Medicare to fund TMS therapy for depressive disorders, but existing patients will miss out – ABC News

Amy* relies on repetitive Transcranial Magnetic Stimulation (rTMS or TMS) to avoid spiralling into a severe depressive state or having suicidal thoughts.

It costs her between $10,000 and $20,000each year and at times she has had to be admitted to hospital in order to receive acute courses of the treatment.

She saysshedoesnot respond well to antidepressant medication, leaving the magnetic treatment as her only real option.

"TMS is crucial," Amy told ABC Radio Brisbane.

"It has been the best thing that has held me for the last few years after having some really big depressive episodes and being back in hospital."

rTMS is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression, according to the Mayo Clinic.

The treatment is often prescribed by psychiatrists when other medications used to manage depression have not worked.

Supplied: Black Dog Institute

From November 1, the Medicare Benefits Schedule (MBS) will cover the prescription and treatment mapping by a psychiatrist, an initial course of up to 35 rTMS treatment sessions, a review of treatment, and a re-treatment of up to 15 sessions,for people over 18 who have been diagnosed with medication-resistant major depressive disorder, a spokesperson from the Department of Health said.

Under this funding model, existing patients like Amy, who receive rTMS regularly, will miss out and have to continue paying the full cost of treatment or be admitted to hospital to receive it.

Amy, who has battled major depressive disorder for almost 20 years, saw results after receiving acute courses of rTMS and now manages her mental health by having regular maintenance treatments at $280 each.

"I went back to having it twice a week and then once a week," she said.

"I'm looking at moving into fortnightly but it really depends on how my mood is going for how frequently I have it."

Amy, a healthcare worker, said the treatmentsplus the rTMS psychiatrist feesadded up very quickly and she hadto pick up extrashifts at work to pay for thetreatment so she could stay well.

"I've literally spent nights just in tears for the fact that I will pick up extra shifts at work and I worked full time to be able to fund my own treatment," Amysaid.

"I function very well in the community and I think I perform quite highly in my job, but having to pick up an extra shift at work to be able to fund your own treatment, is really, really frustrating."

Professor Paul Fitzgerald, a professor of psychiatry at Epworth Healthcare and Monash University, has lobbied for almost a decade to getrTMS treatment covered under the MBS.

Professor Fitzgerald said he was happy to see recognition of the value of the treatment but had "mixed feelings" about how the funding would be rolled out.

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"It's important to state we haven't seen the final implementation and the actual guidance and the actual item numbers, but all the indication we have is that the way it will be implemented will have some not insignificant limitations which, ultimately, we still need to do a lot of work to overcome," he said.

"It looks like Medicare will also have a clause that if you have previously had treatment, you won't be eligible [to receive Medicare-funded treatment] and I'm not quite sure of the rationale for that.

"I certainly think it's somewhat unfair and ... I don't really think there is any scientific reason why if you've had one course of TMS, why you should be denied having it again in the future."

In a response to questions about why existing patients would not receive subsidised treatment, a spokesperson from the Department of Health said the Medical Services Advisory Committee (MSAC) had considered the use of rTMS as a maintenance treatment for major depressive disorder.

"It found there was a clinical need for initial treatment and a retreatment course, however, did not support ongoing treatment due to the limited evidence base," a departmental spokesperson said.

Unsplash: Anthony Tran

Professor Fitzgerald said it had been frustrating to see rTMS treatment evaluated by standards that werenot applied to other equivalent treatments which were funded.

"An example that directly relates to depression, is you can have as many courses ofelectroconvulsive therapy (ECT) for recurrent episodes of depression as you might need, but there isn't the evidence supporting those," hesaid.

"We are going to have a lot of patients who have a successful initial course of treatment, and perhaps some second treatment, but who are then kind of caught because they can't get a treatment when their depression comes back in the future."

Professor Fitzgerald said he was also concerned about the rationale to only fund 15 sessions for the retreatment, which he said was based on strict clinical studies that indicated the average number of treatments needed the second time around was 15.

Patients say a treatment for major depression is changing their lives, but it isn't funded through Medicare and is restricted to those who can afford it.

"So, if the average patient needed 15 treatments, that means half the patients needed 15 or less and half the patients needed 15 or more," he said.

"Anywhere up to half the patients are not going to have enough treatment, that second time around."

Acute courses of TMS are covered if you are a hospitalinpatient, which Amy has been in the past under her private health cover.

Professor Fitzgerald said while therestrictions placed around the funding were likely to avoid costs blowing out, the government was not taking into account the current cost hospitalisation was putting on the healthcare system.

"I think what that equation fails to take into account, is that there is already an enormous cost being spent, and an unnecessary cost being spent, on patients being admitted into hospital environments," he said.

Because rTMS is not yet listed on the MBS, the Department of Health said it did not have the data to know what the cost of treating rTMS patients as inpatientswason the public health system.

* Name has been changed to protect identity.

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Medicare to fund TMS therapy for depressive disorders, but existing patients will miss out - ABC News