TMS Articles
Learn more about different aspects of accelerated fMRI-guided TMS. See if treatment can help you live the life you want to live.
- Lack of neuroimaging — Repetitive TMS uses a one-size-fits-all targeting method that does not account for individual variations in head size, shape, and brain structure, which can significantly impact treatment outcomes. Missing the TMS target site by a few millimeters can reduce the effectiveness of TMS treatment.
- Lack of consistency — With repetitive TMS, the magnetic coil is manually positioned over the brain stimulation site at the start of each session. But if your head moves during treatment—even slightly—the coil doesn't automatically adjust. This can lead to inconsistencies in where the stimulation is delivered, which may reduce treatment effectiveness over time.
- Lengthy course of treatment — Repetitive TMS is administered with daily sessions, 5 days per week over 4 to 6 weeks. This lengthy and demanding treatment schedule is often difficult for patients to complete amidst work, childcare, and other life commitments.
Frequently Asked Questions
How does TMS work?
TMS is a non-invasive outpatient procedure that uses magnetic fields to stimulate a part of the brain that’s consistently impacted by major depression. The brain region it targets is called the dorsolateral prefrontal cortex (DLPFC), which is associated with a patient’s ability to feel positive feelings such as reward and motivation.
During a TMS treatment session, an electromagnetic coil is positioned over the patient's head, directly above the DLPFC, and magnetic pulses are delivered at specific intervals to stimulate the neurons in that area. The result is TMS-induced plasticity that increases neural activity in that region, which can help alleviate symptoms and improve mental health in depressed patients.
What are the potential side effects of TMS?
TMS is a very safe protocol. Less than one in 10,000 treatments has an adverse outcome; the most commonly reported side effects are headache, scalp tenderness, and muscle twitching during treatment.
How is your approach to targeting different from SAINT™ TMS?
SAINT treatment, which stands for Stanford Accelerated Intelligent Neuromodulation Therapy, uses proprietary software developed by Magnus Medical to analyze fMRI data and pinpoint the ideal stimulation site in the dorsolateral prefrontal cortex. This software uses a specific algorithm to identify the brain area most anti-correlated with the subgenual anterior cingulate cortex (sgACC), which is believed to drive depression symptoms.
At Cognitive FX, we also use fMRI scans to determine the optimal stimulation site, but our approach relies on clinical expertise rather than Magnus Medical’s proprietary algorithm. A trained neuroscientist and physician use advanced post-processing of each patient’s brain to identify the ideal target based on functional connectivity patterns. While the methodology differs slightly, the end result—precision targeting of the DLPFC using fMRI—is functionally the same.
This distinction is similar to the difference between a brand-name medication and a compounded version: same active components and clinical intent, just without the proprietary branding. Cognitive FX has been providing clinical fMRI scans for over 10 years and has developed many of the tools needed to process scans in-house, avoiding expensive licensing fees. Allows us to provide the individualized target location at a lower cost.
How confident should I be that fMRI-guided Transcranial Magnet Stimulation can help?
TMS has been around for over 20 years. rTMS, the most common type of TMS, is delivered once a day for six weeks. fMRI-guided Theta Burst TMS is administered in 10-minute sessions, 10 times a day for one week. This new approach has been shown to almost double the efficacy of treatment. 79% of patients reported their depression in remission after treatment.
Why is the functional MRI important for TMS treatment success?
For patients with depression or treatment-resistant depression, the target site is called the Dorsolateral Prefrontal Cortex (DLPFC). This site is found in rTMS therapy by finding the motor cortex and measuring down 5.5cm. This approach can lead to many different targets based on head size and shape, which vary from patient to patient. Functional magnetic resonance imaging allows us to precisely target the DLPFC and ensure we place the TMS coil in the right location every time.
Chen et al 2024
What is the TMS treatment week like at Cognitive FX?
Treatment will last one week, 10 hours a day. The stimulation protocol will last about 12 minutes each hour, and then the remaining time will be used for cardio or rest. You will have your own private room to relax in during the rest period of treatment.
How do I know if your TMS treatment is right for me?
If you are dealing with symptoms of depression, TMS treatment could be right for you. If SSRIs haven't worked or you don't like the way you feel on medication, TMS could be a good option. As of now, fMRI-guided TMS is the most effective treatment option for those dealing with depression.
How much does fMRI-guided accelerated TMS cost at Cognitive FX?
Pricing ranges from $7000 to $12000, depending on what other services you might need. Given the recent FDA clearance of fMRI-guided Theta Burst treatment, most insurance companies have yet to add it to the formularies they cover. Medicare covers in-hospital treatment for $19,703.00. Treatment is eligible for HSA and FSA reimbursement.
What if I can only afford to go through my insurance?
Currently, insurance only covers the rTMS protocol, which takes six weeks and is about 45-50% effective. If you need to pay via insurance, we have a sister clinic that offers rTMS treatment. Compared to other forms of TMS, you’re also likely to find a clinic offering rTMS closer to where you live.
SAINT Treatment Cost vs. Alternatives: What’s the Best Option?
Accelerated TMS Therapy: Complete Treatment Overview
Brain Stimulation Depression Treatment: Types & Effectiveness
