Frequently Asked Questions

Below you will find answers to frequently asked questions about the research-driven, brain-based treatment options available at Breakwater Neuro.

Repetitive Transcranial Magnetic Stimulation (rTMS)

Eligibility

Anyone with symptoms of depression — whether or not it co-occurs with other issues like anxiety, PTSD, OCD, insomnia, or chronic pain — is potentially a candidate for rTMS at Breakwater Neuro. Our current practice is to require that you have tried at least one antidepressant medication without a satisfactory outcome prior to trying rTMS.

There are a few rule-outs, including having metal embedded in or near the head or having an implanted stimulator, pacemaker, or similar device. Dental work is generally not an issue. We currently do not accept patients with a history of seizure.

Our psychiatrist will evaluate you to determine whether rTMS is an appropriate treatment for you.

In most cases, during treatment you can continue taking your medications as prescribed by your doctor.

There are certain medications whose effects can interfere with the effectiveness of the stimulation, so they aren’t compatible with rTMS treatment. These medications would need to be reduced or discontinued for the duration of the treatment. Our psychiatrist can review this with you and develop a plan for tapering off these medications prior to treatment.

Our rTMS services require a referral from a primary care provider. If you would like a referral, contact us and we will send a referral form to your family doctor or nurse practitioner.

Safety and Side Effects

rTMS is a safe treatment with no known lasting negative effects. It does not impact cognitive functions such as memory or concentration.

rTMS is considered a medical procedure, which is why our psychiatrist (a medical doctor) is directly involved in the initial assessment, the intake procedure, the motor threshold determination process, and follow-up appointments with all rTMS clients.

During the treatment, clients may experience some temporary discomfort due to contraction of scalp and jaw muscles in response to the pulsing magnetic field. We give clients earplugs to protect their hearing from the noise of the stimulator.

After a daily treatment, clients sometimes report mild fatigue, headache, light-headedness, or muscle pain in the scalp or forehead for a few hours.

In extremely rare instances rTMS treatment can induce a seizure. We protect against this possibility by screening carefully for seizure risk factors prior to accepting a client for treatment.

The beneficial effects of rTMS increase with increasingly accurate scalp measurements and targeting of the coil. However, there are no negative impacts if the stimulation “misses” the ideal location.

Treatment does not typically cause increased anxiety or depression. Sometimes, however, a combination of side effects and anticipatory feelings about treatment can cause an emotional reaction. This is usually temporary and should improve after the first session or two.

What to expect

Most people don’t find rTMS treatment painful; however, there may be a small amount of discomfort caused by the effect of the stimulation on local scalp and jaw muscles. This is usually limited to the first few treatment sessions.

There is no need for anaesthesia. You will be awake and alert during your rTMS sessions.

Yes. Some of our clients tell us that they can hear a “running water” sound during treatment, which is actually the sound of liquid coolant circulating through the coil.

Yes. It’s safe for you to drive and otherwise go about the rest of your day as you normally would, after treatment.

You may bring someone with you if you wish, and they’re welcome to come take a look at the treatment room and learn about the treatment, but they’ll be asked to wait in the waiting room during the session itself.

As treatment progresses, you may become used to the pulses and they may feel less intense. We sometimes start low and gradually increase the treatment energy until we reach the level set out in our treatment protocols, but after that the stimulation intensity won’t change unless you and the psychiatrist decide together to increase or decrease it.

Yes. The expectation is that you be present for all of your scheduled treatments (Monday to Friday) throughout the planned course of treatment. If you think you might need to be away, please discuss this with the technician before treatment begins, so you can plan an uninterrupted schedule together in advance.

Effectiveness

Roughly two thirds of medication-resistant depressed patients treated with rTMS show a clinically meaningful reduction in symptoms, with about half of those reporting that their depression has cleared completely.

rTMS does not work for everyone. Moreover, patients who have improved with a course of rTMS may have their symptoms return within a few months.

Ongoing research is focused on enhancing response rates and predicting who is most likely to respond to rTMS.

Some patients require no further treatments after receiving a course of rTMS.

In other cases, symptoms start to return after about six to twelve months and additional sessions are required to maintain treatment benefits.

Research suggests that 30 to 40 percent of those who have had a course of rTMS have symptoms re-emerge within a year.

Some patients will start to feel the effects of rTMS after 6 to 10 sessions. For others, there may be a delay in effects and others may not see effects at all.

Roughly, for every three patients:

  • One will see symptoms dramatically improve or go into remission (symptoms disappear).
  • One will see moderate improvements.
  • One will not see any improvements.

Cost

rTMS is not currently covered by OHIP. Some private insurers will cover the treatment on a case-by-case basis. Otherwise, you will need to cover the cost of the treatment yourself.

We can assess you for suitability for rTMS in a one-time, OHIP-billable consultation. If rTMS is approved for you and you wish to proceed, you can then investigate whether your private insurer will fund the treatment for you.

Depending on the number of sessions required to get a good clinical result, the total cost is between $2,250 and $4,500.

Don’t hesitate to reach out to us if you still have questions. We’d be happy to answer them.

Neurofeedback (EEG Biofeedback)

Eligibility

Anyone at all can do neurofeedback. There is published evidence on neurofeedback not only as an intervention for various problems or disorders, but also as a peak-performance method that enhances the functioning even of elite performers such as athletes, musicians and surgeons.

Yes, there is no need to adjust or discontinue medications prior to doing neurofeedback. You may find that success with neurofeedback allows you eventually to reduce or even discontinue medications, but that’s a decision that can be made later.

No. Because neurofeedback is overseen by a psychologist rather than a medical doctor, no formal referral from a family doctor or nurse practitioner is required. You are free to self-refer by contacting us to arrange an appointment.

Safety and side effects

Neurofeedback is completely safe, with no known risks.

Neurofeedback has only very mild side effects. Some will report feeling slightly headachy, tired out or sleepy following a neurofeedback session, depending on the protocol used. These experiences typically resolve soon after the session is done.

What to expect

No, neurofeedback doesn’t hurt. Although there are wires attached to the cap that is placed on your head, no electricity or other energy is actually being delivered to your body. Instead, the wires simply convey information from your scalp to the EEG device, which then passes it along to a computer for processing.

There is no need for anaesthesia. You will be awake and alert during your neurofeedback sessions.

Yes. It’s safe for you to drive and otherwise go about the rest of your day as you normally would, after treatment.

You may bring someone with you if you wish, and they’re welcome to come take a look at the treatment room and learn about the treatment, but they’ll be asked to wait in the waiting room during the session itself.

Effectiveness

There is abundant research on the effectiveness of various applications of neurofeedback. However, as with any method, there are some people who do not respond to the treatment.

Neurofeedback is known to induce effects that are very durable. Typically, research finds them not to have receded at all across follow-up periods of up to a year. The likely reason for this is that unlike brain stimulation techniques like rTMS, neurofeedback uses the brain’s own learning mechanisms, reinforced by reward stimuli, to induce long-term changes in the brain that are then very resistant to change. You can think of it as akin to “teaching someone to fish,” rather than “giving someone a fish.”

Sometimes the effects of neurofeedback are apparent after 4 or 5 sessions. More typically, people notice changes at around the 15-session point.

Cost

Neurofeedback is not a medical treatment, so it isn’t covered by OHIP. As a psychological treatment done under the supervision of a registered psychologist, it is covered by any health benefit plan that covers the services of a psychologist.

A typical course of neurofeedback runs between 20 and 30 sessions. At a rate of $150/session, this results in a total cost somewhere between $3,000 and $4,500.

Don’t hesitate to reach out to us if you still have questions. We’d be happy to answer them.

Heart-rate Variability (HRV) Biofeedback

Eligibility

Anyone can do biofeedback; in fact, many use it as a technique for fostering general wellness and resilience to stress.

Yes, there is no negative interaction between biofeedback and medications.

No. Because biofeedback is overseen by a psychologist rather than a medical doctor, no formal referral from a family doctor or nurse practitioner is required. You are free to self-refer by contacting us to arrange an appointment.

Safety and side effects

Biofeedback has no known risks associated with it.

Biofeedback has no known side effects.

What to expect

No, biofeedback doesn’t hurt. On the contrary, it is usually a very pleasant, relaxing, calming experience.

There is no need for anaesthesia. You will be awake and alert during your biofeedback sessions.

Yes. It’s safe for you to drive and otherwise go about the rest of your day as you normally would, after treatment.

You may bring someone with you if you wish, and they’re welcome to come take a look at the treatment room and learn about the treatment, but they’ll be asked to wait in the waiting room during the session itself.

Effectiveness

There is a considerable body of scientific research on the beneficial effects of biofeedback for a range of issues and concerns.

In the clinical research on biofeedback, the effects have been durable out to at least several months following the end of a course of treatment.

Results should start to be apparent after just a few sessions. This depends partly on whether you are doing a version of biofeedback that involves doing daily sessions at home, in which case you can expect results to happen much more rapidly.

Cost

Biofeedback at Breakwater Neuro is done under the supervision of a registered psychologist. As such, it is reimbursable by any health benefit plan that covers the services of a psychologist.

Sessions of biofeedback cost $150 each. Typically, 20 sessions are plenty to bring about a beneficial effect.

Don’t hesitate to reach out to us if you still have questions. We’d be happy to answer them.

Do you still have questions?

Don’t hesitate to reach out.