Treatment Resistant Depression & TMS Services

Apply to the Treatment Resistant Depression & TMS Program

RICBT is now offering TMS Services to adults under Paul Bowary, MD. Continue reading to learn more about how TMS therapy works and how it will be conducted here at RICBT. To schedule an initial evaluation with Dr. Bowary, or if you have any questions or concerns regarding TMS services, please give our office a call at 401-294-0451 and request to speak with one of our TMS team members.

Transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in a specific area of the brain with suboptimal functioning in patients with depression. Prefrontal TMS therapy repeated daily for four to six weeks is an innovative treatment modality that is approved by the US Food and Drug Administration (FDA) as a safe and effective treatment for depression. TMS is typically used when other depression treatments (eg. antidepressant medications and psychotherapy) have not been effective.

In depression, the electrical and metabolic activity as well as the blood flow in certain areas of the brain is shown to be reduced. TMS can increase this brain activity which is proven to be biomarker of treatment response.  

The pathophysiology of depression is also understood to involve significant brain connectivity dysfunction. TMS is believed to affect two categories of brain connectivity: structural and functional. Structural connectivity refers to the anatomical connections between brain regions. Functional connectivity refers to correlation of neurophysiological events in spatially separated brain regions over time. The brain is known to be so interconnected, thus targeting of one section can trigger effects in other sections. TMS is thought to enhance the brain’s natural ability to change and create new neural connections.

The primary brain region targeted with TMS for depression is the dorsolateral prefrontal cortex also known as the DLPFC, which has demonstrated direct anatomical connectivity to different brain regions thought to control emotional and behavioral patterns. 

According to the National Institute of Mental Health, TMS is beneficial for roughly 50 percent of patients who complete several weeks of regular treatments. Research has shown that 50 to 60 percent of individuals with depression who failed to receive benefits from medications, do experience a clinically meaningful response with TMS therapy. About one-third of these individuals experience a full remission, (their symptoms of depression are permanently absent). The other two-third may require another course of TMS therapy to achieve improvement after depression relapse. Many of these patients feel better for many months after their last treatment was concluded.

Prior to your first treatment session, our TMS team uses advanced technology offered by NeuroStar to determine your unique treatment location and stimulation power needed.  

The TMS treatment procedure is performed while you are awake and reclined comfortably in a treatment chair (much like a dentist’s chair or spa chair). The treatment is non-invasive and is not supposed to affect your level of alertness or memory. You will thus be able to drive yourself to and from treatment session and immediately resume normal daily activities. There is no anesthesia or sedation.

During a treatment session, an electromagnetic coil is placed against your scalp near your forehead area. The coil painlessly delivers targeted magnetic pulses that penetrate the scalp and skull to cause nerve cells to send electrical impulses. The reasoning behind the duration of a TMS treatment course (up to 6 weeks) is that these impulses repetitively trigger a chemical reaction, that only over time, can end up lifting your mood and improving your depression symptoms.

• Initial evaluation appointment with one of our TMS certified doctors. During this visit, you will undergo an extensive psychiatric and medical assessment that will help confirm that TMS therapy is an appropriate treatment for you. You will also be introduce to the clinic, our NeuroStar TMS device, explain the science behind TMS therapy in more detail, and answer any questions you may still have about TMS.

• The first time you will be sitting in the NeuroStar TMS device’s chair will be for the determination of your unique DLPFC location as well as power of stimulation that is needed for your treatment. This session will take less than an hour and will be followed by your first treatment session. Treatment sessions normally last between 19 and 40 minutes. 

• The treatment course consists of a total of 36 treatment sessions. This includes 30 daily treatment sessions (five per week; Monday through Friday) and six “taper phase” treatments given over a span of 3 weeks. You will be asked to fill a standardized depression rating scale once per week which will help our team monitor your progress.

• Our TMS team will collaborate with your outpatient care team (primary care and psychiatric providers) during the course of TMS therapy.

• In the case of a subsequent depression relapse, a repeat course of TMS therapy may be needed and is usually covered by most insurance policies for patients who had a positive response to a previous course of TMS.

• Is NeuroStar safe and does it have any side effects?

As a FDA-cleared depression treatment, NeuroStar Advanced Therapy is safe and easy to tolerate. By design (being a non-drug and non-invasive modality), it is free of systemic side effects. NeuroStar is not expected to have direct effects on cognition or sleep (both of which are expected to get better if related to depression).  The most common side effect associated with NeuroStar is mild to moderate pain or discomfort that typically subsides within the first week of treatment.

• Is NeuroStar covered by insurance?

NeuroStar Advanced Therapy is covered by insurance nationwide, including Medicare and Tricare. Use our coverage search tool to see if your insurance provider covers NeuroStar treatment.

All TMS services will be led by one of our TMS certified doctors, with assistance from our certified TMS treaters.

Apply to the Treatment Resistant Depression & TMS Program