Outline of rTMS Treatment Process

PRE-ARRIVAL:

• If your patient is considering rTMS therapy, please submit a MindCare referral form on his/her behalf. (Please download a referral form here)
• Once your patient decides to proceed with rTMS therapy, an intake consultation with a MindCare Medical doctor will be set and appointment times for the first week of treatment will be arranged.
• A deposit of $1000.00 is required to secure your patient's appointment slot (taken via credit card, cheque, or cash).

 Back to top

FIRST DAY OF TREATMENT:

• Our friendly and highly trained staff will make your patient feel welcomed from the moment he/she walks into the clinic. We do our best to answer questions and provide a comfortable treatment environment.
• Your patient will be asked to complete a Patient Information Questionnaire (contact details, medication history, and emergency contact) and sign treatment consent forms.
• Depression and Anxiety rating scales will be completed on the first and last day of treatment, as well as throughout the treatment course. (Beck’s Depression Index and Hamilton’s Depression / Anxiety Scales)
• Pre-treatment Consult: This consultation will occur with a MindCare physician/psychiatrist, who screens for contraindications to rTMS therapy (please see patient eligibility section) and discusses your patient's medical and psychiatric history and medications. The initial consultation acts as a second screening device, in addition to the referral form, to ensure that your patient is a suitable candidate for rTMS therapy. Any of your patient's questions or concerns can be raised at this time. The initial consultation will take approximately one half hour to an hour.

 Back to top

TREATMENT:

• Following the physician consult, rTMS treatment will commence.
• Treatment is administered by a trained technician, and overseen by a medical doctor. The technician will familiarize your patient with the equipment and treatment procedure prior to commencing the first session. All doctors and medical technicians working at MindCare Centres have been educated in all aspects of rTMS therapy.
• During treatment, patients are fully conscious and able to read or converse with the technician or traveling acquaintance.
• rTMS is an outpatient procedure, which means that no hospitalization is required.
• The rTMS therapy procedure itself is painless, non-invasive, and requires no anesthesia.
• The magnetic stimulation is delivered by a figure 8 coil of conducting wire that is encased in plastic and held close to the scalp.

  

  The intensity of the stimulus that will be delivered is determined by inducing a motor-evoked potential (i.e. causing movement or a twitch to occur) in the abductor pollicis brevis, or thumb muscle. Your patient may feel a tingling or tapping sensation on the head, and scalp muscles may feel a little tense, during and a bit after the procedure. This is normal and may result in a minor headache (experienced by only 1 in 10 patients).
• Your patient will be provided with a set of earplugs and a storing case labeled with his/her initials. These will be used to protect against ear sensitivity to the slightly noisy machine sound.
• Second day of treatment: Once tolerance of treatment has been determined, your patient will be asked to pay the remaining balance towards the cost of treatment.

 Back to top

DURATION:

• The rTMS treatment protocol consists of a minimum of 20-30 sessions.
  
• 2 sessions are administered per day, for 10 days (weekends off).
• Each session is half an hour in length, with a half hour break in between treatment sessions.
• In some cases, 5-10 extra sessions are recommended for late responders. This need will be assessed with your patient individually by a trained medical staff member. We strongly encourage your patient to keep a third week available for additional treatment sessions.

 Back to top

COMMUNICATION:

• Your patient will be encouraged to freely discuss any concerns and feelings that he/she is experiencing, and to ask questions as they arise.
• MindCare staff members appreciate learning how we can help make your patient's treatment experience as comfortable as possible.
• Continuous feedback on your patient's treatment progress will be provided throughout the course of therapy.

 Back to top

LAST DAY OF TREATMENT:

• Treatment response is determined based on clinical assessment scales (Beck’s and Hamilton Depression/ Anxiety scales) and verbal feedback from patients.
• At the end of treatment, your patient will be provided with a Patient Report. This report provides a detailed summary of the treatment received, Depression/ Anxiety assessment scores, and results to date.
• A detailed Physician Report will be sent to you via fax/mail/courier, which will provide a detailed update on your patient's progress.
• Your patient will be provided with a Patient Take-Home Package, consisting of a Patient Satisfaction Survey and Beck’s / Hamilton’s Scales. These forms are to be completed and mailed back to us two weeks following your final treatment.

 Back to top

FOLLOW-UP:

The MindCare Centres team cares about ongoing patient progress following treatment. It is our priority to keep in contact with patients and encourage them to do the same.

• Regular follow-ups via telecom and/or email are maintained.
• Your patient can expect to hear from us at 2 weeks, 1 month, 3 months and 1 year following the final treatment.
• Phone calls to MindCare staff members with questions or concerns are strongly encouraged.

 Back to top

MAINTENANCE:

• Following the first stage of Acute rTMS therapy, Maintenance treatment sessions may be required to prevent any slippage.
• Maintenance therapy typically consists of a minimum of 5-10 treatment sessions.
  
• On average, patients return for maintenance therapy after 8-12 months. This will vary from patient to patient.
• A trained medical staff member will discuss this possibility with your patient following Acute Therapy.
• The need for maintenance treatment is assessed on an individual basis.
• Your patient will be encouraged to call MindCare Centres immediately if he/she senses depressive symptoms returning.
• Patients are encouraged to consult their family doctor or psychiatrist following rTMS therapy, in order to facilitate continued care after the treatment.

 Back to top

COST:

MindCare Centres believes in providing quality patient care, and affordability for our patients is important. Although there has been significant research on the use of rTMS, and the equipment is considered a medical device by Health Canada, this is a new treatment in the medical community.  As with most relatively new treatments and therapies, rTMS is not covered under government insured services in Canada.

• Each treatment sessions costs $250.
• An entire course of Acute Treatment, consisting of 20-30 treatment sessions, is estimated at $5,000 to $7,500.
• Stated costs include the fee for an initial intake consultation with a MindCare physician.

Extended Insurance Coverage:

• Currently the majority of the largest extended insurance providers in Canada cover this treatment on a case-by-case basis.
• As awareness of rTMS among medical providers and medical researchers increases, MindCare Centre is confident that more insurance providers and EAP providers will see this as a cost effective way of helping to treat depression.
• MindCare Centres is pleased to work with patients and physicians to apply for extended insurance coverage.

 Back to top