Overview of Referral Program

Transcranial magnetic stimulation (TMS) therapy represents a novel, evidence-based, and FDA-approved treatment for depression. The West Coast TMS Institute offers referring healthcare providers consultative and treatment services for their depressed patients.

Building a clinician-to-clinician relationship

Patients referred to The West Coast TMS Institute for possible transcranial magnetic stimulation will be provided with a full and comprehensive consultation. If it is determined that TMS is a valid option, then we will develop a TMS treatment plan. Referring clinicians will be updated regularly on their patients’ progress. Although patients receiving TMS are carefully managed and monitored throughout their treatment, referring clinicians remain their primary caregivers. We are committed to collaborating with referring clinicians closely to maintain continuity of care during and after completion of TMS therapy.

Whether you are a therapist, a referring primary psychiatrist, or a primary care physician, there are some important details for you to know about how we will work together once one of your patients is scheduled for TMS therapy at our institute:

• Medication management during TMS treatment:

  Medications change how responsive the brain is to TMS, and can alter the motor threshold necessary for safe and therapeutic treatment. Therefore it is usually best to avoid any medication changes during the period when a patient is undergoing TMS; However, if medication changes are necessary during TMS treatment, they must be discussed in advance with our medical director, Dr. Kira Stein, who may decide that it is safest and/or more therapeutic to recalibrate the motor threshold before proceeding with the next TMS session. This involves an additional procedure and more time allotted per session, and needs to be scheduled carefully to correspond to changes in medication concentrations and steady states.

• After TMS therapy, Dr. Stein will review with referring primary physicians recommendations about whether or not medications can be reduced or discontinued altogether. This involves a risk-benefit analysis individualized for each patient.

• Recommendations regarding psychotherapy during TMS treatment:

  We encourage patients to continue psychotherapy during and after TMS. Psychotherapy helps maximize the gains made from TMS, and is an important component to full patient recovery.

  During the 3rd and 4th week of TMS treatment, we commonly see the most significant changes in patient energy, interest in life and motivation. It is at this point that we present patients with our “Wellness From Depression Program,” which encourages patients to work closely with us and their therapists to gradually commit to more and more tasks and activities that include participation in family and social activities, and undertakings that are likely to be personally gratifying.

• Durability of TMS: What to do if relapse occurs:

  Studies suggest that following successful response to TMS over a 6-month period, relapse rates for patients with treatment-resistant major depression on medication maintenance therapy are quite low (10-12%). For patients who do show early depressive symptoms, a few treatments of TMS may be very effective in “rescuing” patients from a recurrence. In general, more severe cases of depression tend to require more TMS treatments. It is therefore important for primary healthcare providers to closely monitor their patients’ symptoms of depression and to refer patients back to us for booster treatment as soon as possible.

Referring to The West Coast TMS Institute:

If you are seeking a TMS referral partner, we welcome the chance to meet with you to discuss our team-based approach to caring for your patients. We look forward to hearing from you (818-855-1694) to set up a time to talk or visit the Institute.

Should you wish to refer a patient for evaluation for TMS treatment, please download a TMS referral form by Clicking Here.

Reference:

Philip G. Janicak, Ziad Nahas, Sarah H. Lisanby, H. Brent Solvason, Shirlene M. Sampson, William M. McDonald, Lauren B. Marangell, Peter Rosenquist, W. Vaughn McCall, James Kimball. Durability of clinical benefit with transcranial magnetic stimulation (TMS) in the treatment of pharmacoresistant major depression: assessment of relapse during a 6-month, multisite, open-label study. Brain Stimulation, 2010; DOI: 10.1016/j.brs.2010.07.003