TMS FAQs

See Dr Wick’s answers to the most common TMS questions below.
  • Transcranial magnetic stimulation (TMS) is a non-invasive treatment for depression and several other conditions. 

    It is drug-free, safe, usually long lasting and now we are having no out of pocket costs if treating depression. Its been around for 40 years and has been heavily researched but it has taken time coming to Australia. TMS involves using magnetic fields to stimulate different parts of the brain. When this is done repeatedly it can lead to to growth and strengthening of neural connections (this is also known as neuroplasticity). TMS also increases the natural release of brain hormones responsible for depression such as seritonin.

    TMS doesn’t involve any drugs or sedation. Nothing is placed inside the body. TMS avoids the side-effects associated with antidepressants.
  • TMS involves stimulation of nerve cells by using focal magnetic impulses. During a single session, a patient receives thousands of stimulations directed at specific targets in the brain depending on which condition is being treated. When this occurs, brain cells change their activity. This results in safe, non-invasive, long-lasting change.

  • The main benefits of TMS treatment include the following:

    • A course of TMS often results in long-lasting change.

    • TMS is drug free. Patients do not have to deal with medication related side effects.

    • Research suggests TMS has a higher effectiveness than antidepressants in patients with mild-moderate depressions who have not responded to 2 or more antidepressants.

  • TMS has few side effects and is often long lasting. Some patients may occasionally experience temporary light headedness or mild scalp tenderness after treatment. These side effects can be usually fixed quite easily with some modifications. Risk of seizure is very low if you have no risk factors (1 seizure in 50,000 treatment sessions if you have no risk factor). This risk of seizure with TMS  is lower than almost every single antidepressant.

  • TMS was actually invented in the 1985 by Dr Anthony Barker in Sheffield. It was FDA approved in 2007 for Depression. In subsequent years it was used to treat anxiety disorders (PTSD, OCD) and chronic pain.

    TMS has been present in Australia for around 15 years. However, the big change in recent times is that Medicare began to subsidise TMS for the first time in November 2021.

  • For depression, TMS has approximately 60% efficacy in patients who have failed multiple antidepressants. Of these patients, 71% remain in remission after 1 year. In patients who are not treatment-resistant but are highly sensitive to medication, the efficacy is approximately 80%.

    Reference: Camila Cosmo, Amin Zandvakili, Nicholas J Petrosino, Yosef A Berlow, Noah S Philip. Repetitive Transcranial Magnetic Stimulation: Recent Critical Advances in Patient Care. Current Treatment Options in Psychiatry. 2021 Mar; 8:47-63.

  • No its not. ECT (Electroconvulsive therapy) and TMS (Transcranial Magnetic Stimulation) are not the same. While both come under the overall category of “Neurostimulation,” they are actually quite different.

    ECT uses an electric current to specifically cause a seizure. When a person experiences a seizure it is thought that there is a large dump of neurotransmitters (seritonin, noradrenhaline and dopamine) resulting in the “hitting of a reset button.”

    TMS on the otherhand uses a focal magnetic field to penetrate the skull and stimulate the nerves of the brain. This stimulates both growth and healing. Unlike ECT, we do NOT want to cause a seizure.

    ECT is usually done as an inpatient in hospital. It requires sedation that this overseen by an anaesthetist. ECT if often saved by patient with severe catatonic depression or psychosis. TMS, unlike ECT is not associated with cognitive side effects such as memory loss.

  • If treating depression, you will have $0 out of pocket with the Medicare rebate. We are very proud to be the first clinic in Australia to offer this pricing model. To get the medicare rebate you need to be referred by your GP to our psychiatrist for a TMS suitability assessment. We can treat other conditions, but the price will vary depending on the duration of each treatment session and whether we are treating depression as well as another condition.

    DVA and Workcover will also cover TMS.

  • Please see your GP or other medical practitioner for a referral to our service. In order to be eligible for a Medicare rebate for treatment-resistant depression, we need a referral from a GP or psychiatrist.

    If you are a medical practitioner who wishes to refer a patient, please see our ‘Referrals‘ page for options on how to refer to us.

    If you would like to discuss the suitability of a referral or any details of the treatment please call 6230 3996 or email [email protected]

  • No, you do not require an MRI prior to your initial review with the TMS psychiatrist. If further tests are required, the psychiatrist will discuss them with you during your appointment.

  • 1. REFERRAL
    Your GP/psychiatrist will refer you to us for TMS therapy. A team member will contact you to book your first appointment.

    2. INITIAL REVIEW & TMS PRESCRIPTION
    Our TMS Psychiatrist will have an in-depth review with you to ensure you are safe to proceed, obtain informed consent and prescribe the appropriate TMS therapy protocol.

    3. MAPPING & RESTING MOTOR THRESHOLD
    Our TMS Psychiatrist and TMS Technician will perform mapping and determine the RMT prior to the first treatment session. This can be done in advance or on the same day as the first treatment session.

    4. ACUTE TREATMENT PHASE
    You will receive TMS up to 5 times per week for 20-30 sessions, delivered by our TMS Technicians. During this time, we will regularly check to see if you’re responding well to treatment. You can listen to music or watch TV. A nurse will be present to assist you.

    5. ONGOING TREATMENT PHASE
    Our TMS Psychiatrist will review you and assess the need for further TMS sessions (up to 35 total if under Medicare).

    6. DISCHARGE
    Our TMS Psychiatrist will write a detailed treatment summary on discharge. If required, you may have maintenance therapy at a reduced frequency.

  • Yes, you can drive, work, study or do anything that you would do normally. There are no limitations or restrictions on what you can do. There is also no need for any fasting before treatment.

  • Our TMS rooms have televisions and music within the treatment room. As such, you are free to watch TV (Netflix), listen to music, sit quietly, relax or chat with your friendly Neuralia nurse.

  • TMS is not painful or invasive.

    TMS is felt as a rapid tapping sensation over the scalp. This sensation lasts for 4 seconds, after which there is an 11-second gap. This cycle continues for a total of 20 minutes. During this time feel to watch Netflix in our treatment room, listen to music, sit quietly or chat with our TMS nurse.

    If the tapping sensation feels too strong, we simply reduce the intensity. The sensation tends to be variable and depending on an individual’s scalp sensitivity and the stimulus dose.

  • No, you do not. Rather, we recommend not making any changes to your mediction prior to commencing TMS. This allows us to more clearly ascertain the cause of any of your improvements. Often patients who respond well to TMS do end up coming off their medication.

    Please note: this is general advice and your TMS psychiatrist may provide different advice depending on your personal circumstances.

  • Studies have shown that the best results occur when patient have treatments 5 times a week (for a 19 minute session). If the occasional session needs to be skipped, this is unlikely to greatly impact treatment effect. If patients simply cannot attend 5 times a week, we can discuss a reduced frequency of 3-4 days a week.

    The number of total treatments required is variable and individual. Most people require approximately 20 sessions. Some people require up to 35 sessions or more. Medicare currently cover up to 35 sessions for treatment resistant depression.

  • That is ok. Missing the occasional session will not be deterimental. However, missing many treatment sessions in a row is not ideal and may result in decreased effectiveness of the treatment. If you are sick, it is important that you contact us on 6230 3996 or via email at [email protected]

  • Not just yet, your TMS psychiatrist will discuss this issue during your final TMS session. If you have had notable clinical improvement, your TMS psychiatrist will provide your GP a plan for how you can start weaning yourself off the antidepressant. This process should be done cautiously, conservatively an in consultation with your GP.

  • If you have a positive response to TMS but unfortunately begin to relapse, then Medicare will be able to cover a 15 session Retreatment TMS sessions (5 times a week for 3 weeks).  Please call us if your mood begins to deteriorate and we will be happy to advise you on the next course of action.

  • Maintenance TMS is often brought up in the final review if one has had a good response to TMS. Maintenance TMS involves receiving TMS sessions either once a fortnight or once a month to reduce the likelihood of experiencing a relapse or deterioration in your mood. This process can help keep neuroplasticity ticking over. While certainly not a requirement, it does provide additional protection against relapses and increases the likelihood of the changes being long-lasting

  • A well documented phenomenon in TMS has been the intrinsic delay associated with neurostimulation. This is the same reason why we advise patients that signs of improvement are usually first seen between session 15 and 20. As such, it is not uncommon for patients to continue to show improvement for 6 weeks (or longer) after their TMS sessions have ended.

  • If they are starting Maintenance within 2 months (or near enough ie. 2 months + 1 week), then they do not need to remap.

    If they are starting Maintenance between 2 months and 4 months they will will remap them privately at the reduced fee of 100 dollars

  • What is Maintenance TMS?
    Maintenance TMS is for ensuring patients who are doing well remain doing well. Treatment is done either fortnightly (gold standard) or weekly.

    Maintenance TMS is not covered under Medicare’s additional 15 sessions and will be cost patients 70 dollars out of pocket

    What is Retreatment TMS?
    Retreatment TMS is a 15 session course (5 x week for 3 weeks) for depressed pateints who previously did well but now have relapsed. Its a 2nd course.

    Retreatment TMS is covered under Medicare’s additional 15 sessions provided its been 4 month’s since their final TMS session and they did a DASS score at the end of final TMS session and they have done a DASS score at least 4 months later. And this DASS score number has reduced.

Neuralia TMS are the Transcranial Magnetic Stimulation (TMS) specialists in Perth, WA. TMS is non-invasive treatment for depression and several other conditions.

Phone: 6230 3996
Email: [email protected]
Fax: 6230 2231
Healthlink ID: neuralia

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