How have you gone about implementing TMS in your practice or institution?

For me, the hardest issues with TMS are getting insurance to approve it and the time it takes from a patient’s perspective to see a benefit.

When I first invested in the TMS machine, I calculated it could take up to 3 years to pay off the equipment cost. In actuality, I was able to recoup the initial costs in under a year. While I took some limited insurance, my secret was to offer it at a reasonable cost to people who were paying out of pocket (so, I was able to see more patients). I still offer the treatment at a reasonable price point for patients paying out of pocket (usually, these are patients who are either out of network with me or who don’t meet the formal criteria of enough medication trials).

For the patients, I often become a chee...

Our hospital obtained a Neurostar TMS device very early on, thanks to my colleague Scott Aaronson, who focuses on research for treatment-resistant depression. Back in 2009, there were Neurostar and Brainsway devices, and that was about it (in the US at least). Now, there are many manufacturers out there, so it's like buying a new car. You need to consider price, features, coils, software add-ons, maintenance costs, tech support, etc. I made a matrix comparing about 4-5 of the most popular machines and then presented that to our leadership to help select our second device. If you are new to TMS, I would look into a manufacturer that offers in-person training and ongoing, reliable technical support. And I highly recommend a course like PULSES...

I was an early adopter of TMS therapy after seeing how one patient had to travel hundreds of miles to get TMS treatment and the very positive results.

Some of my initial TMS patients were my existing patients, and some had read about it before it was available. They were actively seeking psychiatrists who offered TMS treatment. Some patients had been on multiple medications without much help. One had been treated with ECT several times and relapsed repeatedly. This patient searched for TMS providers and traveled 100 miles round-trip, 5 days each week. The results were very good.

I had another family that traveled about 300 miles and stayed in a motel suite for 6 weeks. I had treated the patient with psychotherapy and medication since preado...