About our TMS Practice
Our Palm Harbor practice offers TMS therapy for adults with depression and a range of related conditions, delivered in a clinical psychiatric setting under the care of a board-certified psychiatrist with over twenty years of experience.
TMS is one of several effective treatment options, and the right approach depends on your specific situation. A careful psychiatric evaluation is essential to understand your concerns, consider TMS in the context of other treatments that may help, and determine the best path forward for your situation.
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, focus, and emotional regulation. 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. Depending on the stimulation parameters, TMS can either increase activity in underactive brain regions (used in depression and many other conditions) or decrease activity in overactive regions (used for conditions like insomnia where excessive arousal or activity drives symptoms).
TMS works directly on the targeted brain region, not through the bloodstream, and avoids the metabolic, sexual, sleep, and weight-related side effects that often drive patients to discontinue antidepressant medications. We work with patients who have stopped medications for these reasons, as well as those who continue medications alongside TMS.
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.
Repeated TMS sessions are thought to work through neuroplasticity — the brain’s natural ability to reorganize and strengthen its neural connections over time. This is why a course of TMS typically involves multiple sessions, and why benefits may continue after the course ends.
TMS is considered an established, evidence-based treatment. The FDA first cleared TMS for major depressive disorder in 2008, and subsequent clearances have expanded uses on specific devices.
TMS is sometimes confused with electroconvulsive therapy (ECT), also known as “shock therapy.” The two are distinct treatments. TMS uses magnetic pulses to gently influence activity in specific brain regions and does not involve electrical current through the brain, anesthesia, sedation, or induced seizures. Patients remain fully awake during sessions and can drive themselves home and return to normal activities the same day.
Conditions We Treat
TMS has received separate FDA clearances for several psychiatric and addiction-related conditions, with each clearance tied to a specific device and protocol. TMS is also supported by clinical research for additional off-label uses. At our practice, we offer TMS for:
- Depression — Persistent low mood, loss of interest, fatigue, or changes in sleep and appetite. FDA-cleared indication for the Exomind device, with the strongest evidence base of any TMS indication. For patients whose depression hasn’t responded to medication, who haven’t tolerated medication side effects, or who prefer not to start a medication.
- Focus and cognitive symptoms — Mental fog, slowed thinking, or attentional lapses that often accompany depression, anxiety, and chronic stress. TMS targeting the prefrontal cortex has been shown in randomized trials to improve sustained attention and processing speed across clinical populations. Evidence is strongest when cognitive symptoms occur alongside a treatable clinical condition. Use of Exomind for cognitive symptoms outside its FDA-cleared depression indication is off-label.
- Anxiety — Ongoing worry, a mind that won’t quiet down, feeling on edge, or trouble relaxing. For patients whose primary presentation is anxiety, we may use a different protocol, designed to calm overactivity in circuits associated with anxious arousal. Evidence is most consistent when anxiety occurs alongside mood symptoms. Use of Exomind for anxiety outside its FDA-cleared depression indication is off-label.
- 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) has been studied as a way to calm this overactivity. CBT-I remains the first-line treatment; TMS may be appropriate when CBT-I hasn’t been enough or isn’t a fit. Use of Exomind for insomnia outside its FDA-cleared depression indication is off-label.
*A note about FDA clearances: TMS has received separate FDA clearances for OCD (BrainsWay H7 deep TMS coil, 2018) and smoking cessation (BrainsWay H4 coil, 2020). Our practice uses the BTL Exomind TMS system, which is FDA-cleared for major depressive disorder. The protocols we use for OCD and smoking cessation are based on the broader clinical evidence supporting TMS for these indications, but are considered off-label when delivered with the Exomind system. We’re glad to discuss what this means for your situation during a consultation.
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 within a clinical psychiatric setting. Dr. Rothschild is a board-certified psychiatrist with subspecialty training in addiction medicine and a long-established Tampa Bay area practice, providing both general psychiatric care and TMS therapy. Patients receive their TMS treatment with appropriate clinical oversight throughout the course of treatment.
Patients come to us for TMS in different ways. Some come specifically for TMS while continuing their primary psychiatric care with their existing clinician. Others choose to receive both their TMS treatment and their broader psychiatric care with our practice. We’ll discuss which approach makes sense for your situation during your initial evaluation. Patients are encouraged to keep any existing clinicians informed about their TMS treatment, and we can provide records on request to support continuity of care.
Careful clinical evaluation and a thorough understanding of your symptoms inform whether TMS is appropriate for you, and if so, which treatment protocol is most likely to help. TMS is not a one-size-fits-all treatment — different conditions respond best to different stimulation parameters, target sites, and session schedules. Determining the right approach for your situation is part of what we do during your initial evaluation.
One example of why careful psychiatric evaluation matters: certain TMS protocols can trigger problematic episodes of elevated mood and energy — what’s called mania or hypomania — in patients with bipolar disorder. These episodes can feel productive at first but often lead to impulsive decisions, sleep disruption, and lasting personal or financial harm, and they’re usually followed by a deeper depressive episode. Bipolar disorder is a diagnosis that is sometimes missed, particularly in patients who present primarily with depressive symptoms. It is not a contraindication for TMS, but it changes which protocols are appropriate. Identifying these clinical nuances before treatment begins is one of the purposes of a psychiatric evaluation.
Our practice uses the BTL Exomind TMS system, which delivers TMS therapy with advanced coil engineering and 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
Treatment courses vary by indication. For FDA-cleared depression, a standard course typically involves multiple sessions per week over several weeks. For other indications, the protocol is determined during your clinical evaluation based on your symptoms, treatment goals, and the available evidence for your specific 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. 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.
