CTMSS Forum - Recent Topics

One-D for OCD/PTSD

Karen Laber — Thu, 21 May 2026 18:40:21 +0000

We have had incredible succes in our office using the ONE-D TMS for depression. I have a late 40's male that has late onset Obsessional/Intrusive thought patterns (No compulsions) and he wants to do the one day TMS. The problem, is that I haven't found any research on any one day TBS inhibitory trials for either RDLFPC r pre-SMA. The only thing I can find is The 5-day ahTBS protocol over the pre-SMA. For context, We use Magventure CB70 coil. According to Open Evidence, the 5-day is the closest to a condensed "one-day-style" rapid protocol for OCD.

Also, not sure if D-cycloserine/Vyvanse that is used for the ONE-D DLFPC would also be efficacious in this situation? Any thoughts would be appreciated.

Blue Cross Blue Shield of TN/Availity/Cohere

Lane Cook — Wed, 13 May 2026 00:47:55 +0000

BCBST announced it was changing precerts from Availity to Cohere (which is a junk site that doesn't work and appears to mainly be an AI radiology precert company). When our office manager attemtped to use the Availity site it forwarded her to Cohere. No help at all, no response for 2 months. Can't get a human on the line at BCBST. Finally got a woman at Cohere and gave her info with no help. She kept saying what was entered wasn't completed, and we had a bunch of drafts but no help there. Finally I contacted Dr. Scott West in Nashville and his office person Desiree thankfully gave us the form to fax into BCBST at their usual fax number. She said on her PC she cannot get Availity to pre-cert TMS but her coworker on her PC can. Anyone else have issues with BCBST, Availity, or Cohere? There's a "Welcome to Cohere" webinar this Thursday and you bet I'll be on it with my office manager.

Peer to Peer for continuance of maintenance Treatments for Tricare Patient

Adejoke Adedeji — Fri, 24 Apr 2026 20:20:44 +0000

Hi everyone! I have a peer to peer for a patient next week. He started TMS with our practice at the end of 2023 and did two full rounds, and now does maintenance 2-3 times per week, depending on his schedule. I am not sure what has triggered this peer review. Every previous PA we submitted for him was approved for 60 treatments with no request for additional information or records. This time, however, Tricare is asking for everything and the kitchen sink! Does anyone have any advice? I have already requested that the patient write a letter and I'm trying to gather as much evidence in support of maintenance treatments.

Thank you in advance!

cardiovascular instability in post-menopausal female taking hormones

David Fohrman — Thu, 09 Apr 2026 16:15:15 +0000

I am currently treating a 55-year-old post-menopausal female, with MDD protocol on the left and iTBS on right (session number 16) who has experienced increased irritability and cardiovascular instability (feeling warm, weird feeling on right side of head, and waking up at night feeling very warm and irritable, increasingly) over past week. She is taking estrogen and testosterone replacement. Any thoughts on the possible cause of this and/or treatment options?

Westin room share for Boston Conference June 4 & 5

Michael Savage — Fri, 06 Mar 2026 21:21:15 +0000

Looking for someone who might want to share a double room for two nights. The total cost is ~917 for two nights. I am clean, quiet, and don't snore!

TMS and D cycloserine

David Sikowitz MD — Tue, 20 Jan 2026 20:02:32 +0000

Dr. Downar presented grand rounds discussing the addition of D Cycloserine to TMS during a one day course of 20 iTBS sessions. Has anybody used D Cycloserine supplementation during a standard 36 day course of TMS? If so, what were the outcomes and are there any safety concerns?

Home device by FLOW Neuroscience for Major Depressive Disorder

Richard Chung — Tue, 13 Jan 2026 22:22:31 +0000

Is anyone familiar with a device called FL-100 by FLOW Neuroscience for the at-home treatment of MDD? I saw statement that is had a 58% remission rate in a sham controlled study... used for FDA approval.

intracebral vascular stent

Francis McDemott — Tue, 18 Nov 2025 21:44:22 +0000

I have a pt who is interested in TMS for depression. She has a vascular stent in the Circle of Willis. The stent is rated for 3 T and can be used safely for MRI. This patient has actually also had a brain MRI since its installation. I have a NeuroStar system, which is 1.5 T at cranial surface. Their medical support team will not step outside the comfort of their own guidelines and will not endorse TMS use for this patient.

My question: What are your thoughts about TMS for this patient. My read is that it should be safe.

Safety of TMS with Inspire Device for OSA

Matthew White — Thu, 14 Aug 2025 14:15:09 +0000

I am a PGY4 psychiatry resident rotating in a TMS clinic. We have a patient who seems to be an excellent candidate for TMS, however they recently (earlier this year) had an Inspire Device placed for OSA. The implant for the device is on the hypoglossal nerve just below the mandible, with the battery pack in the right chest wall. Stimulation can be turned off, but the device itself cannot be turned off. From what I can tell from the manufacturer, the patient has the 3028 model which is conditionally MRI compatible. I cannot find any literature about TMS being done in a patient with this device. I wanted to know if anyone on this forum has successfully completed a course of TMS in a patient wit an Inspire implant?

I'm most concerned that TMS may impact the device, not cause harm to the patient. But I believe the risk is likely quite low.

Any guidance would be appreciated.

Thanks!

Contracting hospitals for TMS

Evaldas Radzevicius — Wed, 06 Aug 2025 20:34:21 +0000

I am trying to negotiate with hospital system for providing TMS in their facilities. I would purchase a machine and deliver treatment. Their question was “what is there for us?” Of course I would rent out a space from them for treatment, but beyond that is there anything that hospital going to gain, can they bill insurance for facility charge?