A Proven Non-Drug Treatment for Depression TMS THERAPY: A Proven Non-Drug Treatment for Depression WoodlandsPsych.com

Major Depression is a Brain Disease

Brain Activity Can Be Altered Chemically by Drugs or Electrically by TMS Drug action is anatomically diffuse and systematic TMS is focused, non-invasive, and non-systemic LEFT PREFRONTAL CORTEX STRIATUM STRIATUM ANTERIOR CINGULATE ANTERIOR CINGULATE HYPOTHALAMUS AMYGDALA HIPPOCAMPUS

A Unique Mechanism of Action The treatment coil produces MRI-strength magnetic field pulses. Magnetic field pulses pass unimpeded through the cranium for 2-3 cm. and induce a small electric current. Induced electric currents stimulate the firing of nearby neurons, causing the release of neurotransmitters and clinical effects.

STAR*D Study demonstrates that current treatments have limited effectiveness Trivedi (2006) Am J Psychiatry; Rush (2006) Am J Psychiatry; Fava (2006) Am J Psychiatry; McGrath (2006) Am J Psychiatry

Likelihood of discontinuing treatment increases with each new medication attempt Systemic Drug Side Effects Weight Gain Constipation Diarrhea Nausea Drowsiness Insomnia Decreased Libido Nervous Anxiety Increased Appetite Decreased Appetite Fatigue Headache/ Migraine Abnormal Ejaculation Impotence Sweating Tremor Treatment Discontinuation Side Effects Weakness Dry Mouth Dizziness Trivedi (2006) Am J Psychiatry; Rush (2006) Am J Psychiatry; Fava (2006) Am J Psychiatry; McGrath (2006) Am J Psychiatry; Neuronetics, Inc. (data on file)

Effective and Durable in a Multi-Site Outcomes Study Consistent Response and Remission Across a Broad Range of Treatment-Resistant Patients The Only TMS System with Durability Established Over 12 Months Long-Term Post-Acute Treatment2 CGI-S Outcomes in Acute Phase1 * 0-1 adequate antidepressant medications ** ≥2 (range 2-14) adequate antidepressant medications 1 in 2 patients responded 1 in 3 patients achieved complete remission of symptoms 36.2% of patients received TMS Therapy reintroduction (average of 16 treatments)

Proven Safety and Tolerability Profile Avoids the side effects commonly associated with medications1 No systemic side effects Excellent treatment adherence with less than 5% discontinuation rate due to adverse events1 No adverse effect on cognition No adverse effect on sleep2 Antidepressant Medications TMS Therapy ADVERSE EVENTS3 Scalp Pain or Discomfort Eye Pain Toothache Muscle Twitching Facial Pain Pain of Skin Adverse events are transient, occur during TMS treatment and do not occur for most patients after the first week of treatment.1 Post-marketing experience confirms that seizure risk is rare with TMS Therapy (<0.1% per patient).3 Adverse events occurring at an incidence >5% and 2x the rate of placebo treatment3

Best Practices Treatment Guideline for Depression Based on 2010 APA guidelines and TMS Therapy indication for use SSRI Adapted from: Practice Guideline for the Treatment of Patients with Major Depressive Disorder, 3rd Edition, APA (2010)

Who is Right for TMS Therapy? Indicated for: Adult patients with Major Depressive Disorder Have failed to achieve satisfactory improvement from antidepressant medication Exposure to a median of 4 antidepressant medications (range 1-23) Patient characteristics: Multiple medication attempts yet still symptomatic Complex drug regimen evaluated Concerned about side effects Motivated to get well

Current Insurance Coverage for TMS Therapy

TMS THERAPY: A Proven Non-Drug Treatment for Depression Medical Director: Marshall B. Lucas, M.D. 281-367-1015 WoodlandsPsych.com