TMS Therapy in Brooklyn with Dr. Bliss Lewis, MD

Transcranial magnetic stimulation (TMS) is a non-invasive, FDA-cleared treatment for depression that has not improved with medication. Dr. Bliss Lewis is a triple board-certified psychiatrist in Park Slope, and she evaluates whether TMS is the right next step and plans care around it. Treatment sessions are currently coordinated with a partner TMS program; Dr. Lewis's team will explain where your sessions would take place before you decide.

Before recommending TMS, Dr. Lewis looks for the reasons depression may not have responded so far: a medical cause, a medication that was never given an adequate trial, sleep, hormones or a missed diagnosis. Sometimes that review changes the plan. When TMS is the right next step, it is part of a wider treatment plan, not a stand-alone procedure.

Who TMS is for

TMS is usually considered for adults with major depressive disorder who have not improved enough after antidepressant trials, or who could not tolerate them. Insurers each set their own criteria, typically two adequate medication trials and, for some plans, a course of psychotherapy. Our guide to every option for treatment-resistant depression puts TMS alongside the alternatives.

TMS is not the right first step for everyone. It is not an emergency treatment, and it is not used when someone has active psychosis or a non-removable metal implant near the head. Dr. Lewis will tell you if another approach fits you better.

Conditions treated with TMS

• Major depressive disorder that has not responded to medication

Research-stage uses such as PTSD, bipolar depression or chronic pain are discussed in the physician's TMS guide, with the evidence for each.

Protocols and equipment

Which device and schedule is right depends on your diagnosis, your history and what your insurance covers. Dr. Lewis will explain the options, including standard daily courses and shorter theta-burst or accelerated schedules, and what the evidence says about each.

For background, see deep TMS vs standard TMS and accelerated TMS: protocols, evidence and FDA status.

What to expect

1. Consultation with Dr. Lewis: your history, past medications with doses and dates, rating scales and a safety screen.
2. An integrative review where it helps: labs, sleep, hormones and current medications. Read why this matters before TMS.
3. Insurance authorization. Most plans require prior authorization; the team will tell you what your plan asks for and what documentation is needed.
4. Mapping session to find your motor threshold and treatment target. Motor threshold and dosing, explained.
5. The treatment course, with symptom ratings at set points so progress is measured, not guessed.
6. Follow-up planning: therapy, medication and what to do if symptoms return.

Safety

The most common side effects are scalp discomfort and headache, which usually ease over the first sessions. Seizure is rare. Our page on TMS safety and seizure risk gives the published figures and explains how screening reduces risk.

Insurance and cost

Coverage for TMS depends on your plan and on meeting its written criteria. Before you commit, the team will tell you what is known about your coverage and likely costs.

Coverage rules differ by plan. See the insurer-by-insurer pages for Medicare, New York Medicaid, Aetna, Cigna, Anthem (Empire) and UnitedHealthcare and Optum.

Start with a conversation

Tell us what you have tried so far. If you are thinking about suicide or are in crisis, call or text 988 (the 988 Suicide & Crisis Lifeline) or go to the nearest emergency room.

Complete the patient interest form

Frequently asked questions

Do I need a referral for TMS?

You can contact the practice directly; you do not need a referral to ask whether TMS may fit you. Your insurance plan may have its own referral or authorization requirements.

How long does a course take?

A standard course for depression is daily sessions on weekdays for several weeks followed by a taper; accelerated schedules compress this. Dr. Lewis will explain which schedule fits your situation and your insurance. See accelerated TMS.

Can I keep seeing my own therapist or psychiatrist?

Yes. Dr. Lewis coordinates with your existing clinicians, and our guide for referring clinicians explains what helps.

Is TMS covered by insurance?

Usually, for depression that meets the plan's criteria. Ask the team about your specific plan.

Sources

1. De Novo Classification Request DEN070003 (NeuroStar TMS System). U.S. Food and Drug Administration, 2008. accessdata.fda.gov