FAQ “Before” Repetitive Transcranial Magnetic Stimulation (rTMS) Therapy
Q1: Am I suitable for rTMS treatment?
A1: At present, the Ministry of Health and Welfare of Taiwan approves rTMS for treatment of depression in adults who do not respond well to at least one antidepressant. However, it is recommended to go to the outpatient clinic for more detailed discussion with a physician for case-by-case evaluation of rTMS.
Q2: Are minors, pregnant women, or people with diagnoses other than depression suitable for rTMS treatment?
A2: To date, rTMS treatment has not been approved for use in the above groups in Taiwan. It is recommended to discuss with a physician for suitability in the outpatient clinic first.
Q3: How can I start rTMS treatment?
A3: An evaluation is mandatory before treatment begins. If you have never visited the psychiatric department of our hospital, please register one of the following outpatient clinic time slots for a complete evaluation with our physician first. Those who have visited the psychiatric department here before, please consult with your physician.
Dr. Cheng-Ta Li: Monday AM; Wednesday AM
Dr. Chih-Ming Cheng: Tuesday PM;Thursday PM; Friday AM
Dr. Jia-Shyun Cheng: Wednesday PM; Friday PM
Q4: Do I need to prepare anything before rTMS treatment?
A4: During the consultation, the doctor will fully explain the rTMS treatment process. You will then be asked to sign a consent form. Please read the form carefully before signing. You will be reached by our treatment center via phone call, confirming the scheduling details with you, in a few days after the consent form is completed.
There is no need for fasting or any special preparations before starting rTMS treatment each time. If you are on medication, please continue to take the medicine according to the doctor's advice, and do not change the type or dosage of the medicine yourself. Inform our staff before every treatment starts. The rTMS treatment does not require anesthesia, which allows you to return home or work immediately after the treatment is completed.
Q5: How long does it take for an rTMS treatment?
A5: It is recommended to proceed once daily on weekdays (W1-W5) for three consecutive weeks during the acute phase, with a total of 15 sessions of treatment. Depending on the severity of symptoms, some patients may need treatments for more than four weeks. The total number of sessions needed for a complete treatment is adjusted according to individual circumstances.
Each session takes approximately 30 minutes (may slightly differ according to treatment parameters). The physician assesses the response to treatment and discusses with the patient at any time, and may adjust the details of the treatment as needed.
Please discuss with the physician to determine the required time for other special conditions.
Q6: How is the treatment scheduled?
A6: You will receive a phone call a few days after the consent form is completed. For the treatment of acute phase, our staff will schedule the sessions at a fixed time, once daily on weekdays (W1-W5), for three consecutive weeks. The sessions last about 30 minutes each, except for the pre-treatment preparation session on the first day, which may take about an hour.
* Those who do not prefer phone calls can take the initiative to contact the center via emails after outpatient evaluation and consent form are completed:
vghtpepredic@gmail.com
Q7: What if I can’t come to the treatment every day?
A7: It is best responded if the treatment is performed continuously during the acute phase based on observational studies. Thus it is recommended to start the treatment when you are most available. If your schedule is really tight, it is still recommended to maintain the sessions no less than three times a week.
Q8: What are the treatment parameters?
A8: There are multiple combinations of effective treatment parameters for rTMS. The excitatory high-frequency stimulation, which is the standard treatment parameters that the FDA approves, is commonly applied to the left dorsolateral prefrontal cortex (DLPFC). Low-frequency stimulation of the right dorsolateral prefrontal cortex and combined treatment of bilateral dorsolateral prefrontal cortex are also possible effective treatments. We will design appropriate treatment parameters for each patient according to their different conditions.
Q9: What are the possible side effects for rTMS treatment?
A9: rTMS is a non-invasive treatment, and its side effects are mostly mild and short-lived. Clinically common side effects are as followings:
- Dizziness, headache, pain in the treated area: Mostly very mild and resolves with a short rest.
- Involuntary twitching of facial muscles during treatment: It is a normal reaction that only appears during treatment sessions (and stops when treatment session is completed), without causing long-term effects.
- Hearing impact: The rTMS machine may produce loud noises during the treatment. Earplugs will be provided to each patient during the entire treatment to avoid impacting hearing.
- A small number of patients, especially those with bipolar mood disorders, may experience elevated mood during the process, and may cause hypomania or mania, but rarely.
- Very rare side effect: seizure (at present, the incidence rate is considered to be less than one in ten thousand)
Q10: Where is the treatment center?
A10: The “Precision Depression Intervention Center'' is located on Shih-Yuan Building 5F. (detailed map as below)
Q11: Is rTMS treatment covered by the national health insurance? How much does it cost?
A11: At present, rTMS is still a self-paid treatment. Each rTMS treatment session costs NTD$5000. The total fee will be NTD$75,000 for 15 sessions of treatment, for example.
Q12: How do I pay the fee?
A12: After the treatment officially starts, our staff will give you the payment slip according to the date. Please go to the payment counter on the first floor of Shih-Yuan Building (lunch break time: 12:00~13:30) or the first floor of the Third Outpatient Clinic Building to pay manually. Do not discard the payment slip after payment, please return it to the treatment unit on the day of treatment.
Q13: What should I do to prepare if I receive a phone call for an electroencephalopathy examination?
A13: You might receive a phone call for an electroencephalopathy examination, which is a non-invasive examination. Please read the following instructions carefully before the examination:
Before examination:
- There is no need to fast or change medications before the examination.
- Please wash your hair the day before the examination and do not apply any hair products (including hair care products).
- Empty your bladder before the examination begins.
- Please make sure to turn off your phone or mute it.
- Be sure to bring glasses if you wear them.
- Please avoid makeup and any hair products on the day of the examination.
During examination:
- During the examination, the staff will clean your scalp with alcohol wipes first before placing electrodes with conductive gel on.
- Please keep your head and body steady during the examination. Follow the instructions from the staff.
- Please stay awake during the examination.
After examination:
After the examination, simply remove the conductive gel on the scalp. You can wash your hair after. If you are worried about the appearance, you may bring a hat with you to the examination.
FAQ “After” Repetitive Transcranial Magnetic Stimulation (rTMS) Therapy
Q1: How long does it take for the treatment to work?
A1: Like pharmacological treatment and other treatments, people respond differently. You might start to notice the treatment effect from during the treatment to three months after the treatment.
Q2: How long does the treatment effect last?
A2: The treatment effect varies from person to person. According to the experience of our past clinical trials, about 60-80% of the patients can maintain therapeutic effect for at least three months. Other studies have also shown that the therapeutic effect can last longer if the combination of drugs is continued after treatment.
Q3: Should I keep doing the rTMS treatment after the first treatment is completed?
A3: Depression may be recurrent. There is indeed a chance of relapse, which might be closely related to psychological, physiological and social environmental factors. The follow-up maintenance treatment can be discussed with your physician according to each individual's condition.
Q4: Can I stop taking the medications?
A4: Depression is a disorder with a tendency of recurrence. Therefore it is highly recommended to continue the medications during the acute phase and the subacute phase, to consolidate the therapeutic effect of rTMS. Discuss with your physician whether to stop the medications afterwards.
Q5: What if my symptoms get worse? Should I do the rTMS treatment again?
A5: There are many ways to treat depression. If the symptoms aggravate, you can discuss the follow-up treatment with your physician first. If your previous treatment with rTMS has been successful, it can be considered as a priority treatment option.
Case sharing:
For more inquiries, contact us.
Precision Depression Intervention Center, Psychiatry Department
TEL: (02) 5570-2205
Open time: Monday to Friday 09:00~12:00 ; 13:30~16:30
Email: vghtpepredic@gmail.com
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