psychiatrist. However, currently at Front Range TMS, Dr. Clint Tanner, MD will perform all treatments of TMS. He will personally verify that each treatment is correctly positioned to give treatment to the depression center of the brain.

If you have and other questions about TMS and Medicare, you can contact us here or go to the contact us page in our website, and we would be happy to answer your questions. We hope that you found our article helpful.

Non Drug Therapy for Depression in Denver Colorado

Many people suffer from depression. Depression is one of the most common illnesses: 18 million adults (one in ten) will have a major depressive episode in a given year. Sometimes medication can be life-saving treatment, but what happens when medications haven’t helped your depression? You can try switching to different medications, but some people have been trying different medications and combinations for years and still suffer from depression.

Enter TMS: Transcranial Magnetic Stimulation. TMS can help those in which medication hasn’t helped. It uses magnetic pulses which creates an electric current which depolarized neurons in specific regions of the brain. This increases blood flow and relieves depression. Front Range TMS delivers non drug therapy for depression in Denver Colorado.

TMS is also a good choice for those people who can’t tolerate medications or feel that certain side effects are unacceptable. We have heard some patients whose depression gets better when on antidepressants, but then they choose to stop the medication because of various side effects that they are experiencing such as weight gain, sexual dysfunction, emotional blunting, cognitive blunting, feeling tired or groggy, having headaches, etc.

TMS is a great choice for those who can’t tolerate antidepressants because of side effects because the side effect profile is very minimal. There can be some headaches/mild irritation to the scalp and only rarely could there be a serious side effect such as a seizure. TMS is delivered daily Monday thru Friday. Each treatment takes about 10 minutes. You can contact us at 720-575-5400 (you can text us too!). Major insurance companies will cover TMS treatment provided you have tried 2-4 medications, trialed therapy, and continue to be depressed. Your insurance company (other than medicare) requires a prior authorization (permission prior to treatment), so we can meet and fill out the appropriate documentation to get approval for your treatment.

TMS therapy

Are you looking for TMS therapy? Many people are looking for alternatives to treat their depression other than just medications. Medications can cause annoying and sometimes debilitating side effects which can include a decrease in sex drive (decrease libido) or other sexual dysfunction, fatigue, insomnia, restlessness, nausea, vomiting, and other problems. The compliance rate for anti-depressants is not surprisingly very low which is estimated to be around 30% or lower.

It is also not a good idea to let a major depressive episode go untreated as depression is “toxic” to the brain and can increase the chances of having future depressive episodes in the future. A FDA cleared(approved) treatment for depression is transcranial magnetic stimulation. This utilizes magnetic pulses to activate parts of the brain that are associated with depression. Over a series of treatments, the brain will respond to the stimulation and give an antidepressant effect which can lead to remission of the depressive episode.

Front Range TMS has the experience to deliver TMS to help with your depression without all of the side effects of medications. Each treatment will last approximately 19 minutes. Depending on your response, you may start feeling better within a few sessions. Some patients take up to 30-36 sessions for the maximum benefit to take effect. Just like medications, response to TMS therapy differs from patient to patient.

If you would like to learn more about TMS, please click here!

If you would like to schedule a free consultation with Dr. Tanner about how TMS can help you, please go to our contact page located here.

We appreciate you taking the time to read about transcranial magnetic stimulation or commonly abbreviated as TMS. If you have more questions about TMS, please take a look at our frequently asked questions located here.

Happy reading!

TMS Solutions

Many people in the Greater Denver Area are looking for a solution to their depression (or TMS Solutions). We frequently will receive calls that our patients have depression, but they do not like medications. They say that the medications “makes me feel weird” or they have intolerable side effects. They also do not like the Stigma of taking medications. “I don’t like having to rely on my medications” or “I feel weak when I have to take a medication everyday” or “I just hate taking something everyday to make me feel better.” They are looking for the right type of treatment that does not have the side effects, the stigma of taking medications, or anything that would alter how they perceive themselves.

This is where TMS comes in as a solution to people’s problems – it is a TMS solutions. The repetitive magnetic pulse can deliver equivalent or better results to improving depression than medications. The durability of TMS is also an important factor as medications have to be consistently taken for continued results. Research has shown that TMS can have a durable effect that can last up to a year or possibly longer and does not require sustained treatment. We hope that you take the opportunity to explore our website and discover the benefits of TMS treatment for depression.

There will always be a role for medications in mental health, but having TMS can be a life-saver for those looking for an alternative to medication. This knowledge can be the hope that you are looking for. If you would like to schedule a free consultation with Dr. Tanner, please contact us here or just us an e-mail, and we will be more than happy to get something scheduled for you.

Thanks for taking the time to read our post.