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

Quick overview Many teens 15 and older can be considered for Transcranial Magnetic Stimulation (TMS) , but eligibility depends on diagnosis, prior treatments, and insurance rules. This guide walks you through the clinical criteria, what TriWest’s change means for families, the paperwork you’ll need, and how Creative Wellness helps get teens from consult to treatment. The big change - TriWest and adolescent TMS In October 2025, TriWest updated its coverage policy to expand TMS coverage to adolescents ages 15 and older . That matters for military families and TriWest-covered dependents because it opens a pathway for in-network coverage of TMS for qualifying teens. NeuroStar also notes that NeuroStar Advanced Therapy is indicated as an adjunctive treatment for Major Depressive Disorder (MDD) in adolescents 15–21 . Clinical eligibility - the checklist clinicians (and insurers) look for Insurance policies and clinical teams generally use similar rules when deciding whether a teen is a candidate for TMS. Use this as a quick checklist : Basic clinical criteria Age: ≥ 15 years old (TriWest-adopted floor; NeuroStar adolescent indication 15–21). Primary diagnosis: Major Depressive Disorder (MDD) - documented by a psychiatrist or qualified clinician. Treatment history: Documented failure of at least two adequate antidepressant trials from different pharmacologic classes (for example, an SSRI + an SNRI), given at therapeutic dose and for an adequate duration. Insurers require clear dates, doses, and reasons for discontinuation. Psychotherapy tried: The teen has not responded adequately to psychotherapy (e.g., CBT) - usually documented therapist notes or a clinician summary are required. Safety / absolute contraindications (typically reviewed during clinical screening) Presence of non-MRI-compatible metal in the head (implants) that would make TMS unsafe. Certain neurological conditions (e.g., uncontrolled seizure disorder) - TMS is generally safe, but seizure history requires physician review. Other medical factors identified during the MD evaluation (cardiac devices, implanted stimulators, etc.). See your clinic’s safety checklist. (Your clinic will screen thoroughly.) Some insurers require an explicit statement that TMS is being requested as a medical treatment for MDD after medication and therapy failures, not as an elective procedure. What documentation to gather - a parent’s checklist When you contact Creative Wellness (or another clinic) and when the clinic files an insurance prior authorization, having clear documentation speeds decisions. Collect the following before the consult whenever possible: A. Psychiatric documentation Recent psychiatric evaluation (or summary) stating diagnosis of MDD and current symptoms. Medication history : names of antidepressants, start/stop dates, doses, duration, and reasons for discontinuation or perceived inadequacy (side effects, lack of benefit). Insurers expect explicit documentation that at least two antidepressants from different classes were tried adequately. Lab / medical notes if applicable (e.g., relevant medical history that affects treatment). B. Psychotherapy documentation Therapist progress notes or summary showing that an evidence-based psychotherapy (e.g., CBT) was tried and did not provide an adequate response. Dates and frequency of therapy are helpful. C. School / functional impact (helpful but optional) A short letter about how symptoms are affecting school, social life, or daily functioning can strengthen medical necessity arguments. D. Insurance & ID Front/back of insurance card, subscriber info, and any military/membership ID (e.g., TriWest details). For TriWest patients, note the adolescent coverage update (Oct 21, 2025) and be prepared to request eligibility confirmation. E. Contact information for prior providers Therapist and prescriber contact details so the clinic can obtain records when needed.

Quick overview Starting Transcranial Magnetic Stimulation (TMS) can feel like stepping into the unknown . While most providers explain the basics, many patients still wonder: What will I feel each day? Will I be able to work? Are side effects common? When will I notice changes? Below is a realistic, day-by-day look at the first week of a typical TMS course at Creative Wellness , so you can begin treatment feeling informed and confident Day 1: Your First Session What happens: Your care team (physician or supervised clinician) will do motor-threshold mapping to find the right coil placement and stimulation level — this personalizes your dose. The first visit usually takes longer than future visits (about 30–60 minutes). What it feels like: You’ll feel a tapping or rhythmic sensation on the scalp where the coil sits. Mild facial muscle twitching is common and normal. Some people report scalp sensitivity during or after the session. Afterward: Most people can drive themselves home and return to normal activities the same day. Plan a light schedule on the first afternoon in case you feel tired or have a mild headache. Day 2–3: Getting Used to It What changes: Sessions are usually shorter (around 15–30 minutes) and follow a predictable routine. The tapping sensation becomes more familiar and less distracting. Common experiences: Mild headache or scalp tenderness that typically responds to OTC analgesics. Feeling tired after some sessions (others feel energized — responses vary). Most people continue working or attending school without issue. Stay hydrated and eat a light snack before your session to reduce the chance of headaches or fatigue. Day 4–5: Settling Into Routine What you’ll notice The treatment routine often “feels normal.” Appointments fit more easily into the day, and initial sensitivity usually lessens. Some patients notice small early changes such as improved sleep, a subtle lift in mood or more energy - but meaningful mood improvement often takes more time. Keep in mind The first week is primarily about adjustment and building consistency. Don’t be discouraged if you don’t feel dramatic changes yet - many patients start noticing clearer benefits around weeks 2–4.

Quick overview Transcranial Magnetic Stimulation (TMS) is a non-drug, clinic-based treatment that targets brain circuits involved in mood. Even though TMS is not a medication, your current prescriptions matter - for safety, for treatment planning, and sometimes for how well TMS works. At Creative Wellness, our medication management approach is collaborative and MD-led: we partner with your prescribing psychiatrist, primary care provider, and family to make sure TMS is safe, well-coordinated, and focused on the best possible outcome. What clinicians watch for 1. Medications that may increase seizure risk Some drugs can lower the brain’s seizure threshold. When we screen patients for TMS, we pay special attention to medications known to increase seizure risk so we can manage that risk appropriately . Examples clinicians commonly review include: Bupropion (Wellbutrin) is associated with increased seizure risk at higher doses or in certain patients. Certain tricyclic antidepressants (TCAs) are used at high doses. Some antipsychotics (dose-dependent effects noted with a few agents). Stimulant medications (used for ADHD) in some clinical contexts. Important: This list is illustrative, not exhaustive. We review every medication and medical history personally during the MD evaluation. If any medication raises concern, your psychiatrist and our MD will discuss options - sometimes no change is needed; other times a temporary adjustment or additional monitoring is recommended. 2. Medications that may affect TMS response Some classes - particularly benzodiazepines - can alter cortical excitability and may, in some patients, blunt the measurable response to stimulation. This doesn’t mean benzodiazepines are always stopped; rather, your care team weighs the benefits (e.g., anxiety control, sleep) against theoretical effects on responsiveness and plans individualized management. 3. Interactions with other advanced therapies If a patient is considering or receiving Spravato® (esketamine) , ketamine, or other procedural treatments, close coordination is required, as these therapies have distinct safety and scheduling requirements. Creative Wellness coordinates timing and monitoring across treatment types to maximize safety and benefit. Our medication-management workflow - step by step 1. Pre-visit medication review & records collection When you contact Creative Wellness we ask for a current medication list (names, doses, start dates) and contact info for the prescribing clinician. Our intake team collects prior psychiatric evaluations and therapy notes when relevant. Having full records speeds approvals and creates a clear clinical picture. 2. MD-led evaluation & motor-threshold mapping An MD performs the initial evaluation, documents the diagnosis, screens for safety concerns, and performs motor-threshold mapping. This MD documentation is the clinical foundation for any prior authorization and for medication decisions during the TMS course. 3. Joint planning with the prescribing psychiatrist If changes to medications are advisable (for safety or to optimize response), our MD will contact your prescribing psychiatrist or primary care clinician to discuss options. Collaborative decisions may include: dose adjustment, temporary holding of a medication, or additional monitoring. We always prioritize continuity of care and shared decision-making. 4. Documentation for payers If an insurer needs justification (for example, documenting medical necessity), we include a clear medication history, rationale for any proposed changes, and the MD’s plan in the prior-authorization packet. Managing this paperwork is part of the service Creative Wellness provides. 5. Ongoing monitoring & communication During your TMS course, we monitor side effects and treatment tolerability at each visit . Any medication concerns that emerge are routed back to the MD and, if needed, to your psychiatrist for timely changes. Practical examples: what coordination looks like Patient on bupropion: The MD reviews dose and seizure history, consults with the prescriber, and either proceeds with standard monitoring, adjusts the dose, or documents the rationale to the insurance company. Patient taking benzodiazepines nightly for anxiety: The team discusses whether a slow taper is clinically appropriate or whether continuing at a stable dose with careful monitoring is preferable. Patient starting Spravato: We coordinate scheduling and medical oversight so that Spravato sessions and TMS sessions don’t conflict and that safety monitoring is in place.

Quick overview Genetic testing is a precision-medicine tool that helps your clinician choose medications and doses more likely to work for you - reducing guesswork, unwanted side effects, and the time spent trialing medicines. At Creative Wellness, we use genetic testing as one important input in medication management, combined with clinical judgment, patient history, and close psychiatric oversight. What is genetic testing for psychiatric medications? Genetic testing (sometimes called pharmacogenetic testing) analyzes a person’s DNA to identify variations in genes that influence how medications are metabolized and how the brain responds to certain drugs. At Creative Wellness, we review a panel of genes (our program evaluates multiple genes that matter for drug metabolism and response) so clinicians can narrow medication choices and dosing options - potentially avoiding medications that are unlikely to help or that carry a higher risk of side effects for that person. Why we offer genetic testing - the benefits Reduce trial-and-error: Rather than trying drug after drug for months , genetic testing helps identify medications and doses that fit a person’s metabolism and genetics, which can shorten the time to an effective treatment. Lower risk of adverse effects: Variations in metabolism genes explain why some patients get intolerable side effects or toxic levels at standard doses - testing flags these risks. Better dosing guidance: For some medications, genetics helps clinicians choose safer starting doses. Useful for multiple scenarios: Genetic testing is valuable for people starting medications for the first time, for those who’ve had bad side effects, and for those who haven’t responded to several prior medications. The variation that affects drug metabolism is common - present in the majority of people - so many patients can benefit. What the test actually shows (and what it doesn’t) What it shows Genetic variants in key metabolism enzymes and receptors that influence how quickly drugs are processed, and whether the patient is likely to be a poor, normal, or rapid metabolizer for a drug class. Guidance about specific drugs and drug classes - for example, medications that may be less effective for you or may require dose adjustments. What it doesn’t show A guarantee that any single medication will work. Genetics is one piece of the puzzle - environmental factors, other medical conditions, interactions, and clinical history matter too. A complete prediction of side effects or long-term outcomes. Clinical judgment remains essential. In short, genetic testing improves the odds and guides safer choices - it does not replace a thoughtful psychiatric evaluation. How genetic testing changes medication selection in practice Here’s how the test informs decisions clinicians actually make: Eliminate unlikely options. If a medication is metabolized very slowly in a given patient, the clinician may avoid it or use a lower dose. Prefer drugs with favorable metabolism. If the panel suggests one medication has a higher likelihood of being effective and well tolerated, the clinician can prioritize that option. Adjust timing and monitoring. For medications where genes affect blood levels, clinicians can plan closer follow-up, slower titration, or lab monitoring. Coordinate complex regimens. When patients take multiple psychiatric medications, genetic results help avoid dangerous interactions or cumulative effects by clarifying metabolism pathways. These changes help patients get to a well-tolerated, effective medication faster and with fewer side effects.

Quick overview On October 21, 2025 , TriWest updated its policy to expand insurance coverage for Transcranial Magnetic Stimulation (TMS) to adolescents ages 15 and older . This opens an important pathway for military families and TriWest beneficiaries to access NeuroStar® Advanced Therapy for Major Depressive Disorder (MDD) - provided clinical and insurer eligibility rules are met. Below is what the policy change actually says, who’s likely to qualify, what paperwork families should collect, and how Creative Wellness supports you through the process. TriWest Policy Update - Key Points Effective date: October 21, 2025 . Age: TriWest expanded coverage to adolescents ages 15+ . Clinical context: NeuroStar Advanced Therapy is indicated as an adjunct for Major Depressive Disorder (MDD) in adolescents 15–21 . Insurance eligibility (summary): Coverage is tied to medical necessity - typically a documented diagnosis of MDD plus evidence that standard care (antidepressant medications and psychotherapy) was unsuccessful. See the next section for the common insurer criteria. Who is likely eligible (insurer & clinical checklist) Most payer policies - TriWest included - evaluate the same core items when approving adolescent TMS: Core insurer/clinical eligibility elements Age ≥ 15 years. (TriWest/NeuroStar adolescent indication 15–21.) Diagnosis: Documented Major Depressive Disorder (MDD) by a psychiatrist or qualified clinician. Medication history: Failure of at least two adequate antidepressant trials from different pharmacologic classes (for example, an SSRI and an SNRI). Insurers require dates, doses, and the reason for stopping (inefficacy or intolerable side effects). Therapy: Documentation showing the teen has not responded adequately to psychotherapy (e.g., CBT) . Written therapist notes or a clinician summary, usually suffice. Safety screening: No contraindications (e.g., certain implants); seizure risk and other medical issues are evaluated during the MD screen and motor-threshold mapping. Clinical note: NeuroStar reports favorable adolescent outcomes in real-world datasets (e.g., improvement and remission rates cited by NeuroStar). These data support adolescent indications, but insurers still require specific documentation that the medical necessity criteria are met. What documents & information to have ready (family checklist) To speed authorization and avoid delays, gather these items before you contact a clinic or submit a referral: Insurance & ID: front/back of the insurance card; TriWest identification/subscriber info. Recent psychiatric evaluation or medical summary stating diagnosis of MDD. Medication log: names, doses, start/stop dates for antidepressants - document at least two trials from different classes and reasons for discontinuation. Therapist notes or summary showing psychotherapy trials (dates, frequency, response). School/functional impact letter (optional but helpful): summary of how symptoms affect school/activities. Contact info for prior providers (prescriber and therapist) so the clinic can obtain records. Parental/guardian consent - clinics will walk you through consent requirements for adolescents.