On the TMS front, I finally got to speak with a TMS practitioner and got a bunch of questions answered. He's a researcher, though, who runs clinical trials with drugs primarily. It's been months since he's had a TMS patient, because there are no more clinical trials his group is involved in now. Several places I've read the most powerful predictor of a successful outcome for a given doc for most non-trivial procedures is the number of times they do the procedure. As a result, I'm going to pass on this provider, but the stats sound worth trying it somewhere else, at least for me.
The procedure is typically one session a day, five days a week for three weeks. Each session is about an hour long with 45 minutes of actual treatment. It is important that the sessions run consecutively – no week or two week breaks for a vacation in the middle of the procedure. Cost is about $12-15K and insurance rarely covers it.
The most recent data shows about 50-60% are able to reduce their meds by half and 30% are able to go off their meds all together. Folks who have failed with multiple anti-depressants taken alone or in combination have lower success rates, but they don't have hard numbers for that. Same is true if someone tried ECT and it failed. Longer term about 30% of the people have a relapse of depession and require booster treatment. The total data available for this is limited, though, as they've only been tracking it for two years.
The most common side effect is minor irritation at the site where the magnetic coil rests. They recommend taking Advil or Tylenol prior to each treatment to minimize the effect. There have been incidents of seizures, but they are apparently very rare. He told me that the frequency is at or below what one gets with anti-depressants and no one at his organization has ever had one. Regardless, he said it's a good idea for an MD to observe the entire first treatment session just in case. He also recommends that the initial alignment/placement be done by an MD. It needs to be accurate to within about a millimeter for best effect.
If one is already on anti-depressants, he does not recommend stopping their use prior to treatment. They do find, though, that it may be desirable to lower dosages as the treatment proceeds. The treatments have a tendency to increase the potency of the anti-depressants one is taking, so scaling back may be appropriate. Prior to every session one fills out a depression scale and there's a brief consultation to determine if a meds adjustment is appropriate.
Stay tuned for info from my next data collection session from a different doc next week.