Frequently Asked Questions - For General Public

Am I a good candidate for rTMS?

You are a good candidate for rTMS if your symptoms have not improved with 1-2 or more medication trials of adequate dose and duration in combination with any counselling you have received. rTMS may also be helpful if you have been unable to tolerate medication.

Coming to the clinic for an assessment is the first step in determining if rTMS is right for you. We will walk you through the process, and provide you with information about rTMs to share with your family physician or treating psychiatrist. During your assessment, you will meet with clinical staff and a physician to assess your symptoms, review your treatment history, and determine if you are a candidate for rTMS.

Assessments can be done in person, or using video conferencing. We have a secure system that protects your privacy and confidentiality. If you are an appropriate candidate, we will provide your assessment findings and a recommended treatment plan to your family physician and VAC Case Manager.

If the treatment plan is approved by your Case Manager, we will then contact you to schedule your treatment.Prior to starting treatment, the question you should ask yourself is, "Am I interested in 3 weeks of daily treatment if it means a 50% chance of overcoming my symptoms?"

Are there any activity restrictions during rTMS treatment?

No. Most people do not require any recovery period after completing a session of rTMS, and may continue their daily activities as usual. There are no restrictions on driving before or after rTMS treatments. You do not need to bring anyone with you to your rTMS sessions, although some people prefer to have a spouse, relative, or friend accompany them for the first few treatments. If you are working, you do not need to stop working to undergo rTMS as long as your schedule can accommodate the treatment visits.

What are the potential benefits of rTMS?

rTMS has been successfully used since 2002 with 50% or greater reduction in symptoms in 50-60% of patients with depression.

What are the potential risks of rTMS?

For the majority of people, there are no serious risks to rTMS. The most common side effect with rTMS is discomfort during the stimulation session itself. In addition to stimulating the brain, the magnetic pulses of rTMS can also stimulate the nerves in the areas of scalp, forehead, or face near the stimulation coil. This creates an unpleasant sensation similar to static electricity. Over the counter pain remedies such as ibuprofen (Advil) or acetaminophen (Tylenol) can be helpful following the first few sessions.

A small number of people report fatigue or a mild headache in the hours after the treatment session is over. A small number of people (3-5%) may feel faint, or may briefly faint, during the first one or two sessions.

Much rarer risks include the emergence of hypomania (a high-energy, hyperactive state similar to the opposite of depression) or thoughts of self-harm (although not actual acts of self-harm) in less than 1% of cases.

The most serious known risk with rTMS is the induction of a seizure during brain stimulation, reported in approximately 1 in 10,000 cases. For comparison, the risk of seizure on most antidepressant medications is about 1-5 in 1,000 cases. Despite the risk of a seizure during actual stimulation, there is no evidence that rTMS can cause the more general condition of epilepsy, in which seizures occur spontaneously outside of stimulation sessions.

What happens during a course of rTMS treatment?

If you decide to undergo rTMS following your assessment, the first step is to get a MRI. After your MRI, you will come to the rTMS clinic for a calibration session, in which we locate the target region of the brain, determine the correct strength of stimulation for treatments and have you complete a series of standardized questionnaires to measure the severity of your symptoms.

A full course of treatment involves 20-30 sessions. With once-daily treatment, the course will last 4-6 weeks. If treatments are given several times per day, the course is shortened to as little as 3 weeks. A treatment session usually lasts just over 45 minutes. However, with some types of rTMS, the session can be completed in 10-15 minutes.

What are the costs associated with rTMS?

rTMS is a fee-for-service offering. There are various funding options available and we will gladly discuss these options with you during your initial assessment.

How can I get an appointment to discuss having rTMS assessment?

To set up an appointment for an rTMS assessment, please call 1-888-400-7094. A referral from your family doctor or treating psychiatrist is required, and can be faxed to our clinic or submitted electronically via the website.

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