Non Invasive Depression Treatment

When antidepressants and therapy have failed, many search for non invasive depression treatment. There are invasive treatments for depression such as electroconvulsive treatment (ECT), vagal nerve stimulation (VNS) and deep brain stimulation (DBS). These can be helpful in extreme cirumcstances, but most people do not wish to undergo anesthesia or surgery for VNS or ECT. They do not want to have memory problems or surgical complications. Patients just want to feel better!

Transcranial magnetic stimulation is a good alternative to these very invasive procedures. It is safe and FDA cleared for the treatment of major depressive disorder. It requires no anesthesia and you can be on your way within a half an hour or less. You can drive after the appointment, and you can go back to work. The procedure is painless and feels like someone who is “tapping” on your head. There are minimal side effects. TMS is typically done Monday through Friday one session each day for up to 36 sessions. The last 6 sessions are “taper off” sessions in which you would do three sessions one week, then two sessions the next week, and then one session the last week. 

Outcomes have been good. TMS is regarded as an effective non invasive depression treatment. We ask that you take a look at our videos on our webpage and look at the information on our webpage to decide if TMS would be a good fit for you. TMS is paid by most major insurance companies provided that prior authorization (pre-approval) is granted by the insurance company. Essentially, they would like to know that you have tried and failed/unable to tolerate a trial of medications and therapy. If this is the case, the insurance company will approve treatment utilizing TMS to help treat your depression. 

If you’d like to make an appointment, you can contact us here. Thank you for reading.

We are commonly asked “What are other treatments for depression?” If medications aren’t effective, and they are helping with depression, then what are other treatments for depression? If medications are ineffective, therapy can utilized to help with depression (CBT – cognitive behavioral therapy, IPT – interpersonal therapy, psychodynamic therapy, behavioral activation).

If therapy is not helping or only helps a little bit, and you find yourself still feeling depressed, there is ECT – electroconvulsive therapy, TMS – Transcranial magnetic stimulation, IV ketamine (this is a medication, but not typically prescribed in a normal outpatient clinic). There are very invasive options such as Deep Brain Stimulation or Vagal Nerve Stimulation which require surgery.

Most people, even those who are very depressed, do not wish to undergo elective surgery for their depression or undergo ECT which have potential side effects including permanent memory loss. IV ketamine is promising, but longevity of this treatment is in question.

Since we are a TMS clinic, we of course feel that TMS is a great “Other” treatment for depression if medications and therapy is not working for you. It does not require anesthesia and has no risks of memory problems unlike ECT. You can drive after treatment or go back to work. Essentially, you can carry on your normal day without interruption other than the time it took for you to come to TMS treatment. It has shown to be effective to treat major depressive disorder and is FDA cleared and most insurance companies will cover TMS treatment provided a prior authorization is obtained prior to treatment.

If you have any questions, we invite you to take a look at our FAQ located here. If you are interested in becoming a patient with us at Front Range TMS, please contact us here, and we’d be happy to try to help you meet your mental health goals.

Different types of therapy for depression

There are different types of therapy (or treatment) for depression. There is medications which include SSRIs like Prozac (fluoxetine), Paxil (Paroxetine), Zoloft (sertraline), Lexapro (Escitalopram), SNRIs like Effexor (Venlafaxine) or Cymbalta (duloxetine) and other medication like Wellbutrin (buproprion) or Remeron (Mirtazapine). 

Alternative medication treatment include Ketamine infusions are being used to treat depression, though this typically does have a very long duration of action.

When these types of medications are not working, there is always psychotherapy utilizing different therapy methods for treatment including Cognitive behavioral therapy (CBT), Interpersonal therapy (IPT), and many others. 

If medications and therapy is not effective, neuromodulation can be used including Electroconvulsive Therapy (ECT) and Transcranial Magnetic Stimulation (TMS). TMS does not have the serious side effects of ECT such as memory loss and does not require anethesia. With TMS, you can drive home/go back to work after the treatment. There are no restrictions to any activities after TMS treatment. You should work with your therapy/physician/psychiatrist to determine which treatment is best to treat your depression. If you do decide that TMS is something that you’d like to seriously consider, you can contact us here. 

If I don’t want medication, what can I do for my depression?

Many people do not like mental health medication. There are a number of reasons that people do not like to take medications including:

1 – Don’t like the side effects of the medication (sexual side effects of SSRIs/SNRIs have been estimated to be as high as 60-70%)
2 – People may feel that “something is wrong with me” if they take mental health medication
3 – People may feel that the stigma of taking mental health medication is not acceptable as other will judge them as “crazy” or “unstable.”
4 – Many people don’t trust pharmaceutical companies and don’t trust medication claims either from effectiveness claims or safety claims
5 – Some people are concerned about long term complications from being on medications for long periods of time
6 – Cost of medication / Cost of physician visits. Although most antidepressants are fairly inexpensive now (with some exceptions), some find the cost of medication to be a hindrance to compliance
7 – Hassle of getting their prescription refilled. Many people have busy lives and do not wish to go to follow-up with their doctor on a regular basis and have to go to the pharmacy on a regular basis. Many people find dealing with insurance claims, waiting in pharmacy lines, waiting to see the doctor as unacceptable. 

There are alternatives to treating your depression that do not include medication. Some try exercise, supplements (i.e. St. John’s Wort), light therapy, and other things to treat their depression. If these things are still not working to help your depression, there is TMS (Transcranial magnetic stimulation) which is a FDA cleared non-medication/drug treatment for major depressive disorder. It can have long lasting effects to treat depression and is covered by most major insurance companies. 

If this seems like something that you’d be interested in, you can contact us at our contact page listed here.

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, 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

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. We hope that we can be of benefit to you. Thanks for reading.