Maintenance and booster sessions in TMS
Dr Rustin Berlow discusses TMS booster or maintenance sessions.
TMS boosters
One type of booster treatment is done in order to make sure the treatment effect lasts. A different kind of booster treatment is also possible. Some people, before they take up an exam, before they do a large presentation or before they participate in a sporting event, some of those people come in to get a little booster for the clarity. That brings up the issue of performance-enhancing TMS in the asymptomatic patient, which is also controversial.
There are many people that taper the TMS. There are some patients that are very sensitive to changes, who are very resistant to change and if you go from doing it every day to not doing it at all, that kind of a change can be disturbing to them, so we do a taper on those people. And actually, the rate of relapse is about 30%, so those people are coming back. That’s not the same thing as booster treatments, but if somebody does come back, obviously you would give them booster treatments to make sure that it’s a well-established change in their brain.
I think that in the next few years, we’re going to find ways to reduce the 30% relapse rate and I think the most important change that will come about is that at the point when the patient has a response from that point. There should be four weeks of stimulation, so if a person begins to have a response at five weeks and it stopped, I think they’re more likely to relapse. It’s something that could be very easily studied. You could take a group of people who’ve relapsed and see what the curve of their scores was and see when exactly they had the most change in their depression level. But in my experience, the moment somebody gets better, we start the clock then and do four weeks. We have a very low rate of relapse. We’ve had about two people.