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TMS Info For Professionals

 

What is rTMS?

rTMS is a Health Canada approved treatment for major depressive disorder. The Canadian Network for Mood and Anxiety Treatment (CANMAT) identify rTMS as a first line treatment for people whose condition has failed to respond to one antidepressant. Unlike psychotherapy or medications, rTMS directly stimulates the brain through the use of a magnetic pulse applied to the scalp. The pulse then directly stimulates neurons in specific brain regions (for example, the dorsolateral prefrontal cortex). The magnetic pulse is as strong as those used in MRI machines, but is much more focused and targeted. This is a non-invasive procedure. Through the repetitive use of these pulses, rTMS aims to either inhibit or stimulate different brain regions in order to attempt to restore normal brain functioning.


What disorders can be treated with rTMS?

rTMS treatment has the most evidence for its effectiveness in the treatment of Major Depressive Disorder. rTMS is Health Canada and FDA approved for this indication. Response rates are approximately 60% and remission rates are approximately 30-40% in those with refractory depression. rTMS can be helpful in treatment of the depressed phase of bipolar disorder, obsessive compulsive disorder, and post-traumatic stress disorder. It is also used for certain pain conditions.


When should I consider referring a patient for rTMS treatment?

rTMS can be considered as treatment in the above mentioned conditions. rTMS can be considered in cases where medications trials have been unsuccessful, but the individual has ongoing significant symptoms of major depression. It can also be considered when medications are poorly tolerated. Remission rates for rTMS start to exceed remission rates for antidepressants after 1 to 2 failed trials of medications. People who were unable to tolerate ECT due to side effects can also consider rTMS.

When an individual is referred to ANSR clinic, they meet with a psychiatrist who completes an assessment to determine whether (1) the individual is an appropriate candidate for rTMS and (2) whether it appears that they would benefit from rTMS. However, because TMS is NOT currently covered by MSI, individuals must have third party payment or pay out of pocket for treatments. The clinic has financing options available. There is no charge for the initial consultation.

 

What medications may interfere with rTMS?


GABAergic medications and anticonvulsants may interfere with the effects of rTMS and are ideally avoided when people receive rTMS treatment. For most patients, if clinically possible, anticonvulsant medications (such as gabapentin, lamotrigine, phenytoin, valproate, carbamazepine) can be discontinued prior to treatment under care of their doctor. Benzodiazepines can also impact rTMS so if possible, it is suggested that these medications be tapered prior to rTMS treatments. These medications can impact the tolerability and likelihood of success with rTMS treatments.

How do I refer a patient for rTMS treatment?

Please complete the referral form and we will contact the patient directly to schedule an appointment. If you would like any further information you can also call us and we would be pleased to speak with you about the treatment and procedure.

We would also be pleased to meet with healthcare providers to allow you to see the machine and how a treatment session works. If you are interested in doing so, please contact us by phone at: 902-466-ANSR (2677) or email: info@ansrclinic.com