Now offering Accelerated TMS
Two-day or Five-day TMS therapy
Since 2011 TMS Huntsville has been treating patients with a standard daily treatment protocol of 36 treatments (or more) stretched out over 9 weeks. Recently the FDA has cleared a protocol of 50 treatments delivered in 5 days. A modified application of this treatment is now offered at TMS HSV. Response data from patients treated so far is available on request.
Over the last 10 years, studies utilizing TMS therapy delivered multiple times a day have shown benefits in accelerating patient response. Now the FDA has cleared an accelerated protocol that delivers 50 treatments during five days.
This protocol was developed at Stanford University and data was published in the American Journal of Psychiatry in 2021 Stanford Neuromodulation Therapy (SNT): A Double-Blind Randomized Controlled Trial . In this study, nearly 80% of treated patients achieved remission from depression compared to 13% that received sham (placebo) treatment . Sham treatment is the delivery of a pulse sensation to the treatment site that does not have a real treatment effect. The sensation mimics the “real treatment” sensation.
What was the schedule and equipment in the SAINT study?
The treatment protocol had patients receiving a 9-minute treatment once per hour 10 times a day with a 50 min rest between sessions for five days. The TMS system utilized a MagVenture Stimulator. Pulses were delivered using intermittent Theta Burst (iTBS) . MagVenture was granted FDA clearance for this second generation TMS type in 2018.
Is Accelerated TMS safe?
Very few side effects occurred during the study. Some patients noted slight fatigue and the frequency of headache was slightly higher compared with the sham placebo TMS group.
Pros of Accelerated Treatment
Certainly, treatment that is completed in five days offers an advantage over the traditional six week plus tapering phase of traditional TMS therapy. The high remission rate with multiple treatments per day also suggests this treatment may be more effective than once daily TMS.
Cons of Accelerated Treatment
This treatment is not yet covered by insurance companies and represents a higher out of pocket cost. The durability of the treatment has not been as well-established as traditional once daily treatment. It could be that patients may need TMS treatment reintroduction more frequently in the future to maintain response.
TMS Huntsville protocol for Accelerated TMS
At TMS Huntsville, we are utilizing a MagVenture TMS System and the same Cool B-65 coil used in the original study. Treatments are 9 min Theta burst as in the original study with a 50 min rest between treatments.
One difference would be the placement of the coil on the scalp. We utilize anatomical landmarks on the skull to approximate the coil position. This approach has been utilized for the last several years great success over a wide variety of patient types.
In the Stanford study, patients underwent structural and functional MRI studies before treatment. During treatment, neuronavigated coil positioning allowed the researchers to choose a position that could enhance treatment response.
More research is needed to determine which aspects of the SAINT protocol have the most impact on response, but it is reassuring that protocols utilizing more than one treatment per day have shown advantages in multiple studies over the last several years.
DISCLAIMER: SAINT TM is a trademark of The Board of Trustees of the Leland Stanford Junior University (“Stanford”) and Magnus Medical is licensed to use this term. TMS Huntsville is not endorsed nor licensed by Magnus Medical or Stanford, and does not claim to be offering the SAINT protocol as prescribed by Stanford University et. al. or Magnus Medical.
The "ONE-D TMS" protocol
(“Optimized, Neuroplasticity-Enhanced Depression treatment” )
This protocol is not yet FDA approved but provides 20 ( not 50) treatments every 30 min instead of every hour like the SAINT protocol. Neuronavigation with MRI for mapping was not used, yet the 32 patients in the original study had 90% response and 70% remission rates on anxiety and depression scales .
When patients need a very short treatment experience , Dr Hayden has offered a protocol modeled after the ONE -D providing 20 treatments split into 2 days. This treatment is optimized with pre-treatment of D cycloserine and lisdexamphetamine (Vyvanse) to improve brain response.
Theta burst treatments ( 3 min) are given every 27 minutes. Patient time is about 5.5 hr at the office for 2 consecutive days.
Low mood, lethargy, apathy, and loss of humor.Overpowering sadness and despairPiercing feelings of shame and guilt.Self-harm, substance abuse, and suicidal ideation.Struggling with responsibilities.Self-isolation from social activities.In Major Depressive Disorder, these symptoms persist and the assistance of a mental health professional is needed. Call 1-800-273-TALK
When I met Dr. Hayden, I felt like I was pushing around a metaphorical grocery cart full of fragments, shards, and pieces of myself. Everything was stuffed randomly in bags and boxes. There was never any reason to talk about this scattered mess of components, because how could any good be found in such chaos?
During TMS treatment, I felt like these fragments began to coalesce into whole pieces of me that I thought were lost. Things that had been lost for years returned to me: my creativity, the light I carry for helping people, my intellectual curiosity. Instead of waiting for each day to be over, I found myself singing my toddler to sleep with all the love and peace I deserve.
Following TMS, I find myself no longer standing on the shore watching the ocean and the horizon line. Now, I have access to the space in the sky above the land and sea. No longer am I a sleepy and lonely observer. Finally, I am a part of the world around me in all dimensions.
Dr. Hayden has curated a careful collection of support staff. I cannot give a higher complement to his whole practice, from scheduling, to prescription management, to TMS therapy; all personnel are intent on their patient and are carefully attuned to their emotional needs as these needs evolve over the course of treatment. There was never a doubt in my mind that my health and well-being were the top priority. Dr. Hayden’s success is rooted in his intense curiosity and can also be attributed to his adaptability and agile consideration when off-normal circumstances are presented.
For anyone considering TMS therapy, I highly recommend it. I only wish I had found this practice much sooner and gotten more of my life back!
I will try to keep this short but there is so much I would like to say to sing the praises of Dr.Hayden and his staff. Never have I experienced such caring and compassion in a healthcare environment not to mention the expertise in their field of study. Thank you Dr.Hayden for accepting me as a patient. TMS saved my life!