About our TMS Practice
Our Palm Harbor practice provides TMS therapy in a clinical psychiatric setting, led by a board-certified psychiatrist with over twenty years of experience. TMS is one of several effective treatments Dr. Rothschild offers, and the right approach depends on your specific situation. A careful psychiatric evaluation helps determine whether TMS is right for you and how it fits with your overall care.
What is TMS Therapy
Transcranial Magnetic Stimulation (TMS) is a non-invasive, FDA-cleared treatment that uses targeted magnetic pulses to stimulate areas of the brain involved in mood, thinking, and emotional regulation. TMS is considered a well-established, evidence-based, and effective treatment. The FDA first cleared TMS for major depressive disorder in 2008, and subsequent clearances have expanded its approved uses on specific devices.
TMS works by delivering brief magnetic pulses through a coil placed gently against the scalp. The pulses pass painlessly through the skull and affect neural activity in targeted regions of the brain. During treatment, most patients feel a light tapping sensation on the scalp. It is not “shock therapy.” Unlike electroconvulsive therapy (ECT), TMS does not cause seizures or require sedation or anesthesia.
Each session typically lasts 20 to 30 minutes. Patients remain awake throughout, can drive themselves home immediately afterward, and resume normal activities the same day.
Different stimulation protocols are used to help normalize activity in the brain networks involved in a given condition. While strong evidence shows that TMS works, exactly how it works is still being studied. Like other treatments and natural recovery, it is thought to act through neuroplasticity, the brain’s ability to reorganize and strengthen its connections over time. This is why a course of TMS involves multiple sessions, and why benefits may continue after the course ends.
TMS works directly on the targeted brain region, not through the bloodstream. It is very well tolerated, without ongoing side effects frequently associated with medications. Most patients continue their current medications during TMS, which is often the most effective approach. For others, TMS becomes part of a broader plan to safely reduce or simplify their medication regimen under careful medical supervision.
Each session typically lasts 20 to 30 minutes. Patients remain awake, usually feeling relaxed throughout the treatment, and can drive themselves home immediately afterward and resume normal activities the same day.
Conditions We Treat
At our practice, we offer TMS for the following conditions:
- Depression — Persistent low mood, loss of interest, fatigue, or changes in sleep and appetite. The most common protocol uses high-frequency stimulation to the left prefrontal cortex, a region that often shows reduced activity in depression. Other protocols, including low-frequency stimulation to the right prefrontal cortex, are also effective and may be used depending on the clinical situation. This is the FDA-cleared use of the Exomind device and has the strongest evidence base of any TMS indication. TMS is often used for patients whose depression hasn’t responded to medication, who haven’t tolerated medication side effects, or who prefer not to start a medication.
- Anxiety — Ongoing worry, a mind that won’t quiet down, feeling on edge, or trouble relaxing. For patients whose anxiety occurs alongside depression, TMS may help both, and improvement in anxiety often tracks improvement in mood. For anxiety on its own, the evidence is more limited.
- Insomnia and sleep disturbances — Difficulty falling asleep, staying asleep, or feeling rested. Often a problem of brain wiring, the prefrontal cortex stays overactive at night despite physical exhaustion. A different TMS protocol, low-frequency stimulation to the prefrontal cortex, has been studied as a way to dampen this hyperarousal, with growing evidence across thousands of patients. CBT-I remains the first-line treatment; TMS may be appropriate when CBT-I hasn’t been enough or isn’t a fit.
- Focus and cognitive symptoms — Mental fog, slowed thinking, or trouble concentrating that often accompanies depression, anxiety, and chronic stress. These symptoms frequently improve as the underlying condition is treated.
- Binge eating and food cravings — Loss of control over eating, or strong recurring food cravings. Early research suggests TMS can help with the impulse-control difficulties that underlie these patterns. This is not a weight-loss treatment per se.
The Exomind TMS device is FDA-cleared for depression. Using it for the other conditions above is considered off-label, which is common and accepted in medical practice; many TMS protocols in clinical use are not separately FDA-cleared. The evidence supporting these uses varies, with some conditions backed by stronger research than others. Dr. Rothschild will review the evidence relevant to your situation so you can make an informed decision.
TMS continues to be investigated for additional conditions, including ADHD, addiction, fibromyalgia, and tinnitus. The evidence base for these uses is still developing. If you’re considering TMS for a condition not listed in our offerings above, we’re happy to discuss the research and whether it might be appropriate for your situation during a consultation.
Why Choose Our Practice for TMS?
Our practice offers TMS in a comfortable, relaxing setting within a clinical psychiatric practice. Dr. Rothschild is a board-certified psychiatrist with subspecialty training in addiction medicine and forensic psychiatry, providing both general psychiatric care and TMS therapy with clinical oversight throughout.
You don’t need to change doctors to receive TMS here. Many patients continue with their current medication prescriber for ongoing care while coming to us for treatment, and we coordinate records as needed. We can also manage your broader psychiatric care if you prefer..
TMS is not a one-size-fits-all treatment. Dr. Rothschild will help determine the stimulation parameters, target site, and session schedule best suited to your condition. One example of why a careful psychiatric evaluation matters: certain TMS protocols can worsen symptoms in patients with bipolar disorder, a diagnosis that is sometimes missed in patients who have only been treated for depression. Bipolar disorder is not a contraindication for TMS, but it may change which protocol is appropriate.
Our practice uses the BTL Exomind TMS system, which delivers TMS therapy with advanced coil engineering and offers proprietary stimulation protocols. The specific protocol used in your treatment depends on the indication being addressed and is determined during your initial evaluation.
What to expect
A standard course for depression typically involves around 30 to 36 sessions, delivered multiple times per week over several weeks. Accelerated protocols have shown effectiveness and can shorten treatment to as little as several days. The appropriateness of accelerated scheduling is discussed during your evaluation, and your specific protocol is determined based on your symptoms, goals, and the evidence for your condition.
Some patients begin to notice improvement within the first two weeks; others may take longer. We track outcomes throughout treatment using validated measures and adjust the approach as needed. TMS has a well-established safety record across more than two decades of clinical use. The most common side effect is mild scalp discomfort at the stimulation site, which usually improves over the course of treatment. Serious side effects are rare.
TMS is generally not appropriate for patients with metal implants in the head or neck, cochlear implants, deep brain stimulators, cardiac pacemakers, a history of seizures or epilepsy, or those who are pregnant. We screen carefully for these contraindications before any treatment begins.
Insurance and Cost
Our practice is currently out-of-network with all insurance carriers. Patients pay directly for treatment and may submit claims to their insurance for possible out-of-network reimbursement when treatment is for FDA-cleared indications. We can provide an itemized superbill to support your claim.
Off-label TMS is private-pay only and is not eligible for insurance reimbursement. We recommend contacting your insurance carrier directly to confirm your out-of-network mental health benefits and any prior authorization requirements before beginning treatment.
Schedule a Consultation
The first step is a 15-minute phone consultation to discuss what you’re hoping to address, learn how TMS works, and determine whether scheduling a clinical evaluation is the appropriate next step. There is no charge for this initial call.
Or call us directly at (727) 786-8000.
