Mood and Anxiety Rating Scales

Please be sure to complete this online form as part of Medicare's TMS eligibility requirements

For Patients:

First Name *

Last Name *

Clinic *

Email *

Date *

How many TMS sessions have you had? *Please estimate if you are unsure. Leave it blank if not applicable

On which side were you treated?

Left sideRight side

CES-D Total

Interpretation

D1

A1

S1

Obsession total

Compulsion total

Y-BOCS Total

Review of Symptoms:

Please provide further detail regarding the above symptoms

Have you had any side effects from TMS? *

Please provide detail of any TMS side effectsleave blank if no TMS side effects

Please list any questions you would like to ask your TMS Psychiatrist

Additional Info

Frequently Asked Questions (FAQ) for patients finishing up their TMS treatment sessions

Q: TMS has worked for me, should I stop my antidepressants?

A: Not just yet, your TMS psychiatrist will discuss this issue during your final TMS session. If you have had notable clinical improvement, your TMS psychiatrist will provide your GP a plan for how you can start weaning yourself off the antidepressant. This process should be done cautiously, conservatively an in consultation with your GP.

Q: What is a Retreatment TMS?

A: If you have a positive response to TMS but unfortunately begin to relapse, then Medicare will be able to cover a 15 session Retreatment TMS course (5 times a week for 3 weeks). Please call us if your mood begins to deteriorate and we will be happy to advise you on the next course of action.

Q: What is Maintenance TMS ?

A: Maintenance TMS is often brought up in the final review if one has had a good response to TMS. Maintenance TMS involves receiving TMS sessions either once a fortnight or once a month to reduce the likelihood of experiencing a relapse or deterioration in your mood. This process can help keep neuroplasticity ticking over. While certainly not a requirement, it does provide additional protection against relapses and increases the likelihood of the changes being long-lasting.

Q: In the last 8 weeks, I have had several major events occur in my life. Will this have stopped my TMS from working?

A: This is not likely to be the case. Despite external events, TMS should still be either stimulating nerves (promoting neuroplasticity) or inhibiting nerves. It is possible that the effects of TMS may be masked by the gravity of these external events. Hopefully, when these stressors subside, the impact of TMS may become clearer.

Q: What should I do if I have not experienced benefits by session 30?

A: A well documented phenomenon in TMS has been the intrinsic delay associated with neurostimulation. This is the same reason why we advise patients that signs of improvement are usually first seen between session 15 and 20. As such, it is not uncommon for patients to continue to show improvement for 6 weeks (or longer) after their TMS sessions have ended.

CESD-R

Please read each statement and select which indicates how much the statement applied to you over the past week. There are no right or wrong answers. Do not spend too much time on any statement.

The rating scale is as follows:

0 Rarely or None of the Time (Less than 1 Day)

1 Some or a Little of the Time (1-2 Days)

2 Occasionally (3-4 Days)

3 Most of the Time or All the Time (5-7 Days)

I felt that I could not shake off the blues even with help from my family or friends *

DASS

Please read each statement and select which indicates how much the statement applied to you over the past week. There are no right or wrong answers. Do not spend too much time on any statement.

The rating scale is as follows:

0 Did not apply to me at all (Never)

1 Applied to me to some degree, or some of the time (Sometimes)

2 Applied to me to a considerable degree, or a good part of time (Often)

3 Applied to me very much, or most of the time (Almost Always)

I found it hard to wind down *

0123

I was aware of dryness of my mouth *

0123

I couldn’t seem to experience any positive feeling at all *

0123

I experienced breathing difficulty (eg, excessively rapid breathing, breathlessness in the absence of physical exertion) *

0123

I found it difficult to work up the initiative to do things *

0123

I tended to over-react to situations *

0123

I experienced trembling (eg, in the hands) *

0123

I felt that I was using a lot of nervous energy *

0123

I was worried about situations in which I might panic and make a fool of myself *

0123

I felt that I had nothing to look forward to *

0123

I found myself getting agitated *

0123

I found it difficult to relax *

0123

I felt down-hearted and blue *

0123

I was intolerant of anything that kept me from getting on with what I was doing *

0123

I felt I was close to panic *

0123

I was unable to become enthusiastic about anything *

0123

I felt I wasn’t worth much as a person *

0123

I felt that I was rather touchy *

0123

I was aware of the action of my heart in the absence of physical exertion (eg, sense of heart rate increase, heart missing a beat) *

0123

I felt scared without any good reason *

0123

I felt that life was meaningless *

0123

F1

F2

IMPORTANT MESSAGE

After pressing submit you should see the following:

If you don't, please check over your answers.

You have likely missed one of the questions and the form will not have been submitted.

Save and Complete Later

For Patients:

Review of Symptoms:

Additional Info

Frequently Asked Questions (FAQ) for patients finishing up their TMS treatment sessions

CESD-R

DASS

Y-BOCS

Patient Feedback

IMPORTANT MESSAGE

Save and Complete Later