THETA BURST STIMULATION (TBS)
In the United States, the FDA-approved procedure for treating depression with TMS uses a protocol of repetitive, single-burst stimuli, called rTMS. This protocol, which was FDA approved for the treatment of depression in 2008, is safe, effective and well-tolerated. However, new, potentially better TMS protocols are on the horizon. In fact, in late 2018 TBS, aka Express TMS, was FDA approved for the treatment of depression.
Just like conventional rTMS, TBS uses magnetic energy to stimulate the prefrontal cortex of the brain and improve depressive symptoms. The difference lies in how the stimulation is delivered. The TBS protocol delivers stimuli in a unique pattern—three rapid bursts of pulses at 50 hz, repeated every 200 ms. Compared to the conventional rTMS, this protocol more continuously stimulates the brain. As a result, the treatment time is greatly reduced. Theta Burst Stimulation only takes 4 minutes, and research shows that it works equally well, if not better, than standard protocols that take upwards of 20 minutes.
How do we use TBS at Pacific Psychiatric Intervention & Wellness Centers (PPIWC)?
TBS treatments are used in several ways at PPIWC. It is used either as a stand alone treatment, or in conjunction with other treatments such as rTMS and ketamine therapy. When combined with rTMS or ketamine therapy, the likelihood of remission is dramatically improved. Because individual TBS treatments take such little time, we are able to offer this as a much more inexpensive alternative to rTMS for patients that aren’t able to use health insurance to cover the cost of the rTMS. Out of pocket costs for TBS treatments are less than $100 on average, compared to $300 for rTMS. Additionally, because TBS treatments take only a few minutes, we are able to several treatments per day, which can shorten the overall length of treatment by several weeks, making it a much more convenient schedule than rTMS