Dr Cady Explains TMS 30 min 

+Melissa DeCapua Thank you so much Melissa!

Hello == Doctor == I have been suffering from depression for the past 22 years and to this very moment I write for you == I have not improved my depression == and the problem is that I am now a phallus == 50 years old == I do not feel sexual desire == absolute and final === Can you tell me how the way to cure this malignant disease?

+Chary Torres Dear Chary - sorry to hear about this, and sorry for my delayed response. I hope that you are finding the hope that you need for your son. Thank you for the kind words. Best wishes.

+Ryan J Dear Ryan: Thanks so much for your kind words. Good luck with the book!

@Ryan j could you please give me any advice on tms for ocd ...I am desperate for any info..

@@lcadymd how effective is tms for ocd...some say it can make them worse?

@@ashmac1397 Hello, Ash Mac. Several things to consider: 1) TMS is not FDA approved for OCD. 2) Left sided stimulation could theoretically make it worse. 3) Right sided stimulation - at the slow pulse rate of one pulse every second is outstanding fo the treatment of anxiety, and I have also used it for OCD. I've never had a patient with OCD, exclusively, that I've treated with TMS, but I have had some patients with mixed depression, anxiety, and OCD that I have treated. As I reviewed in the video, the depression is on the left side of the brain and is a fast pulse treatment. The anxiety(and OCD treatment, is on the RIGHT side of the brain and much less intense - just one pulse every second instead of 40 pulses in 4 seconds (which is what is used on the left). Everyone that I have treated this way has gotten at least somewhat better, if not radically improved.

@@lcadymd thank you so much for your reply...I greatly appreciate your response..would it be possible to email you with just a few questions? Thank you

Afura33 The problem is most insurance companies want you to try medication first before anything. TMS is an expensive treatment towards depression unless you have your own money for it not happening however I agree with you. I use be a TMS tech

It can be a first line therapy for elderly on lots of meds as a slew of antidepressants could harm them. But, yes, Medicare requires you to have a history of many med failures first to qualify for TMS.

Depression doesn't go away by tms therapy , maintenance therapy is costly

@@KaraChampagne medication for depression are inexpensive alternative

Louis Cady, MD those with bipolar disorder need the magnet on the RIGHT brain hemisphere. Other wise you get mania and can be severe.

is this only for the most sever depression or mild to moderate depression also? is it insurance covered? who is the right or a good candidate for this?

Moderate to severe depression. Per FDA label, having failed ONE antidepressant. I think this is certainly a low bar. Unfortunately, insurance companies will fight you tooth and nail not to cover it, and will demand multiple other steps first. And then they still do not pay sometimes. The right candidate for this procedure is as follows (and these are all personal opinions): - someone who has failed multiple medications, at high dosages, and for a respectable period of time - someone who has their thyroid, adrenal, and sex hormones balanced. - someone who has their nutritional status assessed and is adequately supplemented. - someone who has (a) either PURE biological depression, or (b) if there are psychological components, they are in THERAPY for same. This treatment has not cognitive-behavioral therapy type of intervention effects. - someone who is able to show up for treatments for a minimum of four weeks, five days a week. Hope this helps. Best personal regards, Doc C

@@haroldppowell5856 Not necessarily. I have successfully treated bipolar patients who are ABSOLUTELY STABLE on mood stabilizing agents with TMS for their active depression and it works well. You are correct, however, in that if a bipolar patient is not adequately stable, TMS can trigger mania.

+EspressoCatPlays Thank you so much. I have visited your beautiful country, and am impressed with the Karolinska Institute, which has a well-deserved international reputation. I'm sorry that this is not more available. I should emphasize that it is not available "first prime treatment for depression" in my country, either. You must have failed at least one antidepressant to qualify for approved usage of it here. Good luck and thank you so much for writing.

+Louis Cady, MD I am doing better now, sleep well. It at least feel like I do not have depression right now. Thank you for taking your time and answering. I had try a lot of medicine and talk to my psychotherapist for a year.

+EspressoCatPlays Fantastic. Great to hear.

+origdjfaze3 Thank you so much.

hi doctor thank you so much for your information I have a question is there treatment so expensive or no because I really need it can you give me please how many time we have to do and there any insurance cover the treatment or no

Yes, although the usage of TMS in other applications besides the treatment of major depression is "off label." I have used it to treat anxiety disorders as well as what certainly looked like abscess of compulsive disorder. It might help insomnia if insomnia is occurring in the context of depression. I'm sorry it has taken me so long to reply; there has been a hang up on my computer in terms of answering questions on this RU-vid channel. I think I've got it worked out now. Good luck to you, and thanks for writing.

Louis Cady, MD Anytime. Thanks for the response.

Dave Blasko I wanna know that too

Yes. They have it at my psychiatrist office in Frisco TX

Cameron Booth it's available in Baytown Tx, and Clear Lake Tx.

Cameron Booth take 2 aaa batteries. One positive end first in left ear canal next flat end first in right ear canal remove in 5 minutes. At own risk please. As oftten as needed for depression.

Thanks so much for your question. The reasons the treatment are so expensive are: (1) it costs roughly $100 each time a patient is treated. The TMS facility has to pay that fee to Neuronetics each time. There is no escaping it. Previously, it was the cost of the SenStar which I talked about in this video. Now, it's a procedure fee that is paid to Neuronetics IN ADVANCE. If this is not paid, the machine will not activate to deliver a treatment. (2) The machine costs money. (3) The person operating it (the TMS treater) costs money. That person has to be paid by the TMS facility. (4) The overhead for the floor space costs money. That's about it. I personally know of colleagues whose reimbursement rates from insurance companies were so bad that it was costing THEM $50 to administer each treatment. In other words, they were losing money on each treatment. Multiple that by 20 - 30 treatments per patient, and that's $1,000 to $1500 loss on the bottom line where your expenses are outstripping your income. You can't do that too many times (on a consistent basis) until you go bankrupt. Please understand - we don't do this for the money. There are other ways to make more money, faster, in psychiatry (ketamine infusions being one of them). Pushing meds, seeing 10 - 15 patients an hour, and collecting miniscule co-pays and reimbursements from insurance companies is another.(We don't do this - I think it's dangerous and immoral.) We do this as a service for our patients, to whom we are deeply devoted. But, on the flip side, I (and other TMS providers) have to be able to make a small profit on each treatment, or the drag on the bottom line outweighs or ability to do it. In other words, you've got to be able to keep the doors open to treat patients, and you can't do that if you run your practice into bankruptcy. I know this is a long answer, but I hope it helps. Best wishes to you in your journey.

+Nima Amiri Fard Abolverdi Great questions. Good studies are available on www.pubmed.gov . I also have several presentations on my slide share website at www.slideshare.net/lcadymd which have multiple studies on the different slides and references clearly marked at the bottom. I have used TMS off-label of anxiety and severe OCD, as well as off-label for bipolar depression (while making sure that the bipolar patient had adequate mood stabilization in place), as well as the FDA labeled usage for unipolar major depression unresponsive to at least one antidepressant.

+Louis Cady, MD Hi, Thank you for your reply, and yes I have looked at some papers since my comment on here; and I must say that TMS has a lot of potential. We ourselves are aiming to open a clinic to practice dTMS for the treatment of dementia related symptoms. I have connected with you on Linkedin if thats ok and maybe we could have a more in depth conversation about TMS on Linkedin. Thank you and have a great day. Nima

+Nima Amiri Fard Abolverdi Thanks Nima. I look forward to sharing ideas with you on Linked In!

+Cam Munroe You are welcome. I do not know about its availability in New Zealand.

Hi Nabila. It is not, per se useful for PTSD, but it IS useful for depression. Whatever the source. Good luck, and be well. Namaste

I have fillings, four of them. I know they are okay for sure. I had TMS today for the first time.

Thanks!

You can have fillings.

HI Anuj. TMS is not FDA approved for the treatment of panic attacks. I have used it off-label for the treatment of anxiety and obsessive compulsive disorder, but not panic. Best regards, Doc C

Hi there. I can't tell you exactly how many Teslas is required. Here are some things to consider: - the theoretical concept of putting oNE neuron (like a frog leg motor neuron as an experimental preparation) in front of a TSM magnet and seeing what field strength might be required to depolarize the membrane is one thing. But it's purely experimental and theoretical. - i can tell you that the Neurostar TMS has a 1.5 Tesla coil Some other machines have a bit more strength. The question is now just "how many Teslas do you need," but, rather, how many will be required. For elderly patients, who have had some brain atrophy resulting in their cortex not being in as close a proximity to their skull as younger people, more energy will be required. - I can tell you that 1.5 Tesla coil strength , on the Neurostar machine, differentiated from placebo and was comparable to the results from ECT. Hope this helps.

It may. Particularly anxiety. But it is "off label."

Yes. However, we typically keep patients on their antidepressants or start a really good one during their treatments. Also, we take great care to make sure the patient is hormonally optimized. At present, we have absolutely no patients that are requiring on going "maintenance" treatments.

Yes you can use that device. I just looked it up. This is not an FDA approved device. Would use it in cooperation with a mental health professional. Good luck.

thanks for reply actually I would like to take a treatment from your hospital but for US medical visa I need invitation

Hi Hemin. It would be more than one treatment session. The minimum that I would do would be 10 - 20, depending on your status, medications, and if there is anything else that could be done for you. If you are interested in pursing this, please reply with a confidential e-mail so that I can sent my staff's e-mail to you. They can facilitate this. If a letter is required, I can furnish you one.

Are there any guarantees in life?

yes

Angie Lucas what a stupid answer!!! This costs up to 12 k. You understand that?

Insurance is accepted

+Léo Vaz Thank you for your question - at least, I will take it as a question. There is actually a 26 second pause built in between every train of 40 pulses. The pulse train takes 4 seconds. Therefore, there are 40 pulses delivered every 1/2 minute. It takes 75 pulse trains to get to 3000 pulses. That produces a total time of 37.5 minutes. You have identified an omission in my discussion and I am sorry about that omission. The reason for the built in "pause" enforced by the machine is that to continue to deliver pulses in a nonstop fashion would definitely increase the risk of causing a seizure, even though the magnetic coil is not located over the motor strip. Hope this helps with your understanding.

+Louis Cady, MD cool... thank you for the awnser.

+Louis Cady, MD does it work for bipolar