Psychiatric Care & TMS Therapy for the Greater Puget Sound of Washington

Quick Overview Yes - in most cases. TMS (Transcranial Magnetic Stimulation) is an outpatient, non-systemic, and non-sedating treatment designed so that most people can return to their daily activities, including work, right after sessions. Below, we cover what to expect during a typical course, common side effects, scheduling tips for working patients, and exactly when you might need to take time off or adjust your work schedule. What a typi cal TMS course looks like Most TMS courses are administered five days a week (Monday–Friday) for about 4–6 weeks. Sessions themselves usually last about 20–40 minutes, and many protocols are 20 minutes or less. Before treatment begins, you’ll have an initial consultation and a mapping/motor-threshold assessment that determines the precise target and dose for your daily sessions. Because sessions are short and non-sedating, patients are generally able to drive themselves home and return to their normal daily plans after each appointment. That means many people keep working during their treatment. Because sessions are short and non-sedating, patients are generally able to drive themselves home and return to their normal daily plans after each appointment. That means many people keep working during their treatment. Common side effects and how they affect work The most common effects reported during TMS are mild scalp discomfort or headache, which usually resolve quickly after a session. These side effects rarely require extended time off work. A small percentage of patients experience a temporary increase in symptoms mid-course (sometimes called the “dip”), and clinicians monitor for that and offer support. If you do experience unexpected or persistent effects, your care team will review your treatment plan with you. Read More: TMS Benefits and Side Effects Practical scheduling tips for working patients Here are practical steps most working patients use to keep work and treatment balanced: Schedule sessions around your workday. Book sessions early morning, lunch hour, or late afternoon so they fit with your routine. Because sessions are short, many people attend without missing a full workday. Work remotely on session days if possible. If your job allows flexible/remote work, doing your session near your workspace or working from home afterward reduces commute time. Plan for the occasional “dip.” About 10–15% of patients may feel a temporary worsening of symptoms mid-course. If your job is safety-sensitive (driving, heavy machinery), talk with your clinician about timing or remote options. Talk to your employer in advance. If you expect to need flexibility, consider a short note from your clinician or HR conversation - many employers will accommodate a 4–6 week daily-treatment schedule. Use short breaks wisely. The treatment chair time is often 20 minutes; factor in check-in and any brief observation, and you’re typically looking at a 45–60 minute block out of your day.

Quick Overview An insurance denial for TMS is stressful, but not the end of the road. Many denials can be reversed with a well-documented appeal, clinical support from your treatment team, and persistence. This guide gives you exactly what to do next - step by step - plus appeal templates you can use right away. Immediate steps when you get a denial Read the denial letter carefully. Note whether it’s a coverage denial, a medical-necessity denial, or a coding/prior-authorization denial. Look for appeal deadlines and the insurer’s appeals contact. Save everything. Keep the denial letter, any emails, and the date/time of phone calls. Request a written explanation of benefits (EOB) and the denial reason code. Ask the insurer for the precise reason and the name/phone number of the caseworker. Contact your clinic. Tell Creative Wellness (or your clinic) right away - we run benefits checks and handle prior authorization paperwork. Clinics commonly help with appeals and prior authorization documentation. Step-by-step appeals plan Step 1 - Verify deadlines & next actions Check the denial letter for exact appeal deadlines and whether an expedited review is possible (often called “urgent” or “expedited” appeal). Note timelines: insurers vary - some expect appeals within 30 days, others allow up to 180 days; urgent appeals are sometimes handled within 72 hours. Always use the insurer’s stated timeline. Step 2 - Gather records and evidence Collect everything your appeal will need: Denial letter & EOB (front & back) Copy of the insurance policy language if available (or the relevant medical necessity criteria) Clinical notes showing diagnosis and prior treatments tried (medications, therapy) Documentation of prior authorizations and prior-authorization communications (if any) TMS treatment plan and mapping/motor threshold notes, if available Letters from treating clinicians (psychiatrist, referring MD) stating medical necessity Peer-reviewed evidence or guidelines (Clinical TMS Society or key articles) — your clinic can supply suggested citations. Tip: Clinics routinely assemble this evidence for you and can create a provider appeal letter. Clinics also handle prior authorization paperwork and appeals logistics. Step 3 - File a patient appeal (use the template below) Submit a clear, concise patient appeal letter that states the facts, why the treatment is medically necessary, and what evidence you are sending. Use certified mail or the insurer’s online appeal form if available. See the template below. Step 4 - Ask your provider for a clinical appeal (use the provider template) A provider letter from your prescribing psychiatrist or the TMS medical director is often the most persuasive piece of evidence. The provider should explain the history of treatment failures, specific reasons TMS is appropriate, and attach relevant clinical notes and test results. Step 5 - Follow up by phone & get a case number Call the insurer after filing and ask for the appeal case number, the expected resolution date, and the name of the reviewer, if possible. Keep notes of the conversation (date, time, person, summary). Step 6 - Escalate if needed (external review/state regulator) If the internal appeal is denied, request an external review by an independent reviewer or contact your state insurance commissioner for help with the process. Many states require insurers to tell you how to request an external review. Step 7 - Consider alternatives while you appeal Ask the clinic about temporary options: payment plans, financing, or alternative treatments (eg, Spravato ) while the appeal is pending. Creative Wellness offers benefits checks and helps explain payment options.

Transcranial Magnetic Stimulation (TMS) is a safe, non-invasive, FDA-cleared treatment that helps rebuild brain activity in people with depression and certain other conditions. Many patients respond well: real-world and clinical data show a high response and remission rate for those who complete a full course of treatment. That said, TMS doesn’t help everyone on the first course. Below is a clear, patient-friendly explanation of why that happens, how clinicians approach it, and what practical options exist if you’re not satisfied with your results. Why TMS Sometimes Doesn’t “Work” Right Away 1. The brain needs time to adapt - the “TMS dip.” Some patients experience a temporary worsening of symptoms a few weeks into treatment - a phenomenon often called the TMS dip. It’s thought to reflect the brain’s neuroplastic changes as circuits reorganize; for most people, this is a short-lived phenomenon that precedes improvement. Clinics frequently warn patients about the dip and monitor it closely. 2. Treatment parameters may need adjustment. TMS requires correct coil targeting, intensity, and schedule. If coil placement, stimulation intensity, or session frequency is suboptimal, the standard protocol may not produce a response for a particular patient. Clinicians will often reassess mapping and parameters if improvement is delayed. 3. An incomplete course or timing. Many people see meaningful changes between sessions 20–30, and full benefits may appear by week 6–8. For some, the response is delayed, and a longer course or extra sessions are required. Real-world outcomes show many patients respond after completing a full regimen. 4. Underlying diagnosis or comorbidities. If symptoms are driven by an untreated medical issue, substance use, or a misdiagnosis, TMS may be less effective. A careful diagnostic review can reveal whether another condition is limiting response. 5. Medication interactions, life stressors, or adherence issues. Changes in medication , inconsistent attendance, or major life stress can blunt the response. Good clinical coordination between psychiatry, psychotherapy, and the TMS team helps mitigate these factors.

Quick Overiew Finishing a course of Transcranial Magnetic Stimulation (TMS) can bring real relief - but patients commonly ask: how long do the benefits last, what happens next, and what options exist if symptoms return? This guide explains typical follow-up care, maintenance, and booster options, evidence about long-term durability, and practical next steps Creative Wellness TMS offers to help patients preserve and extend treatment gains. Quick facts: the typical TMS course & follow-up Typical course: Most TMS courses are delivered 5 days/week for 4–6 weeks; sessions are ~20–40 minutes. Clinics typically perform a mapping session and record the motor threshold to deliver the correct dose and reproducible coil placement. When people usually improve: Many responders show clinical improvement between sessions 20–30; some patients have delayed benefit toward the end of week 6. Immediately after your course: the clinical review At the end of a TMS course, your care team typically performs a final clinical review to: Measure symptom change using standard scales, Ask about functioning (sleep, work, mood), Discuss whether goals were met and next steps. Clinics often schedule a wrap-up visit specifically to review outcomes and plan follow-up Contact us Here Maintenance, boosters, and retreatment - what’s the difference? Maintenance TMS: Planned, periodic sessions intended to maintain gains for patients who responded. Some clinics offer a maintenance schedule (for example, tapering frequency) when clinically indicated. Maintenance may be discussed as an option after successful treatment. Booster sessions: Short courses or single sessions are used when a patient notices symptom worsening after an initial positive response. Retreatment / repeated course: For those who didn’t achieve full response, extending or repeating the full course is sometimes helpful - clinicians will reassess mapping and parameters first. Important note: Maintenance sessions and certain retreatment approaches may not be covered by insurance, so clinicians review options and costs with each patient. What the evidence says about long-term results Studies and clinic reports suggest durable benefit for many patients: Clinic-level and trial data show that a meaningful portion of patients have sustained improvement at 12 months - some reports note ~68% sustained improvement and ~45% complete remission at one year in certain cohorts. However, response varies by individual and by the exact protocol, device, and patient selection; ongoing monitoring and coordinated care matter for long-term success. When a patient’s symptoms return: practical next steps If symptoms return or the initial response is incomplete, clinicians typically follow a stepwise approach: Clinical reassessment - review medical history, medications, sleep, substance use, and life stressors to identify reversible contributors. Confirm technical accuracy - check recorded mapping, motor threshold, and coil placement; remapping or parameter adjustment can improve outcomes. Consider boosters or repeat course - for responders who relapse, boosters or a repeat/extended course may restore benefit. For non-responders, clinicians may consider a different protocol or device. Combine treatments when appropriate - adding or optimizing psychiatric medication, psychotherapy, or considering other advanced options (Spravato/esketamine, ketamine, or ECT in selected cases) is a standard part of evidence-based care. Your psychiatrist and TMS team collaborate on these decisions.

Understanding Your Mental Health Care Options If you’re exploring treatment for depression, anxiety, or ongoing mental health symptoms, you may feel overwhelmed by the number of options available. Many people ask: “Should I try therapy, medication, TMS, Spravato, or genetic testing - and how do I know what’s right for me?” The truth is, there’s no one-size-fits-all answer. Each approach works differently, and the best plan often depends on your history, symptoms, and how you’ve responded to treatment in the past. Below is a clear comparison of four commonly used approaches: Counseling (therapy), TMS therapy, Spravato (esketamine), and genetic testing.