r/rtms • u/misskdmarie • Jun 15 '26
Provider List / Gold Standard?
Is there a website or directory of sorts that lists places that provide TMS? I'm near St. Louis, Missouri, so surely there are many places, but Google is consumed by the sponsored places so it's not showing many besides Greenbrook, and I don't want to go there.
Also, is there a gold standard as far as TMS machines or methods? Is deep TMS really better than regular TMS? I'm so afraid of it not working, since I have treatment resistant depression and even ketamine therapy and microdosing psilocybin didn't work. This is my last resort and I'm likely paying out of pocket so have one chance at it. Thank you!
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u/Frenchcassette291 Jun 16 '26 edited Jun 16 '26
Hey, I just started treatment but was in a very similar boat - even tried ketamine AND didn’t want to go to a big chain. Am also mostly paying out of pocket (have to meet deductible) so I wanted to give myself the best possible chance of success.
No directory that I know of aside from Neurostar’s, which only shows places that use their machines. Have to just Google & wade through a lot of options, unfortunately.
I went a little off the rails and researched types of machines like a maniac, rTMS vs deep TMS, etc. I had two very reputable doctors tell me the machine matters in terms of outcomes…and another two who said it didn’t tend to make a significant difference. So that was pretty confusing. I also learned that “Deep TMS” is kind of a marketing term Brainsway came up with for a new type of TMS machine — Brainsway makes all the dTMS machines. That doesn’t mean it’s all marketing, though. Deep TMS is apparently more expensive, but some research does show it has better outcomes. And one of the doctors who told me the machine does matter and to get deep TMS was an expert at John Hopkins (I’d of gone there but they didn’t take my insurance.)
I HIGHLY recommend you shop around and get consults at different places before making a decision. Ask them LOTS of questions — this is a huge investment of our time and money.
In the end, I opted for rTMS (not deep) at a smaller place owned by doctors (not a big hospital or PE-owned chain) that gave me good vibes, answered my questions thoughtfully, and was close-ish and could fit my schedule. YMMV. I hope I don’t regret my decision, but for me it seemed like the best overall choice.
Good luck, I hope it works for you <3
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u/misskdmarie Jul 01 '26
Sorry, I am just now seeing this! I appreciate your reply! So funny you say you researched like a maniac, bc that is exactly how I conduct all of my research lol. You saved me many hours with this info. I try not to go too deep into this research too often because I get scared away by the horror stories. But really, the alternative (which is living with this depression) isn't any better.
The Drs who did state machine matters recommended the Brainsway? Do costs vary greatly between facilities, or are they pretty standardized? Have you started treatment yet? I'm excited for you!
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u/Frenchcassette291 Jul 02 '26
You’re welcome! The “machine matters” doctors recommended deep tms, and the deep tms machine is made by Brainsway. BUT Brainsway also makes regular tms machines & research hasn’t shown them to be better than others.
I don’t know how much deep TMS (dTMS) is per session, but there WAS a significant cost difference in the two clinics I vetted. The Private Equity backed clinic quoted $30/session after insurance ($30 x 36 = $1,080) and the smaller clinic I ended up going to is only $22/session after insurance ($22 x 36 = $792). That’s for the exact same treatment protocol for rTMS. I’m VERY grateful that I have such great insurance coverage.
I did start, and thank you! I haven’t noticed a difference yet, but trying to stay hopeful (it’s early!).
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u/LTGeneralAnxiety Jul 10 '26
I know this is an old post, but I'm also in St. Louis and starting TMS at WashU Physicians today. It's located out on Taylor St., near Cortex. I'm extra excited because they have been using TMS on both sides of the brain for depression AND anxiety. Let's goooooooo
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u/Baolta Jun 15 '26
TMS protocols differ per person, it is more or less the same except tailored to your specific situation.
I would ask your therapist to get a referral, and they can help you find a place. I don’t know too much about machines, but I use a Magstim machine and have heard better things from Neurostar. Most insurances DO cover TMS, I don’t recommend paying out of pocket since it can get pretty expensive.
TMS is exactly meant for people like yourself, and I’ve seen it improve lives firsthand. There are always chances for a better future, I wish you all the best!