TMS (also called repetitive TMS, rTMS, or rTMS treatment) is a safe, effective, and FDA-approved treatment for major depression that uses magnetic pulses, and doesn’t require antidepressant medications, surgery, or implanted devices. TMS offers an alternative to first-line treatment options for patients diagnosed with treatment-resistant depression and targets specific areas of the brain involved in mood regulation to relieve depression symptoms.

How Does TMS Work in The Brain to Treat Depression?

  • We use the NeuroStar® transcranial magnetic stimulator to direct magnetic pulses to a specific area of the brain involved in mood regulation called the dorsolateral prefrontal cortex (or DLPFC).
  • An electric current passes through a magnetic coil positioned over the head, generating a magnetic field that stimulates neurons (nerve cells) in the brain that are thought to be underactive in a person with depression.
  • TMS requires multiple treatment sessions over a period of 9 weeks. Over time, TMS allows neurons to change the way they communicate with each other, forming new communication pathways and new patterns of behavior.

Learn more about what happens in the brain after a TMS session.

At Madison Avenue TMS & Psychiatry, your care is our highest priority. We are dedicated to providing you with all the necessary tools and information that will make your TMS therapy in New York City as comfortable and effective as possible.

Our friendly staff is available to address any of your questions or concerns every step of the way. They will help you understand how TMS is used in the treatment of depression, what to expect from TMS therapy in NYC, and support you in your mental health journey.


What to Expect from TMS Therapy in NYC, From Start to Finish

TMS therapy screening - phone

Preliminary Phone Screening

If you’re interested in finding out whether TMS treatment is right for you, please take our quiz. If you’d like to commence treatment, please contact us for a preliminary phone screening.

During this initial conversation, we will gather some basic information and ask about your insurance coverage, as well as answer any questions you may have about undergoing TMS therapy in NYC. Once we’ve contacted your insurance company, we will reach out to you again to discuss insurance coverage/payment options.

TMS treatment evaluation

Pre-Treatment Evaluation

This consultation is a chance for Dr. David Woo to get to know you, your symptoms, and your medical history to determine if TMS therapy in New York City is the best treatment option for you, and to tell you more about the TMS treatment process. After this appointment, we will submit a pre-authorization to your insurance company and coordinate your insurance coverage. We are also able to work with you to arrange an out-of-pocket payment plan, if necessary.

TMS brain mapping treatment

Brain Mapping + First Treatment

The first step for successful TMS treatment is effective mapping of the patient’s brain to determine which point on the head should receive stimulation. During the mapping session, the technician will use the TMS device to send magnetic pulses and register the brain’s response until the optimal point is identified. This visit will take approximately 1.5 hours, and includes both the mapping process and the first TMS treatment.

TMS treatment weekly course

6-Week Treatment Course

Patients come in for treatment five days per week (Monday-Friday) for six weeks. After mapping, subsequent treatment sessions last approximately 20 minutes. Our treatment rooms are designed for your comfort, and we invite you to relax, watch television, or listen to your favorite music during sessions. Patients are asked to complete a weekly evaluation to measure progress. If determined necessary at any point during treatment, the technician may perform a re-mapping to improve treatment effectiveness.

TMS weekly taper period

3-Week Taper Period

After the six-week treatment course, there is a three-week taper period. Patients will need to come into the office for three TMS sessions in the seventh week, two sessions in the eighth week, and one final session in the ninth week.


Conditions That Transcranial Magnetic Stimulation (TMS) Can Treat

In the United States, the Food and Drug Administration (FDA) has only approved TMS for treatment-resistant major depressive disorder (MDD) and obsessive-compulsive disorder (OCD). However, numerous clinical trials provide evidence that TMS can safely and effectively treat other conditions, such as anxiety, PTSD (post-traumatic stress disorder), Parkinson’s disease, and ADHD. (1,2,3,4,5) Learn more about other conditions TMS can treat.

Insurance Coverage for TMS

Almost all major insurance providers cover TMS. Even if we’re not in-network with your insurance provider, we’re able to negotiate coverage for TMS as an out-of-network provider with nearly any plan. TMS is covered by Medicare, and sometimes by Medicaid. Learn more about insurance coverage for TMS.

Insurance coverage for TMS depends on a few factors, some including the condition being treated and the specific details of the patient’s individual insurance plan (like copay, deductible, and whether they have coinsurance). If insurance coverage isn’t an option, we can also work with you to develop an out-of-pocket payment plan to cover TMS therapy costs.

Cost of TMS Treatment

TMS therapy requires only a 9-week treatment period, and provides proven long-lasting results. TMS is covered by insurance, so the final costs of TMS will vary from patient to patient, depending on their insurance plan. Learn more about how the costs of TMS compare to the costs of antidepressant medications.


Frequently Asked Questions on TMS Treatment

What are the side effects of TMS?

There are only a few (usually minor) side effects reported by patients, and the majority of patients do not stop treatment due to them. The most common side effect reported by patients is slight pain or discomfort in the treatment area, usually only reported in the first week. Learn more about the potential side effects of TMS.


Will the treatment sessions fit into my schedule?

The Madison Avenue TMS & Psychiatry team will work with you to coordinate your schedule for TMS therapy in NYC. Office hours are Monday through Friday from 9am to 5pm, and flexible treatment schedules can be arranged. If you need to miss a treatment session, please let us know, and we will reschedule for the next available date and time that works for you.


What can I do and not do after a TMS session?

You can return to your normal daily activities immediately after each TMS session.


Can TMS be combined with other depression treatments, like my current medication?

TMS can be combined with most antidepressant medications, but Dr. Woo will evaluate all of your current medications and their compatibility during your pre-treatment evaluation appointment. You’re welcome to continue any psychotherapy you’re currently undergoing, or if you’re interested, we can offer you psychotherapy and medication management.


When will I start to see results with TMS?

The time it takes to see results with TMS will vary from patient to patient. Some patients report an improvement in depression symptoms in as little as 2 weeks, while others don’t notice an improvement until week 4 or 5. Patients who take longer to notice symptom relief are still receiving effective treatment and can still experience long-lasting relief from their depression symptoms. Learn more about what can affect your time to results.


How long do TMS results last?

How long the effects of TMS last will vary from patient to patient. Studies show that patients who achieve remission from depression are more likely to continue to show signs of remission or response to treatment even one year after completing a round of treatment. In some cases, patients may need a maintenance session of TMS. Learn more about what influences how long TMS results can last.


Who will I interact with during treatment?

Throughout therapy at Madison Avenue TMS & Psychiatry, you will see a technician at each of your appointments, who will guide you through each treatment. Dr. Woo will check in on your progress at least weekly, and he’s available for additional check-ins anytime you’d like.


Is your TMS therapy NYC location easy to get to?

Though appointments are required several times per week during the first 6 weeks of TMS therapy in New York City, public transportation makes it easy to get here. We’re located at 515 Madison Avenue, just one block from the E and M trains and a 10-minute walk to the N, R, W, and 6 trains. The north-south bus stops right on the corner, and the cross-town bus stops only four streets up. Parking is also available around the corner. Learn more about how to get here.


Is TMS right for me?

TMS is considered when patients do not see improvement in depression symptoms after trying at least 2 types of antidepressants. TMS cannot be administered to patients who have implanted metallic devices in or around the head (such as aneurysm clips or coils and electrodes that monitor brain activity) or who have electrical implants (such as pacemakers and ICDs). Learn more about who is a good candidate for TMS.


Resources:

1. L.Carmi et al. Deep Transcranial Magnetic Stimulation (TMS) in Obsessive Compulsive Disorder (Ocd) Patients. European Psychiatry. Published March 2015. https://www.sciencedirect.com/science/article/pii/S0924933815306180. Accessed July 09, 2020.

2. Paulesu E, Sambugaro E, Torti T, Danelli L, Ferri F, Scialfa G, Sberna M, Ruggiero GM, Bottini G, Sassaroli S. Neural correlates of worry in generalized anxiety disorder and in normal controls: a functional MRI study. Psychological Medicine. 2010;40(1):117-124. https://pubmed.ncbi.nlm.nih.gov/19419593/. Accessed July 09, 2020.

3. Namgung E, Kim M, and Yoon S. Repetitive transcranial magnetic stimulation in trauma-related conditions. Neuropsychiatric Disease and Treatment. 2019;15:701–712. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6430993/. Accessed July 09, 2020.

4. Khedr EM, Al-Fawal B, Abdel Wraith A, Saber M, Hasan AM, Bassiony A, Nasr Eldein A, Ahmeda, and Rothwell JC. The Effect of 20 Hz versus 1 Hz Repetitive Transcranial Magnetic Stimulation on Motor Dysfunction in Parkinson’s Disease: Which Is More Beneficial? Journal of Parkinson’s Disease. 2019;9(2):379-387. https://pubmed.ncbi.nlm.nih.gov/30909248/. Accessed July 09, 2020.

5. Cao P, Xing J, Cao Y, Cheng Q, Sun X, Kang Q, Dai L, Zhou X, and Song Z. Clinical effects of repetitive transcranial magnetic stimulation combined with atomoxetine in the treatment of attention-deficit hyperactivity disorder. Neuropsychiatric Disease and Treatment. 2018;14:3231-3240. https://pubmed.ncbi.nlm.nih.gov/30538481/. Accessed July 09, 2020.

6. FDA NEWS RELEASE. FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder. Press Announcements. Published August 17, 2018. https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-transcranial-magnetic-stimulation-treatment-obsessive-compulsive-disorder. Accessed August 28, 2020.