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655 Redwood Hwy, Suite 240, Mill Valley, CA, 94941

Phone/Fax: 866-247-4292

Email: info@segaltelenet.com

Frequently Asked Questions

TMS

Telepsychiatry

Spravato

Transcranial Magnetic Stimulation TMS

There is new hope for people who suffer with depression—Transcranial Magnetic Stimulation (TMS). It is especially helpful with treatment-resistant depression, for those who do not respond to antidepressants, as well as people who wish to avoid the side effects frequently caused by medication. TMS treatment usually includes four to six weeks of non-invasive, in-office treatments that take less than an hour each day, five days each week.

What is TMS?

TMS is a treatment that safely delivers magnetic pulses to areas of the brain that are responsible for mood. Instead of using invasive electrical currents like in electroconvulsive therapy (ECT), the magnetic pulses from TMS are similar in strength to those emitted during a typical MRI. The pulses are directed toward the prefrontal cortex of the brain to change the magnetic field and stimulate neurons within the mood center. This not only mitigates depression for a short time but can also result in long lasting relief.

What is TBS?

Theta Burst Stimulation (TBS) is a newer form of TMS. Here, the magnetic pulses are applied in a certain pattern, called bursts. Research studies with TBS have been shown to produce similar if not greater effects on brain activity compared to standard repetitive transcranial magnetic stimulation ( rTMS).

What is qEEG?

Quantitative Electroencephalography (qEEG) is a procedure that processes the recorded EEG activity from a multi-electrode recording using a computer. This multi-channel EEG data is processed with various algorithms, such as the “Fourier” classically, or in more modern applications “Wavelet” analysis). The digital data is statistically analyzed, sometimes comparing values with “normative” database reference values. The processed EEG is commonly converted into color maps of brain functioning called “Brain maps”.

The EEG and the derived qEEG information can be interpreted and used by experts as a clinical tool to evaluate brain function, and to track the changes in brain function due to various interventions such as TMS/TBS, Neurofeedback or medication.

Quantitative Electroencephalography (qEEG) processing techniques and the use of modern analytic software to processes the EEG/qEEG gives us the ability to view the dynamic changes taking place throughout the brain during cognitive processing tasks, and this novel approach can be used to assist us in determining which areas of the brain are engaged and processing efficiently.

Benefits of TMS
  • Non-invasive—no anesthesia, electrodes or electrical current used
  • Simple, in-office—administered by a technician and the patient can drive home afterward
  • For treatment-resistant depression—those not helped by antidepressants can benefit
  • No drug side effects—no reported nausea, weight gain, dry mouth or decreased sex drive
  • Long-lasting—after initial 4-6 weeks, maintenance may or may not be needed later
How does TMS work?

TMS treatment is performed in a doctor’s office, while the patient is fully awake and seated in a comfortable chair. Because the magnetic pulses make a sound similar to that of a woodpecker, earplugs are provided. The TMS device is then placed in the proper position on the head and the magnetic pulses are delivered. The process usually takes between 4 and 20+ minutes.

Is it relatively simple?
  • Patient takes a seat
  • Device is placed on the head
  • Pulses are delivered for a short time
  • Patient returns to daily activities
Conditions treated by TMS?

In the United States, the FDA approved TMS in 2008 as a treatment to alleviate the symptoms of treatment-resistant depression. It has also been approved for depression in Canada, Australia, New Zealand, Europe, and Israel. In addition, it has been CE approved in Europe for the treatment of bipolar disorder, PTSD, chronic pain, OCD, and adult AD/HD.

Advantages over other treatments?

In the past, the most common treatments for depression have been medication and/or psychotherapy. With TMS, psychotherapy is still encouraged because it can help people maintain mental health. However, unlike antidepressants, TMS has few if any side effects.

Reported side effects of antidepressants include:
  • Nausea
  • Weight gain
  • Fatigue or drowsiness
  • Insomnia
  • Dry mouth
  • Decreased sexual desire or function
  • Anxiety
  • Irritability
  • Dizziness
Side effects of TMS

Some patients report slight headaches or some discomfort at the treatment site just during the actual treatment. About a third of patients notice a prickly, tingly sensation on their scalp while the stimulating pulses are being administered. One in 10,000 patients experience a mild seizure; however, it should be noted that this risk is approximately the same as that cause by some antidepressants. In addition, the seizures related to TMS typically end when the magnetic stimulation is stopped.

Exceptions to TMS treatment

People who have metal implanted in or near their head should not have TMS. Exceptions include those with dental fillings, crowns and/or braces. Metals that prevent TMS treatment include:

  • Pacemakers or implanted defibrillators
  • Any stents from the neck up
  • Aneurysm clips
  • Metallic implants in ears or eyes
  • Ammo fragments near the head
  • Facial tattoos with metallic ink
  • Any metal near the head that cannot be removed
TMS and insurance

As TMS is being used by more physicians and patients with notable positive results, more and more insurance companies now cover or partially cover the treatment. Major insurance companies in the United States that now cover TMS include Anthem Blue Cross Blue Shield and MHN (HealthNet). Several other state and national companies provide reimbursement when TMS is deemed appropriate. Your local TMS treatment provider can help you determine eligibility and many will submit the paperwork for you.

Most common questions about telepsychiatry

Telepsychiatry, or telemedicine, is a specifically defined form of video conferencing that can provide psychiatric services to patients living in remote locations or otherwise undeserved areas. It can connect patients, psychiatrists, physicians, and other healthcare professionals through the use of television cameras and microphones. Telemedicine currently provides an array of services, including but not limited to diagnosis and assessment; medication management; and individual and group therapy. It also provides an opportunity for consultative services between psychiatrists, primary care physicians and other healthcare providers. Telepsychiatry is also being used to provide patients with second opinions in areas where only one psychiatrist is available.

What is telepsychiatry?

Telepsychiatry is the practice of psychiatry conducted via a video conference connection. A live, secure video connection is established between an offsite location (a clinic, doctor’s office or home office) and a mental health facility. A typical psychiatric office visit is conducted except that the physician and the patient are not in the same physical location. 

Is there a startup cost?

There is no start up cost associated with using the telepsychiatry platform unless you need to purchase a webcam and microphone. On average both can be purchased for less than a total of $200.

What equipment is required?

All that is needed for connection to our network is a Windows (XP SP2 or newer) or Mac (Intel based) system with Internet access, a webcam and a microphone. We recommend a Logitech HD Pro Webcam C920 for the video and a Phoenix Duet USB Speakerphone for the audio. We can test any webcam and/or microphone you may have to see if they would be appropriate for our solution.

Is there a fee to use the platform?

There is no fee to use our platform.

Is it secure and HIPPA compliant?

Yes, all communications are sent using 256-bit AES encryption. We take appropriate measures to comply with the all HIPAA privacy and security rules.

How can telepsychiatry benefit hospitals and mental health clinics?

Facilities in remote rural locations that have a difficult time recruiting can benefit from telepsychiatry. Telepsychiatry providers can be physically located anywhere in the United States, but as long as they have the appropriate licenses, they can see your patients. Another use for telepsychiatry is to fill a part-time position. If your facility has enough volume only for a half-time provider, you might have an easier time finding a telepsychiatry provider to fill that need than recruiting a psychiatrist to work on-site part-time. Telepsychiatry can be your back-up for vacations, leaves or after hours on-call coverage.

Do you offer support?

Yes, we offer 24-hour support, seven days a week. In addition, our trained IT professionals can assist with any technical difficulties you may encounter.

Is my existing camera and microphone compatible with your telepsychiatry platform?

Almost any third-party webcam or video conferencing equipment will work. In addition, we can test any webcam and/or microphone you may have to see if they would be appropriate for our solution.

Do you support other video conferencing equipment?

We are compatible with traditional boardroom-style video conferencing equipment like Polycom and/or Cisco (Tandberg) hardware codecs. There is no need to substitute your existing telemedicine equipment. Our heterogeneous solution is capable of connecting with almost any platform available.

What is the most important information I should know about SPRAVATO?
SPRAVATO can cause serious side effects, including:
  • Sedation and dissociation. SPRAVATO may cause sleepiness (sedation), fainting, dizziness, spinning sensation, anxiety, or feeling disconnected from yourself, your thoughts, feelings, space and time (dissociation).
    • Tell your healthcare provider right away if you feel like you cannot stay awake or if you feel like you are going to pass out.
    • Your healthcare provider must monitor you for serious side effects for at least 2 hours after taking SPRAVATO. Your healthcare provider will decide when you are ready to leave the healthcare setting.
  • Abuse and misuse. There is a risk for abuse and physical and psychological dependence with SPRAVATO treatment. Your healthcare provider should check you for signs of abuse and dependence before and during treatment with SPRAVATO.
    • Tell your healthcare provider if you have ever abused or been dependent on alcohol, prescription medicines, or street drugs.
    • Your healthcare provider can tell you more about the differences between physical and psychological dependence and drug addiction.
  • SPRAVATO Risk Evaluation and Mitigation Strategy (REMS). Because of the risks for sedation, dissociation, and abuse and misuse, SPRAVATO is only available through a restricted program called the SPRAVATO Risk Evaluation and Mitigation Strategy (REMS) Program. SPRAVATO can only be administered at healthcare settings certified in the SPRAVATO REMS Program. Patients treated in outpatient healthcare settings (e.g., medical offices and clinics) must be enrolled in the program.
  • Increased risk of suicidal thoughts and actions. Antidepressant medicines may increase suicidal thoughts and actions in some people 24 years of age and younger, especially within the first few months of treatment or when the dose is changed.
SPRAVATO is not for use in children

Depression and other serious mental illnesses are the most important causes of suicidal thoughts and actions. Some people may have a higher risk of having suicidal thoughts or actions. These include people who have (or have a family history of) depression or a history of suicidal thoughts or actions.

How can I watch for and try to prevent suicidal thoughts and actions in myself or a family member?
  • Pay close attention to any changes, especially sudden changes, in mood, behavior, thoughts, or feelings, or if you develop suicidal thoughts or actions.
  • Tell your healthcare provider right away if you have any new or sudden changes in mood, behavior, thoughts, or feelings.
  • Keep all follow-up visits with your healthcare provider as scheduled. Call your healthcare provider between visits as needed, especially if you have concerns about symptoms.
Do not take SPRAVATO if you:
  • Have blood vessel (aneurysmal vascular) disease (including in the brain, chest, abdominal aorta, arms and legs)
  • Have an abnormal connection between your veins and arteries (arteriovenous malformation)
  • Have a history of bleeding in the brain
  • Are allergic to esketamine, ketamine, or any of the other ingredients in SPRAVATO.

If you are not sure if you have any of the above conditions, talk to your healthcare provider before taking SPRAVATO.

Before you take SPRAVATO, tell your healthcare provider about all of your medical conditions, including if you:
  • Have heart or brain problems, including:
    • High blood pressure (hypertension)
    • Slow or fast heartbeats that cause shortness of breath, chest pain, lightheadedness, or fainting
    • History of heart attack
    • History of stroke
    • Heart valve disease or heart failure
    • History of brain injury or any condition where there is increased pressure in the brain
  • Have liver problems
  • Have ever had a condition called “psychosis” (see, feel, or hear things that are not there, or believe in things that are not true).
  • Are pregnant or plan to become pregnant. SPRAVATO® may harm your baby. You should not take SPRAVATO® if you are pregnant.
    • Tell your healthcare provider right away if you become pregnant during treatment with SPRAVATO®.
    • If you are able to become pregnant, talk to your healthcare provider about methods to prevent pregnancy during treatment with SPRAVATO®.
    • There is a pregnancy registry for women who are exposed to SPRAVATO® during pregnancy. The purpose of the registry is to collect information about the health of women exposed to SPRAVATO and their baby. If you become pregnant during treatment with SPRAVATO, talk to your healthcare provider about registering with the National Pregnancy Registry for Antidepressants at 1-844-405-6185 or online at https://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/antidepressants/.
  • Are breastfeeding or plan to breastfeed. You should not breastfeed during treatment with SPRAVATO.
How will I take SPRAVATO?
  • You will take SPRAVATO nasal spray yourself, under the supervision of a healthcare provider in a healthcare setting. Your healthcare provider will show you how to use the SPRAVATO nasal spray device.
  • Your healthcare provider will tell you how much SPRAVATO you will take and when you will take it.
  • Follow your SPRAVATO treatment schedule exactly as your healthcare provider tells you to.
  • During and after each use of the SPRAVATO nasal spray device, you will be checked by a healthcare provider who will decide when you are ready to leave the healthcare setting.
  • You will need to plan for a caregiver or family member to drive you home after taking SPRAVATO.
  • If you miss a SPRAVATO treatment, your healthcare provider may change your dose and treatment schedule.
  • Some people taking SPRAVATO get nausea and vomiting. You should not eat for at least 2 hours before taking SPRAVATO and not drink liquids at least 30 minutes before taking SPRAVATO.
  • If you take a nasal corticosteroid or nasal decongestant medicine, take these medicines at least 1 hour before taking SPRAVATO.
What should I avoid while taking SPRAVATO?

Do not drive, operate machinery, or do anything where you need to be completely alert after taking SPRAVATO. Do not take part in these activities until the next day following a restful sleep. See “What is the most important information I should know about SPRAVATO?”.

What are the possible side effects of SPRAVATO?
  • Increased blood pressure.  SPRAVATO can cause a temporary increase in your blood pressure that may last for about 4 hours after taking a dose. Your healthcare provider will check your blood pressure before taking SPRAVATO and for at least 2 hours after you take SPRAVATO. Tell your healthcare provider right away if you get chest pain, shortness of breath, sudden severe headache, change in vision, or seizures after taking SPRAVATO.
  • Problems with thinking clearly. Tell your healthcare provider if you have problems thinking or remembering.
  • Bladder problems. Tell your healthcare provider if you develop trouble urinating, such as a frequent or urgent need to urinate, pain when urinating, or frequently urinating at night.
The most common side effects of SPRAVATO when used along with an antidepressant taken by mouth include:
  • feeling disconnected from yourself, your thoughts, feelings and things around you
  • dizziness
  • nausea
  • feeling sleepy
  • spinning sensation 
  • decreased feeling of sensitivity (numbness)
  • feeling anxious
  • lack of energy
  • increased blood pressure
  • vomiting
  • feeling drunk
  • feeling very happy or excited