7708_Optimizing_Patient_Selection_for_TMS_Treatment.pptx

TMS

1. Optimizing Patient Selection for TMS Treatment

2. MDD diagnosis Criteria for TMS Coverage by Insurance Companies Failure to ≥ 3 psychotropic medications At least 2 augmentation strategies

3. Augmentation Strategies to Consider Before TMS Treatment Aripiprazole FDA Approved Bupropion Other Commonly Used Quetiapine Buspirone

4. Criteria for TMS Coverage by Insurance Companies Intolerance to a certain number of medications Previous response to TMS ECT could not be performed Psychotherapy was tried

5. Search for the criteria by each insurance company Call the insurance company Fill out forms listing patient’s previous medication trials Confirming TMS Eligibility With Insurance Companies

6. If an Insurance Company Does Not Cover TBS, Perform Standard TMS

7. Medicare and TMS Coverage Started covering rTMS for depression in 2014, soon followed by insurance companies Medicare: Coverage: Is determined by medical necessity criteria Is provided through a local coverage determination

8. When to Avoid TMS History of seizures Contraindication Increases the risk of seizures during TMS Reason Metallic objects within 30 cm of the coil Can heat up during TMS and cause damage

9. TMS Manufacturers' Warnings: Untested Conditions Cerebrovascular disease Dementia Severe head trauma Tumors Increasing intracranial pressure Pregnant

10. TMS Usage by Age Range 22–70 FDA Approved From 18 years old Off Label

11. Other Off-Label Uses of TMS Bipolar depression Neurologic conditions Other major psychiatric disorders

12. Studies Suggest TMS Is Helpful and Safe for Bipolar Depression

13. Considerations for Choosing Suitable Patients for TMS Patient’s history of depressive symptoms Number of medications tried

14. Considerations for Choosing Suitable Patients for TMS Determine: The length of the depressive episode Severity and urgency of depression

15. Presence of psychotic symptoms Failure to thrive Cannot wait 6 weeks to see whether the patient improves Clinical Scenarios for Choosing ECT Over TMS

16. TMS Potential Effectiveness in Treatment-Resistant Cases History of side effects from medications More Likely to Be Effective Most antidepressants and augmentation strategies have been tried ECT has been tried Ketamine did not work Less Likely to Be Effective:

17. For Patients Who Do Not Respond, Ensure Psychotherapy Techniques Are Being Used

18. Discussing TMS Treatment With Patients Inform about: Treatment duration Characteristics of TBS or TMS How depressive symptoms will be measured

19. Additional Information About TMS to Share With Patients Response rate: 50%–60% There might be pain at the scalp site Logistics, insurance, and costs

20. Relapse rate after 6 months: 50% Patients should continue with medication and psychotherapy Insurance does not cover maintenance TMS What Happens After TMS Treatment?

21. Nonmedication Options for Treatment-Resistant Depression ECT Ketamine TMS Options: Factors to Consider: Cost Availability Time involvement Transportation to treatment

22. Obtain the patient's depression history, details of the current episode, and past treatments. Insurance medical necessity criteria guide whether a patient is eligible for TMS. Key Points

23. Contraindications for TMS include seizure history or presence of metallic objects in the head. Practical aspects of TMS include logistics and insurance coverage. Key Points

24. Next Presentation Exploring Other Uses of TMS