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Transcranial Magnetic Stimulation (TMS)

What is TMS?

Butler Hospital-What is TMS

Transcranial Magnetic Stimulation (TMS) is a revolutionary treatment, approved by the FDA, for patients suffering from depression and obsessive-compulsive disorder (OCD) who have not responded to standard medications and therapy. A device placed on the patient’s head delivers targeted magnetic pulses that penetrate the scalp and skull to induce activity in brain cells (called neurons) underneath the scalp to target specific areas of the brain. TMS therapy is a non-invasive treatment, and it does not require anesthesia or sedation. Patients remain fully awake and alert during their TMS treatment sessions and they can travel independently to the clinic and continue with their day-to-day activities without limitation.

Published reports from TMS treatment studies show more than half of patients treated with TMS therapy experienced significant improvements in their symptoms and about one-third of patients experience remission. TMS treated patients have experienced significant improvements in their anxiety, functioning, pleasure, appetite changes, aches and pains, and lack of energy, and other debilitating symptoms associated with their illness.

Contact Information:

TMS Clinic
Butler Hospital
345 Blackstone Boulevard
Delmonico 1A
Providence, RI 02906
P: (401) 455-6632
F: (401) 455-6686
Email: BRAIN@CareNE.org

Click here to begin the screening process with our TMS team.

Clinic Hours: Monday-Friday 8:00 am-5:30 pm

For Physicians
For clinicians, if you would like to refer your patient for consideration of TMS Therapy, please download and complete this form and fax to (401) 455-6686.

TMS Therapy at Butler Hospital

In October of 2008, the FDA approved the first TMS device to treat depression, and Butler Hospital’s TMS Clinic team includes researchers who have continued to study TMS since that point in time. The Butler TMS Clinic was opened to the public for non-research standard care in January 2009 and has remained one of the busiest TMS programs in the Northeast since then. Our state-of-the-art treatment facility houses multiple FDA-cleared devices for standard TMS clinical care, as well as investigational devices for research clinical trials. TMS researchers at Butler continue to conduct investigations aimed to make the TMS therapy outcomes even better and more personalized for each patient.

A typical course of TMS therapy includes:

  • 6-9 weeks of daily (Monday through Friday) treatments, five per week that can last up to 30 minutes
  • Serial assessments of symptoms/response with standardized rating scales
  • Collaboration between the TMS team and a patient's regular outpatient care team during the course of TMS therapy. Butler TMS patients will continue to meet with their outpatient clinicians and prescribers for medication management and psychotherapy
  • An end-of-treatment summary of their TMS course is sent to the patient's treating clinicians to document outcomes, plans, and recommendations
  • A repeat course of TMS therapy is covered by most insurance policies for patients who showed a positive response to a past course of TMS and experienced subsequent depression relapse

We strive to make the process of referring patients to the Butler TMS Clinic as easy and effective as possible. Most of our patients receive TMS therapy as a covered service through their health insurance policy. As such, we go the extra mile to obtain source documentation of past treatment history.

For additional information, please click here to hear Dr. Linda Carpenter, lead TMS expert and the director of the TMS Clinic at Butler Hospital, speak about TMS Therapy. 

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TMS for Other Indications

As of January 2024, the FDA has approved the use of TMS for Major Depressive Disorder (MDD), Obsessive Compulsive Disorder (OCD), and Smoking Cessation. Insurance coverage is available for MDD and OCD so please contact the clinic and our team will verify your insurance and coordinate benefits. There is extensive literature using TMS to treat other indications such as Alzheimer’s Disease, Dementia, Addictions, Executive Functioning deficits (ADD, ADHD), PTSD, Autism, Pain syndromes, and Bipolar Disorder are backed by scientific evidence and has shown TMS can be used off-label to alleviate and/or treat illnesses.   This may be available on a self-pay basis and can be discussed on a case-by-case basis.

Is TMS covered by Insurance?

TMS treatment for depression is covered by nearly all insurance carriers including Medicare and Medicaid. A screening process is used to determine whether each patient meets their insurance policy’s coverage criteria. An outpatient appointment, called a TMS Consultation visit, takes place with a TMS provider prior to starting the course of TMS therapy. When a patient is determined to be eligible, our TMS Clinic staff will submit the required pre-authorization information and work with insurance companies to obtain coverage.

Typical eligibility requirements for insurance coverage of TMS include a patient:

  • Current primary diagnosis of unipolar major depressive disorder (MDD), single episode, or recurrent episode without psychotic features.
  • Current episodes characterized by a moderate to severe level of current depressive symptoms (standardized rating scales are used to access severity).
  • The patient has the ability to remain safe and is sufficiently stable for treatment on an outpatient basis.
  • Lack of response or inability to tolerate oral antidepressant medications
  • A patient may or may not have had a past trial of electroconvulsive therapy (ECT). To date, the history of past ECT is not related to TMS response.

TMS Therapy at Butler Hospital

 

Are you a candidate for TMS?

To find out if you are a candidate for TMS, you can begin by calling (401) 455-6632 or by filling out the form below and someone on the team will be in contact with you shortly.

Patient Resources

TMS
Care New England

TMS is non-invasive and does not involve surgery or insertion of intravenous lines or anything else put into your body.

TMS
Care New England

Over 10,000 active TMS treatments were safely performed during clinical trials with the type of TMS device used at Butler Hospital.

TMS
Eric Tirrell

Published reports from TMS treatment studies show more than half of patients treated with TMS therapy experienced significant improvements in depression symptoms and about one-third of patients experi...

Frequently Asked Questions

Have questions about what to expect as a patient or who will be involved in the treatment? We've got you covered.

Learn More

Patient Testimonials

“TMS is my lifesaver. The treatment I received is beyond compare. It is a very healing environment with the most amazing staff. When I am here, I know I am in the best, most capable hands.”

“I want to thank you for changing my life. When I first came in for a consultation, I didn’t know what to expect. You were open and honest. This was my last hope to feel better. I can’t thank you enough for changing my life. You have given me hope for the future. I feel like my life has just begun.”

“You will never know how much I appreciate your guidance through the past few months. You’ve been the best cheerleaders anyone could ask for. Seeing your smiles every morning and hearing your kind words made each treatment comfortable and I admire your professionalism and dedication to the TMS program.”

“I want to thank you for all that you’ve done to help me get to a better place. When I came in for my first treatment I was so nervous. I was so grateful for everyone’s smiles, reassurance, and thoughtfulness through my treatments. You have done do much for me- you allowed me to have hope for a better future.”

 “I want to take a moment to thank you all for the fantastic job you do. I have always felt your genuine concern and investment in my wellbeing. Each time I have come to TMS I have been at the end of my rope and you have all shown me compassion at a time I didn’t think I was worthy of. Daily you show me sincere empathy and investment in my recovery. You are all so well suited for the work you do and I am grateful for you all! 

TMS and Other Neuromodulation Research

Since 2015, the TMS Clinical Service has been closely integrated with the Neuromodulation Research division at Butler Hospital with its goal to bridge the gap between scientific research and clinical practice in non-invasive brain stimulation.   The incorporation of research findings with clinical expertise is crucial to help inform TMS practitioners into providing the best care and to enhance patient outcomes. This research has expanded beyond TMS to include other forms of brain stimulation such as using wearable devices and to gain a better understanding into other clinical services we offer such as Esketamine and ECT.   These procedures may include the collection of brain imaging (MRI, EEG), blood biomarkers, physiological data (heart rate, nerve conduction, blood pressure), working memory, behavioral, and cognitive tasks, ecological momentary assessments, and the use of other psychometric surveys to help us investigate potential biomarkers into clinical response and develop ways to personalize treatment.      

The Neuromodulation Research program at Butler shares a close connection with Butler Hospital COBRE (Center of Biomedical Research Excellence) for Neuromodulation with shared research goals to support innovative clinical research in neuromodulation (i.e., brain stimulation) and career development of investigators in the field.  

Meet the Team

Linda Carpenter, MD

Director, Butler TMS Clinic and Neuromodulation Research Facility

Linda L. Carpenter, MD is a Professor of Psychiatry in the Alpert Medical School of Brown University and Chief of the Mood Disorders Program at Butler Hospital. She completed her undergraduate degree at the University of Michigan and medical school at the University of Pennsylvania. She did an internship in internal medicine, psychiatry residency, and research fellowship at Yale, and then joined the faculty of the Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University in 1997. 

Eric Tirrell

TMS Clinical Supervisor/Neuromodulation Research Facility Coordinator

Mr. Eric Tirrell completed his undergraduate degree in psychology at the University of Rhode Island.  He is the TMS and Esketamine clinical supervisor of Butler Hospital’s TMS Clinic and has been providing TMS treatment for neuropsychiatric disorders for over 8 years. He has extensive experience with all aspects of TMS clinical care and he is well versed in operating Neurostar, Magstim, Nexstim, MagnMore, Magventure and other investigational TMS device systems using a variety of TMS protocols and coils. 

Audrey Tyrka, MD, PhD

Dr. Audrey Tyrka received her MD and PhD in medicine and psychology through a combined program at the University of Pennsylvania. She completed the psychiatry residency at the Warren Alpert Medical School of Brown University with research training in clinical neuroscience. She is the Director of Research at Butler hospital, and also directs our Laboratory for Clinical and Translational Neuroscience. 

Benjamin Greenberg, MD, PhD

Dr. Benjamin Greenberg has a BA in psychology from Amherst College, a PhD in neurosciences from UC San Diego, and an MD from the University of Miami, with psychiatry residency at Johns Hopkins. He then led adult OCD research at NIMH, where he performed the first transcranial magnetic stimulation (TMS) study in that illness. At Butler Hospital and Brown since 2000, he has focused on invasive neurosurgeries including ventral capsulotomy and deep brain stimulation (DBS). 

Brian Tesar, MD

Dr. Brian Tesar received a B.A. with honors in Chemistry from the University of Chicago in 1987. He studied medicine and biochemistry and received his M.D. from the University of Illinois in 1992. Dr. Tesar completed a psychiatric residency program with Washington University in St. Louis in 1996. 

Fatih Kokdere, MD

Dr. Kokdere received his medical degree from Yeditepe University located in his hometown Istanbul, Turkey. Following his graduation, he joined Butler Hospital’s TMS Clinic and Neuromodulation Research Facility as a postdoctoral research fellow. He completed his psychiatry residency at MercyOne Des Moines Medical Center in Iowa and returned to our TMS Clinic as an attending psychiatrist.

Lawrence Price, MD

Dr. Lawrence Price attended the University of Michigan, where he  received a B.S. with highest honors in psychology and high distinction in 1974, followed by an M.D. in 1978. After an internship in internal medicine at Norwalk Hospital, he completed a residency and fellowship in psychiatry at Yale University. From 1982 until 1996, Dr. Price was on the faculty in the Department of Psychiatry at Yale University, where he served as Associate Professor and Director of the Clinical Neuroscience Research Unit at the Connecticut Mental Health Center. 

Melissa Burt, RN

Clinical and Research Nurse

Ms. Melissa Burt graduated with a Bachelor of Science in Human Development and Family Studies from the University of Rhode Island (URI) in 1996. She completed an internship while at URI at Butler Hospital’s partial hospital in 1996 then shortly after, she was hired as a mental health worker.  She then received her CNA license and subsequently her RN license in 2004. 

Nimalan Murugan

Interventional Psychiatry Technician

Mr. Nim Murugan serves as a TMS-Interventional Clinical Technician at Butler Hospital. Nim attended the University of Michigan, where he received a B.S. in Neuroscience in 2021. Prior to TMS, he was immersed in sleep research where he investigated circadian re-entrainment and delineated phenotypes pertaining Shift Work Disorder: his background nurtured his interest towards providing depression relief. 

Wenricka Griffith

Interventional Psychiatry Technician

Wenricka Griffith completed her undergraduate degree at the University of Rhode Island studying Biological Sciences (B.S.) on the premed track. While there, she spent time involved in many clubs and multicultural organizations mainly devoted to community service and providing leadership and academic resources to students who may find challenges within the sciences. At the TMS clinic, she hopes to provide the best patient care, a well-inclusive environment and build relationships amongst individuals who are treated with TMS. 

Carissa Perez

Interventional Psychiatry Technician

Born and raised in California, Carissa graduated from Brown University in 2021 with a bachelor's degree in Psychology. While at Brown, she was a research assistant in the Aging and Cognition Lab investigating self-efficacy in older adults and was a member of the Women's Water Polo team (All-American '19 & '20). Since graduating, she was a research assistant in the Mood Disorders Research Program at Butler Hospital and evaluated Epigenetics in adolescents with early life stress.

Barbara D’Antonino

Administrative Assistant

Ms. Barbara D’Antonino graduated from Katherine Gibbs in Providence, RI with an Associate’s Degree as a Certified Medical/Executive Assistant.  She is the Administrative Assistant for the TMS Clinic that comes with over 30 years’ experience working with children, adults and geriatrics in mental health and other sub-specialties.  She received her LNA license while living in Vermont.