The Clinical Application of Transcranial Magnetic Stimulation

Transcranial magnetic stimulation (TMS) provides psychiatrists with a new treatment o!ering in clinical practice. Providing an o"ce-based procedure is new for psychiatrists, and incorporating this procedure into practice has brought new challenges. The clinical delivery of TMS has various possibilities for o"ce operations, management, and overall structure. Di!erent clinical models and providers include traditional private practices, device partnerships, networked practices, institutions, and dedicated TMS centers. Practical considerations of using TMS, such as o"ce set-up, training, sta"ng, and safety considerations are reviewed. More insurance plans are now covering TMS, but usually only after failure of multiple antidepressant medications. Criteria vary, but they play a large role in shaping the practice. TMS treatments can be clinically categorized as acute, tapering, booster, or maintenance treatments, depending on when they are being delivered. [Psychiatr Ann. 2014; 44(6):305–309.] Transcranial magnetic stimulation (TMS) has created a new paradigm for psychiatric treatment. For decades, psychotherapy and prescription pads have dominated psychiatry, but now, with the advent of TMS, there is a medical procedure that can be performed right in the doctor’s office. It is easy to underestimate how different this is for psychiatrists, who are now in the position of actively delivering a treatment to a mostly passive patient. TMS is expanding what constitutes traditional psychiatric practice. In October 2008, Neuronetics (Malvern, PA) received clearance from the U.S. Food and Drug Administration (FDA) for the first TMS machine (the NeuroStar TMS Therapy System) (Figure 1), and they began installing machines in 2009. The Deep TMS System device (Brainsway, Jerusalem, Israel) (Figure 2), which utilizes a magnet with a different geometry and magnetic field than the NeuroStar device, was approved by the FDA in January 2013. Now, not only is TMS finding its role in psychiTodd M. Hutton, MD, FAPA, is Associate Clinical Professor of Psychiatry, USC Keck School of Medicine; and Medical Director, Southern California TMS Center. Address correspondence to: Todd M. Hutton, MD, FAPA, 180 S. Lake Avenue, Suite 615, Pasadena, CA 91101; email: todd@socaltms.