Mood and Anxiety Rating Scales

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

Following your recent TMS review with your psychiatrists, we kindly request that you fill out the Maintenance/Retreatment TMS Consent Form. This form mirrors the one you previously completed at the start of your TMS course; however, as the course has concluded, we require a new consent form to be filled out. Should you have any queries, please do not hesitate to reach out to our administrative staff for assistance.

Background:

Individualised Transcranial Magnetic Stimulation (TMS) is a non-invasive therapy using electromagnetic stimulation of the brain. The magnetic field produced by the procedure induces trace amounts of electrical current in the brain. It is used after diagnosis for treatment and has shown great promise in the treatment of certain conditions or disorders that are not responsive to conventional treatments.

The procedure is administered by placing a special coil over the head while the patient remains seated in a chair. A powerful magnetic field is pulsed over regions of the brain based on a specific treatment protocol. It is often described as a tapping sensation. Patients are thoroughly screened and evaluated before the treatment and are monitored during TMS treatment session by a trained and TMS clinician or other certified clinician or practitioner to minimise any risk from the procedure, to monitor the patient’s response to treatment, and to monitor proper for continued treatment coil contact.

There is no guarantee that patients will respond positively to this therapy. TMS is Therapeutic Goods Agency (TGA)-approved for specific conditions, such as major depressive disorder in adult patients, and other conditions depending on the TMS system being used fo­­r treatment. In addition to Depression, TMS has been used to treat Generalised Anxiety Disorder (GAD), Post-Traumatic Stress Disorder (PTSD), Obsessive-Compulsive Disorder (OCD), Attention Deficit Hyperactivity Disorder (ADHD), Chronic Pain, Migraines, Fibromyalgia, Chronic Fatigue Syndrome, Insomnia, Post-Stroke Depression, Parkinson's Disease, Tinnitus, Alcohol Addiction, or Nicotine Addiction.

Our treatment protocols may involve the use of Theta Burst stimulation, a newer method that has been studied in research trials since 2005. The FDA approved Theta Burst for clinical use in 2018. According to the 2024 guidelines of the Royal Australian and New Zealand College of Psychiatrists (RANZCP), “commencing with left high frequency (LHF), right unilateral low frequency (RLF), left intermittent Theta Burst stimulation (iTBS), and sequential bilateral approaches are all supported by the available evidence.” A large non-inferiority trial found that iTBS applied to the left DLPFC produced effects equivalent to standard rTMS, and its use has become increasingly common in clinical practice (Blumberger et al., 2018). Additional clinical trials have confirmed the efficacy and safety of iTBS for treating depression (Clinical TMS Society, 2023)

You are free to stop therapy at any time

If being treated with any Non Depression TMS protocols:

Off-label device use (OLDU) means using an FDA/TGA (Therapeutic Goods Administration)-Australia cleared device for a different condition, or using a device settings, that have not been specifically cleared by the FDA/TGA. OLDU is common, it occurs in every specialty of medicine. After a device has been cleared for one condition, clinicians are not limited to the FDA-approved indications and are allowed to use it for any condition if, in their professional judgment, it is reasonably safe and effective, and potential risks outweigh potential benefits in the clinician’s determination. TMS used for conditions other than treatment resistant depression is currently deemed as a “off label” treatment in Australia.

Commonly used off-label uses for TMS includes conditions such as OCD (Obsessive Sleep Disorder), GAD (Generalised Anxiety Disorder), PTSD (Post Traumatic Stress Disorder), ADHD (Attention Deficit Hyperactivity Disorder), Chronic Pain, Migraines/Headaches, Fibromyalgia, Tinnitus, Parkinson's Disease, Nicotine/Alcohol Addiction, varying frequencies and amplitude of stimulation, varying positions on the head to stimulate different parts of the brain, shorter or extended protocols, more or less time between stimulation sessions, the use of non superficial TMS coils eg. double cone coil used in OCD, and/or bilateral treatments.

While evidence exists supporting the use of TMS for these conditions, patients should understand that such "off-label" TMS therapy is supported by less evidence compared to its use for treatment-resistant depression. As "off-label" TMS has been studied less extensively than TMS for treatment-resistant depression, there may be a higher risk of side effects.

For more specific information about the efficacy of TMS in treating any of the previously mentioned non-mental health conditions, please refer to the comprehensive systematic review by Lefaucheur et al. (2020), which compiled 50 different research studies. The review is titled "Evidence-based guidelines on the therapeutic use of TMS. An update: 2014-2018," published in Clinical Neurophysiology, Volume 131, 2020, and can be accessed here.

For a summary of some of the research (including efficacy rates for each of the aforementioned conditions), please see below and visit this link.

The information below references various studies on the efficacy of Transcranial Magnetic Stimulation (TMS). However, it’s important to recognise that the quality and findings of individual studies can vary, and not all results are universally conclusive. As such, there can be a risk of overgeneralisation/misrepresentation of findings. Meta-analyses, which combine data from multiple trials, offer a broader view but may still reflect differences in study design, patient groups, and treatment protocols. We recommend discussing any concerns with your psychiatrist to understand what TMS can offer in your specific case.

Depression: 

In the meta analysis by Vida et al in 2023 titled “Efficacy of repetitive transcranial magnetic stimulation (rTMS) adjunctive therapy for major depressive disorder (MDD) after two antidepressant treatment failures: meta-analysis of randomised sham-controlled trials” the response rate was almost two and a half times more with active rTMS treatment (RR: 2.25, NNT: 6.1) compared the sham group (those not getting TMS). This difference was even more pronounced when analysing remission rates. Based on the 9 analysed studies, nearly 36% of the TRD patients with rTMS treatment achieved remission (in the absence of Maintenance TMS).

PTSD (Post Traumatic Stress Disorder):

A recent meta-analysis by Harris et al in 2021 included 19 studies (376 participants) and revealed a large positive effect of TMS on PTSD symptoms: d = 1.17, 95% confidence interval (CI) = [0.89–1.45], p  0.001. This result comes from a review of 19 studies involving 376 people, showing that TMS treatment has a strong positive impact on reducing PTSD symptoms. The number "d = 1.17" is a way to measure how big the effect is, and anything above 0.8 is considered a large effect. 

So, 1.17 indicates a strong improvement in PTSD symptoms after TMS. The "95% confidence interval (CI) = [0.89–1.45]" means that researchers are 95% confident that the real effect of TMS falls between 0.89 and 1.45, which still represents a large positive impact. Finally, "p 0.001" shows that the result is statistically significant, meaning there’s a very small chance (less than 0.1%) that these findings happened by random chance. In simple terms, this data strongly supports the idea that TMS is signficantly effective in reducing PTSD symptoms. [2]

OCD (Obsessive Compulsive Disorder): 

A meta-analysis by Rehn et al published in the Journal of Psychiatric Research in 2018 examined 18 randomised controlled trials involving TMS for OCD. The analysis found that active TMS was significantly superior to sham TMS in reducing OCD symptoms, with a moderate effect size. Notably, the study also reported that higher frequencies of stimulation and longer treatment durations were associated with better outcomes. Note that his TMS course use deep coil. [3] 

Another significant study by Carmi et al, published in the American Journal of Psychiatry in 2019, evaluated the efficacy of dTMS for OCD. This multicenter, double-blind, randomized trial involved 99 patients and found that after 6 weeks of treatment, 38.1% of patients in the active dTMS group achieved a response (defined as a ≥30% reduction in Y-BOCS score), compared to just 11.1% in the sham group. [4]

PLEASE NOTE: For OCD we often use a specialised TMS coil called the double cone coil for our protocols. As per Rossi et al 2021, "Double-cone (or angled butterfly/double) coils are a larger version of figure-8 coils where the two circular windings are angled toward the subject’s head to increase the magnetic field strength in depth as well as the electrical efficiency. Consequently, the double-cone coil E-field penetrates deeper and is less focal than conventional figure-8 coils (Deng et al., 2014, 2013). Double-cone coils have been used to target various brain regions that may be difficult to reach with standard figure-8 coils, such as the leg motor area or medial prefrontal cortex, and were claimed to reach effectively the cingulate, insula, and cerebellum. In studies reviewed, no serious AEs such as seizures were reported (Ciampi de Andrade et al, 2012; Blumberger et al., 2018; Dunlop et al., 2015; Fernandez et al., 2018; Gerschlager et al., 2002; Grossheinrich et al., 2009; Huang et al., 2018; Kreuzer et al., 2015a; Kreuzer et al., 2015b; Modirrousta et al., 2015; Nauczyciel et al., 2014; Popa et al., 2010; Riehl, 2008; Ruohonen and Ilmoniemi, 2005; Sutter et al., 2015). "

Tinnitus:

The systematic review and meta-analysis of 29 randomised studies with 1,228 patients found that repetitive transcranial magnetic stimulation (rTMS) was effective in reducing symptoms of chronic tinnitus. The response rate showed significant improvements in Tinnitus Handicap Inventory (THI) scores compared to sham-rTMS at several intervals: [9] 

 • 1 week post-intervention: Mean difference (MD) of -7.92 (95% CI: -14.18, -1.66) 

 • 1 month post-intervention: MD of -8.52 (95% CI: -12.49, -4.55) 

 • 6 months post-intervention: MD of -6.53 (95% CI: -11.40, -1.66) . [9] 

This indicates that about 40-60% of patients experienced meaningful symptom relief, with effects lasting up to six months after treatment. However, it should be noted that the response rates can vary, and the efficacy of rTMS needs further validation in larger trials to confirm safety and long-term benefits. 

As per Rossi 2021 et al, "there is a risk of worsening hyperacusis by performing stimulations applied over the auditory cortex, near the ear, in patients with rTMS indicated for the treatment of tinnitus, especially when hyperacusis was already present before rTMS (Lefaucheur et al., 2012). More generally, pre-existing auditory symptoms were found to be possibly aggravated by rTMS applied over the auditory cortex in 1–2.2% of patients treated for tinnitus or auditory hallucinations. This risk can be reduced with hearing protection.

Parkinson's Disease (Motor Symptoms): 

To measure improvements in motor symptoms, the study by Zanjani et al 2015 used scores from the Unified Parkinson’s Disease Rating Scale (UPDRS), particularly sections II (which focuses on daily activities) and III (which focuses on motor function). [10] Lower scores on these sections indicate improvement. 

Key Findings: 

• Short-term Effects: When looking at the short-term effects (up to 1 day after treatment), active rTMS (real stimulation) significantly improved motor symptoms, as shown by a 3.8-point improvement in UPDRS III scores compared to the sham group (fake treatment). The effect size (Cohen's d of 0.27) indicates that the improvement was modest but noticeable. [10]

• Long-term Effects: One month after treatment, the difference in motor improvement between the active and sham groups was not statistically significant, but there was still a 6.3-point improvement in motor symptoms from baseline in the active rTMS group. [10]

  • The placebo effect (improvement due to belief in treatment, not the treatment itself) was not seen, as those in the sham group did not show significant improvement in motor symptoms (UPDRS III scores). [10]

Conclusion: While rTMS targeting the M1 showed some positive effects on motor symptoms in the short term, especially right after treatment, the long-term benefits were less clear. The researchers recommend more studies to confirm these findings and better understand the effects of rTMS in PD treatment. In summary, rTMS may help improve movement problems in Parkinson’s patients, but the improvements are more noticeable in the short term, and further research is needed to draw stronger conclusions.

Nicotine Addiction:

Li et al in 2013, produced a tudy investigated whether high-frequency repetitive transcranial magnetic stimulation (rTMS) could reduce cigarette cravings in people who are dependent on nicotine. [12] 

The results were as follows. Stimulation of the left DLFPC with real, but not sham, rTMS reduced craving significantly from baseline (64.1± 5.9 vs. 45.7±6.4, t = 2.69, p = 0.018). When compared to neutral cue craving, the effect of real TMS on cue craving was significantly greater than the effect of sham TMS (12.5 ±10.4 vs. −9.1±10.4; t = 2.07, p = 0.049). More decreases in subjective craving induced by TMS correlated positively with higher Fagerström Test for Nicotine Dependence (FTND) score (r = 0.58, p = 0.031) and more cigarettes smoked per day (r = 0.57, p = 0.035). [12] 

Here's a breakdown of the findings:

• Participants: Sixteen people who were nicotine-dependent but not actively seeking treatment participated in the study.

• Study Design: The participants were randomly assigned to receive either:

• Real rTMS: High-frequency (10 Hz) stimulation applied to the left dorsolateral prefrontal cortex (DLPFC).

• Sham rTMS: A fake version of the treatment (like a placebo), where it looks and feels like rTMS but doesn't actually stimulate the brain.

• Procedure: The participants were exposed to smoking cues (things that might make them want to smoke) before and after rTMS treatment and asked to rate how much they craved a cigarette after each exposure. [12]

Results 

• Reduced Cravings: For those who received real rTMS, cravings significantly decreased after the treatment, from a baseline craving score of 64.1 to 45.7 (on a scale out of 100). This reduction was statistically significant (p = 0.018), meaning it is unlikely to have happened by chance. [12] In contrast, the sham rTMS group did not show a significant reduction in craving.

• Comparison to Neutral Cues: When comparing the real rTMS effect with neutral (non-smoking) cues, the reduction in cravings was much greater in the real rTMS group compared to the sham group.

• Correlation with Nicotine Dependence: The more dependent a participant was on nicotine (measured by the Fagerström Test for Nicotine Dependence) and the more cigarettes they smoked per day, the larger the reduction in craving after real rTMS. This suggests that people with higher nicotine dependence experienced a greater benefit from the rTMS.

Conclusions 

• rTMS Reduced Cravings: A single session of high-frequency rTMS to the left DLPFC significantly reduced the urge to smoke when exposed to smoking cues.

• Potential Smoking Cessation Aid: This suggests that rTMS could be helpful as part of a smoking cessation treatment plan, though more research is needed to confirm its effectiveness over the long term. In summary, this study shows that rTMS may help reduce cravings in nicotine-dependent people, especially those with higher nicotine dependence. More research is needed to explore how it could be used to help people quit smoking.

ADHD (Attention Deficit Hyperactivity Disorder):

In a study by Chen at al in 2023, a meta-analysis of five RCTs with 189 participants (mean age of 32.78 and 8.53 years in adult and child/adolescent populations, respectively) demonstrated that rTMS was more effective for improving sustained attention in patients with ADHD compared with the control groups (SMD = 0.54, p = 0.001). A secondary analysis also showed that rTMS was more effective for improving processing speed than the control groups (SMD = 0.59, p = 0.002) but not for enhancing memory or executive function. [5] 

1.  Sustained Attention: The analysis showed that rTMS (repetitive transcranial magnetic stimulation) was more effective than control treatments (such as sham or placebo) at improving sustained attention in people with ADHD. The effect size (SMD = 0.54) suggests a moderate improvement, and the result was statistically significant (p = 0.001), meaning it's unlikely to be due to chance. [5]

2. Processing Speed: In a secondary analysis, the study found that rTMS also improved processing speed (how quickly participants could complete tasks) more than the control groups. This improvement was slightly larger (SMD = 0.59) and also statistically significant (p = 0.002).

3. Memory : However, rTMS did not significantly improve memory compared to control treatments.

In summary, rTMS appears to be helpful for improving sustained attention and processing speed in people with ADHD, but it doesn't seem to have much effect on memory.

Chronic Pain:

As per the RANZCP (Royal Australian and New Zealand College of Psychiatry) 2024 TMS guidelines, "A large number of studies have explored the use of TMS in the treatment of chronic pain although these have varied substantially in the pain syndrome targeted and the type of TMS used. Benefits have been seen in studies applying stimulation to the primary motor cortex (M1), to the DLPFC and using deep TMS. The most consistent promising effects seen in clinical trials have been present when stimulation has been applied to the left M1 although it has been pro- posed that optimal treatment should involve a systematic evaluation of multiple treatment targets in an individual patient (Lefaucheur and Nguyen, 2019). 

A meta-analysis conducted to characterise the potential analgesic effects of high-frequency rTMS over the DLPFC on chronic pain identified no overall effect of TMS across chronic pain conditions, although there was a significant short-term analgesia in neuropathic pain conditions only (Che et al., 2021). Furthermore, significant analgesic effects in chronic pain were demonstrated with stimulation of the M1 site although optimal protocols have not yet been confirmed (Lefaucheur and Nguyen, 2019). "

Based on the MDPI article titled Transcranial Magnetic Stimulation to Treat Neuropathic Pain: A Bibliometric Analysis, the response rate for TMS in treating chronic neuropathic pain ranges between 30% and 40%. This means that approximately 30-40% of patients treated with TMS experience significant pain relief compared to placebo. [6] This response rate is considered moderate and suggests that while TMS can provide substantial pain relief for some patients, it is not universally effective. 

The efficacy of TMS tends to vary depending on individual factors, the type of neuropathic pain being treated, and the stimulation protocol. This was similar to results found by the Walton Centre’s trial, which is the only NHS (National Health Service) in the UK conducting TMS specifically for chronic pain.

Migraines/Headaches: 

In a 2022 study by Zhong et al, a meta-analysis combined results from 8 studies and found that rTMS, particularly when applied to the left dorsolateral prefrontal cortex (LDLPFC), significantly reduced how often people experienced migraine attacks. Random effects analysis showed an effect size of −1.13 [95% confidence interval (CI): −1.69 to −0.58] on the frequency of migraine attacks, indicating that rTMS was more effective for decreasing migraine attacks than the sham rTMS. 

The effect size being -1.13, meant that migraine frequency dropped signficantly in those treated with rTMS compared to those who got a fake (sham) treatment. The confidence interval (CI: -1.69 to -0.58) shows that researchers are confident the true effect is somewhere within that range. In simpler terms, the confidence interval shows that rTMS reduces migraines, and researchers are 95% sure that the true amount of reduction is somewhere between a moderate and a large effect. [8]

Fibromyalgia: 

In a meta analysis by Su et al in 2021, Pain 16 randomised controlled trials were compared in terms of reduction of pain intensity. All comparisons underwent meta-analysis, which revealed significantly less pain in the rTMS group after treatment (SMD, −0.751, 95% CI, −0.991 to −0.511, I2 = 35.9%). [7] Here's a breakdown of the numbers: 

1.  Pain Reduction After Treatment: The meta-analysis looked at 16 studies and found that people in the rTMS treatment group experienced significantly less pain compared to others. The standardized mean difference (SMD) was -0.751, meaning there was a moderate reduction in pain. A negative number here shows that pain decreased. The 95% confidence interval (CI) of -0.991 to -0.511 means the researchers are confident that the true reduction in pain falls within this range. The "I² = 35.9%" refers to how consistent the studies were with each other, with a lower percentage indicating less variability between studies. [7]

2. No Publication Bias: The funnel plot and Egger test are ways to check if the results might be skewed because only certain studies were published (called publication bias). A "p = 0.88" means there's no evidence of publication bias, which supports the reliability of the findings. [7]

3. Pain Reduction Over Time: 2 Weeks to One Month Follow-Up: The studies showed that the reduction in pain was still significant after two weeks to one month, with an SMD of -0.516 (again, a moderate decrease in pain). [7] 1.5 to 3 Months Follow-Up: Even after one and a half to three months, the reduction in pain remained significant, with an SMD of -0.588. [7] The "I²" values indicate how similar the results were across the studies. At two weeks to one month, I² was 0.0%, meaning there was almost no variation between the studies. For the longer follow-up, I² was 52.6%, indicating more variability between the studies. [7]

Overall, these findings suggest that rTMS treatment significantly reduces pain, and the effect lasts for several months after the treatment ends. There was no sign of bias in the studies, meaning the results are likely reliable.

Post Stroke Depression:

In a systematic review by Gao et al , a total of 8 trials was included and 336 participants provided data for meta-analyses. Large effects were found for rTMS + cognitive training on global cognition (g = 0.780, 95 % CI = 0.477-1.083), executive function (g = 0.769, 95 % CI = 0.291-1.247), working memory (g = 0.609, 95 % CI = 0.158-1.061) and medium improvement on ADL (g = 0.418, 95 % CI = 0.058-0.778) were seen. [11]. While, no effects were found on memory or attention. Subgroup analyses showed that combinations of phase of stroke onset, rTMS frequency, stimulation site and stimulation sessions were potent factors that modulate the effects of rTMS + cognitive training for cognitive function. 

 Here’s a breakdown of the key findings in simpler terms: 

1. Participants and Scope: The study analysed data from 336 participants across 8 trials, all aimed at evaluating how well rTMS combined with cognitive training works to improve brain function. [11]

2. Large Effects: The combination of rTMS and cognitive training showed significant improvements in: Global cognition (overall mental abilities), with a large effect size (g = 0.780), meaning it had a strong positive impact. Executive function (skills like planning, problem-solving, and organizing), with another large effect size (g = 0.769). Working memory (the ability to hold and use information in the short term), with a noticeable improvement (g = 0.609). [11]

3. Medium Improvement in Daily Living: There was a moderate improvement in activities of daily living (ADL), which means that rTMS helped participants perform everyday tasks better (g = 0.418). [11]

4. No Improvement in Memory or Attention: The treatment combination did not show significant improvements in memory or attention.

5. Subgroup Analysis: The study also found that certain factors, like the phase of stroke recovery, rTMS frequency, the part of the brain being stimulated, and the number of treatment sessions, influenced how effective the rTMS and cognitive training were for improving cognitive functions.

In summary, combining rTMS with cognitive training significantly improved general cognition, executive function, working memory, and daily activities, but had no effect on memory or attention. Additionally, certain treatment variables could influence the effectiveness of the therapy.

Alcohol Addiction:

A systematic review and meta analysis by Mehta et al 2024 reports on the use of repetitive transcranial magnetic stimulation (rTMS) to treat alcohol use disorder (AUD) and other substance use disorders (SUDs). [13] Here is a breakdown of the findings. 

Overview of Alcohol Studies: 

Number of Studies: 16 studies examined the effects of rTMS on AUD, focusing on reducing alcohol cravings and alcohol consumption. Participants: 2406 participants were involved in rTMS studies across all SUDs, including AUD. rTMS Treatment: Most of the AUD studies used multiple rTMS sessions (10–20 sessions) with high-frequency (HF) stimulation targeting different parts of the brain, including the dorsolateral prefrontal cortex (DLPFC) and the medial prefrontal cortex (mPFC). These brain areas are involved in self-control, decision-making, and cravings. [13] 

Key Findings on Alcohol Addiction: 

1. Positive Effects on Craving and Consumption: 7 of 16 studies showed that rTMS significantly reduced alcohol cravings and/or alcohol consumption compared to a sham (placebo) treatment. Specifically, deep TMS (using specialized H-coils that can penetrate deeper into the brain) was highlighted as potentially more effective than traditional rTMS. For instance, studies using H-coils targeting the mPFC and anterior cingulate cortex (ACC) reported significant reductions in alcohol cravings. One study used a special protocol called continuous theta burst stimulation (cTBS) and found a significant reduction in alcohol cravings after 10 sessions targeting the mPFC.

2. Meta-Analysis Results: A meta-analysis combining results from 10 studies (447 participants) found that repeated rTMS sessions significantly reduced alcohol cravings compared to sham treatments, with a moderate-to-large effect (SMD = -1.25). This means participants felt noticeably fewer cravings after rTMS. Another meta-analysis of 5 studies (184 participants) found that repeated rTMS significantly reduced alcohol consumption, meaning participants drank less alcohol after the treatment (SMD = -1.39). [13]

3. Single-Session rTMS: In contrast to the multi-session studies, 5 studies that tested the effects of a single session of rTMS on alcohol cravings and consumption showed no significant improvements. This suggests that a single rTMS session is not enough to reduce cravings or drinking. [13]

Conclusion for Alcohol Addiction: 

Multiple sessions of rTMS, especially when using deep TMS targeting the DLPFC, mPFC, or ACC, appear to effectively reduce alcohol cravings and alcohol consumption in people with alcohol use disorder. 

Single sessions of rTMS do not seem to have any significant effect on cravings or consumption. 

The findings suggest that rTMS, particularly when delivered over multiple sessions and targeting key brain regions, could be a promising tool to help people with alcohol addiction reduce their cravings and alcohol intake, but further research is necessary to confirm these results and explore long-term effectiveness. 

In summary, rTMS shows potential as a treatment for alcohol addiction, particularly when delivered in multiple sessions, but single-session treatments are not effective.

PLEASE NOTE: 

This section is only relevant AFTER you have spoken to the TMS psychiatrist and read the information in this form. The official TMS consent form will be signed in the presence of your TMS psychiatrist.

• I have been informed of the nature of TMS,its effects, anticipated length of time of treatment, frequency and duration of treatment, side effects,possible alternative methods of treatment (eg. medication, therapy),benefits and risks of the planned TMS course and have given my consent voluntarily to participate in TMS treatment.

• I acknowledge having read the TMS information sheets and have been provided with the opportunity to discuss this material with the Psychiatrist and TMS operator.

• I understand that I can change my mind at any stage, even after a course of treatment has begun.

• I have not been guaranteed the TMS treatment will be successful as treatment outcomesmay vary between individuals.I understand the TMS treatment is not a cure for the condition, so I may still relapse in the future.

• I acknowledge that there is a camera in the room so nurses can monitor the positioning of the TMS coil on your head. This will be used if a TMS nurse has left the room.

• I acknowledge there has been a discussion of risk benefit analysis in relation to my medical condition with respect to the aforementioned risks (including the low risk of seizures).

• If I regularly drink more than four standard drinks of alcohol on most days, or if I abruptly stop using alcohol or benzodiazepines after frequent excessive use, I am at an increased risk of experiencing withdrawal seizures related to alcohol or benzodiazepines. I agree to inform the TMS nursing or medical team if I intend to change the dosage, quantity, or frequency of my usage. Furthermore, if I change my medication or experience any medical issues during a course of TMS, I will inform the TMS doctor, as these changes or illnesses could increase the risk of seizure.

• I acknowledge that wearing earplugs is required, and if I choose to decline ear protection, I do so against medical advice and accept any associated risks, including the possibility of worsening tinnitus or hearing issue. If you have tinnitus, wearing ear plugs is a must.

• I acknowledge that ear protection, specifically earplugs, is advised as an integral part of the TMS treatment protocol.

• I understand that declining ear protection is against medical advice, and I assume full responsibility for any potential adverse outcomes, including but not limited to, exacerbation of tinnitus or other hearing-related complications.

• If I have tinnitus or migraines, I acknowledge that TMS stimulation could potentially worsen either condition, usually temporarily.Depending on the results of a risk-benefit analysis, protocols will be specifically chosen to try to reduce (but not fully eliminate) the risk of this occurring.I will inform the doctor immediately if I observe any such changes. Should this occur, the doctor may adjust the protocols, change the location of the treatment, pause treatment until symptoms subside, or terminate the treatment altogether. For individuals with pre-existing tinnitus, ear protection (ear plugs) is expressly required to mitigate associated risks.

• If I have Bipolar Disorder, I acknowledge that I am at an increased risk of switching to a manic episode. This risk is usually reduced by taking a mood-stabilising medication. I acknowledge that if I have bipolar disorder, I am required to take all prescribed medications, including any mood-stabilising medications, as directed by my primary psychiatrist or GP to help reduce the risk of adverse effects during TMS treatment.

• I agree to promptly inform the TMS team and my primary treating doctor of any significant changes in my medical or mental health status, including shifts in mood, new symptoms, or any deterioration in mental health, to ensure coordinated and comprehensive care throughout my treatment. I understand that failure to disclose these changes may result in treatment complications.

• I understand that the TMS treatment involves the use of a coil held in place by a mechanical boom arm. While every precaution is taken to ensure proper handling and maintenance of the equipment, I acknowledge that there is a very small risk of mechanical injury resulting from unexpected equipment failure or user error. This includes, but is not limited to, the possibility of the boom arm or coil shifting or falling, which could result in minor physical injury. I understand that all staff are trained to minimise this risk, and I consent to proceed with treatment acknowledging this potential, albeit rare, risk.

• I am aware that if I am started on the left side of the brain (prefrontal cortex) and there have not been any improvements by around session 20, I may be switched to the right side of the head. If I am started on the right side of the brain (prefrontal cortex), and there have not been any improvements by around session 20 then I will have a discussion with one of our TMS clinicians prior to any changes in protocol.

• I understand that most patients who benefit from TMS experience results by the fourth week of treatment. Some patients may experience results in less time while others may take longer.

• I acknowledge that the TMS clinic is responsible exclusively for the administration of TMS and managing any direct side effects related to this treatment. The responsibility for the overall management of my mental health, including but not limited to changes in medication, significant deteriorations in mental health or potential suicidal thoughts, remains with my referring and primary treating doctor (General Practitioner or Psychiatrist, if applicable). Should there be any significant deterioration in my mental health, I agree to inform both my primary treating doctor and my TMS nurse.

• If received Medicare rebated TMS, I declare that I am over 18 years old, have been diagnosed with a Major Depressive Episode, have not previously received TMS, have received psychological therapy, have failed to receive satisfactory improvement for Major depressive episode despite the adequate trial of at least 2 different classes of antidepressant medication for at least 3 weeks.

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.

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)

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)

Obsessions are unwanted ideas, images or impulses that intrude on thinking against your wishes and efforts to resist them. They usually involve themes of harm, risk and danger. Common obsessions are excessive fears of contamination; recurring doubts about danger, extreme concern with order, symmetry, or exactness; fear of losing important things.

Compulsions are urges that people have to do something to lessen feelings of anxiety or other discomfort. Oftenthey do repetitive, purposeful, intentional behaviors called rituals. The behavior itself may seem appropriate but itbecomes a ritual when done to excess. Washing, checking, repeating, straightening, hoarding and many otherbehaviors can be rituals. Some rituals are mental. For example, thinking or saying things over and over under yourbreath.

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.