Edward Ratush MD
Dr. Ratush is available early morning, evenings, weekends and holidays. Call for an appt:  (917) 512-6082
NEUROSTAR TMS
WHY CHOOSE TMS RECOVERY?


Neurostar TMS Therapy is the most innovative method cleared by the US Food and Drug Administration (FDA) for patients suffering from major depressive disorder. It is the only form of TMS therapy that has been FDA-approved for treatment-resistant depression. For other Psychiatric and Neurological Disorders TMS Recovey is beeing utilized as an off-label treatment. It is thought that TMS will eventually be approved by the FDA for the treatment of several disorders originating in the brain. Contact Dr. Ratush if you are interested in TMS Recovery. He will evaluate your eligibility for treatment and discuss the benefits/risks and up to date evidence for using TMS Recovery in your specific case.

Transcranial Magnetic Stimulation is a treament that can be performed in a psychiatrist's office, under their supervision, using medical device called the NeuroStar TMS Therapy system.

Non-invasive

TMS Therapy does not involve surgery. It does not require any anesthesia or sedation, as the patient remains awake and alert during the treatment.

Non-systemic

TMS Therapy is not taken by mouth and does not circulate in the blood stream throughout the body.

What is Treatment-Resistant Depression?

While currently available medications and psychotherapies are effective for many people with depression, unfortunately a substantial number of people do not respond. When depression is resistant to treatment, it can become chronic, lasting for long periods of time in some cases. Depression can also recur, making long-term maintenance strategies very important.

Through a treatment coil, the NeuroStar TMS Therapy system generates highly concentrated, magnetic fields which turn on and off very rapidly. These magnetic fields are the same type and strength as those produced by a magnetic resonance imaging (MRI) machine.

The treatment coil is applied to the head above the left prefrontal cortex. This part of the brain is involved with mood regulation, and therefore is the location where the magnetic fields are focused. These magnetic fields do not directly affect the whole brain; they only reach about 2-3 centimeters into the brain directly beneath the treatment coil. As these magnetic fields move into the brain, they produce very small electrical currents. These electrical currents activate cells within the brain which are thought to release neurotransmitters.

BENEFITS AND RISKS


NeuroStar TMS Therapy has been demonstrated to be safe and tolerable.

Over 10,000 active treatments were safely performed with NeuroStar TMS Therapy during the clinical trials.

No side effects such as weight gain, sexual problems, stomach problems, sleepiness, or dry mouth were seen during trials.

There were no negative effects on memory or ability to concentrate

The most commonly reported side effect related to treatment was scalp pain or discomfort during the treatment session. This side effect was generally mild to moderate, and occurred less frequently after the first week of treatment. Less than 5% of patients treated with NeuroStar TMS Therapy discontinued treatment due to side effects.

NeuroStar TMS Therapy has been demonstrated to be effective in Major Depressive Disorder.

Efficacy was established in a controlled clinical trial comparing active treatment with the NeuroStar TMS Therapy system to an inactive device. Patients treated with active NeuroStar TMS Therapy experienced an average reduction in their depression symptom score of 22.1% compared to a 9% average reduction in patients receiving inactive treatment. NeuroStar-treated patients also experienced significant improvement in anxiety, appetite changes, aches and pains, and lack of energy associated with depression.

In an open label trial, which is most like a real world clinical practice, approximately 1 out of 2 patients treated with NeuroStar TMS Therapy experienced significant improvement in depression symptoms. Approximately 1 out of 3 patients treated with NeuroStar TMS Therapy experienced complete symptom relief at the end of 6 weeks. As with any antidepressant treatment, patients should be monitored for symptoms of worsening depression.

Which patients are good candidates for NeuroStar TMS Therapy?

NeuroStar TMS Therapy is an appropriate treatment option for adult patients with Major Depressive Disorder who have failed to achieve satisfactory improvement from one prior antidepressant medication at or above the minimal effective dose and duration in the current episode.

In clinical trials, half of the patients had been treated with at least four medication treatment attempts, one of which was at an adequate dose and duration.

NeuroStar TMS Therapy has not been studied in patients who have not received prior antidepressant treatment. Efficacy has not been established in patients who have failed to receive benefit from two or more prior antidepressant medications at minimal effective dose and duration in the current episode.

Not all patients are appropriate candidates for NeuroStar TMS Therapy. To determine if NeuroStar TMS Therapy may be right for you, contact our office to speak with a physician.

Patients That Should Not Receive NeuroStar TMS Therapy

NeuroStar TMS Therapy should not be used in patients with implanted metallic devices or non-removable metallic objects in or around the head (for example, metal plates in the skull, aneurysm coils, etc.) because serious injury could result.

Patients with braces and metal fillings are acceptable for treatment; however, patients with other metal within their mouth should discuss this with their physician.

NeuroStar TMS Therapy should not be used in patients with implants controlled by physiological signals. This includes pacemakers, implantable cardioverter defibrillators (ICDs) and vagus nerve stimulators (VNS).

WHAT PATIENTS CAN EXPECT


Pre-treatment Consultation

If you are considering Neurostar TMS Therapy, a pre-treatment consultion will take place. Once you decide to proceed with TMS, a consultation will occur with Dr. Ratush who screens for contraindications to TMS as well as discuss your medical and psychiatric history and medications. The initial consultation acts to ensure that you are a suitable candidate for TMS therapy. Any of your remaining questions or concerns can be raised at this time. An intake consultation with the psychiatrist is intended to answer all of your questions about TMS before you begin the treatment.
The costs of services section below will help explain payment policies and staff are also available in order to help explain payment requirements.

First Day of Treatment

Treatment is administered by a trained technician and overseen by a medical doctor. The technician will familiarize you with the equipment and treatment procedure prior to commencing the first session. All staff have been educated and trained regarding the use of TMS using the NeuroStar TMS Therapy System.
During treatment, patients are fully conscious and able to read or converse with the technician.

TMS is an outpatient procedure, which means that no hospitalization is required.
TMS itself is painless, non-invasive, and requires no anesthesia.

The magnetic stimulation is delivered using the NeuroStar TMS Therapy System which assures the TMS treatment is directed appropriately to the brain. The intensity of the stimulus that will be delivered is determined by inducing a motor-evoked potential (i.e. causing movement or a twitch to occur) in the abductor pollicis brevis, or thumb muscle. You may feel a tingling or tapping sensation on the head, and scalp muscles may feel a little tense, during and a bit after the procedure. This is normal and may result in a minor headache.

Duration

TMS treatment protocol consists of 10 to 30 sessions. Sessions are usually Monday through Friday over 4 to 6 weeks, excluding holidays.
Each treatment session is approximately 40 minutes. The goal is for a patient to be able to drive to the office locally, receive treatment and drive back home or to work in approximately two to three hours.
In some cases, 5-10 extra sessions are recommended for late responders. This need will be assessed with you individually by your psychiatrist.

Communication

You are encouraged to freely discuss any concerns and feelings that you are experiencing, and to ask questions as they arise.
The technicians appreciate learning how we can help make your treatment experience as comfortable as possible.
Feedback on your treatment progress will be provided throughout the course of therapy.

Last Day of Treatment

Treatment response is determined based on clinical assessment scale and verbal feedback from patients.
At the end of treatment, you will be provided with a Patient Report. This report provides a detailed summary of the treatment received, Depression/Anxiety assessment scores, and results to date.
A detailed Physician Report will be sent via fax/mail/courier to your referring physician, providing a detailed update on your progress.

Follow-up

Our team cares about ongoing patient progress following treatment. It is our priority to keep in contact with patients and encourage them to do the same.
Regular follow-ups via telecom and/or email are encouraged.
Please expect to hear from us following the final treatment.
Calls to staff members with questions or concerns are strongly encouraged.

Maintenance

Following the first stage of Acute TMS therapy, Maintenance Treatment sessions may be required to prevent any slippage.
Maintenance Therapy will vary from patient to patient and is assessed on an individual basis. A trained medical staff member will discuss this possibility with you following Acute Therapy.
You will be encouraged to call Dr. Ratush immediately if you sense depressive symptoms returning.

Please consult Dr. Ratush following TMS therapy in order to facilitate continued care after the treatment.

PAYING FOR NEUROSTAR TMS THERAPY


Every person's is situation is unique and cost of treatment will vary according to the particular clinical needs of each patient, protocol design and length of treatment. Because the expense of illness is so great for so many we at RecoverMD we are committed to designing a treatment plan that is effective in relieving your symptoms as well as being cost conscious. Please feel free to contact us to learn more about using TMS Recovery for your recovery.

Financing Available:

If you cannot gain financial assistance through your insurance company, please keep in mind that several third-party companies offer mental health financing. One of these companies is Clark Behavioral Health Financing (CBHF). You may access a copy of their brochure on the NeuroStar website. CBHF can be reached at 800-755-3080. Our payment program is flexible and depending on your clinical needs several options may be available for you to afford the TMS Recovery treatment.

Insurance Coverage:

NeuroStar TMS Therapy is currently being covered by insurance companies on a case by case basis. Because TMS is a newly FDA approved treatment may INS companies are not familiar with how valuable this treatment is to their clients. At RecoverMD will assist you in this process. Together we can find out if you can get coverage and to proceed if coverage is initially denied so that you can win after appeal. Please contact us to learn more about the process of getting TMS covered for you.

TMS RECOVERY FOR PSYCHIATRIC AND NEUROLOGICAL DISORDERS


Although TMS Therapy has only been FDA-cleared for the treatment of Depression, there is a great deal of evidence that supports TMS efficacy in other arenas. It is thought that TMS will eventually be approved by the FDA for the treatment of several disorders originating in the brain. Several clinical studies have been conducted and are currently underway to show the effectiveness of TMS Recovey for a variety of Brain disorders below:

Obsessive-Compulsive Disorder (OCD), Post-traumatic Stress Disorder (PTSD), and Bipolar Disorder

Several clinical studies have shown the efficacy of TMS Therapy for the treatment of Obsessive-Compulsive Disorder (OCD), Posttraumatic Stress Disorder (PTSD), and Bipolar Disorder. Below are a few resources showing the progress of TMS in treating these disorders. More information is available on the web. Contact Dr. Ratush if you are interested in using TMS for the treatment of these disorders. He will evaluate your eligibility for treatment and discuss the benefits/risks of using TMS in your specific case.



Chronic Pain, Fibromyalgia, and Migraines

Several clinical studies have shown the efficacy of TMS Therapy for the treatment of chronic pain, fibromyalgia, and migraines with aura. Below are a few resources showing the progress of TMS in treating these disorders. More information is available on the web. Contact Dr. Ratush if you are interested in using TMS for the treatment of these disorders. He will evaluate your eligibility for treatment and discuss the benefits/risks of using TMS in your specific case.



Parkinson's Disease and Stroke Recovery

Several clinical studies have shown the efficacy of TMS Therapy for the treatment of Parkinson's disease and the advancement of stroke recovery. Below are a few resources showing the progress of TMS in treating these disorders. More information is available on the web. Contact Dr. Ratush if you are interested in using TMS for the treatment of these disorders. He will evaluate your eligibility for treatment and discuss the benefits/risks of using TMS in your specific case.



Cerebral Palsy, Autism, and Auditory Hallucinations

Several clinical studies have shown the efficacy of TMS Therapy for the treatment of cerebral palsy, autism, and auditory hallucinations associated with schizophrenia. Below are a few resources showing the progress of TMS in treating these disorders. More information is available on the web. Contact Dr. Ratush if you are interested in using TMS for the treatment of these disorders. He will evaluate your eligibility for treatment and discuss the benefits/risks of using TMS in your specific case.


DEPRESSION DURING PREGNANCY AND POSTPARTUM DEPRESSION


Is NeuroStar safe for use during pregnancy?

NeuroStar TMS Therapy is currently FDA-approved for the treatment of depression and because there are no systemic side-effects. Several studies have shown that TMS is a great option for pregnant and post partum women suffering from the debilitating effects of depression. The extent of neonatal risks from the maternal use of psychotropic drugs are still mostly unknown, therefore many doctors recommend that mothers discontinue their use during pregnancy. Because TMS is non-systemic and non-invasive, it does not run the risk of negatively affecting the developing fetus or nursing baby the way that psychotropic drugs can.