TMS for Bipolar Depression: What Patients in Washington Need to Know

Ashley Keays • April 29, 2026

Bipolar disorder has two sides - the highs (mania) and the lows (depression). For most people, the lows are where they spend most of their time, and the lows are usually what does the most damage to work, relationships, and day-to-day life. They're also the harder side to treat. Most bipolar medications are aimed at the highs, and many people try one after another for years without finding something that holds.


TMS - a treatment that uses gentle magnetic pulses to the brain - is giving some of these patients a real option. But bipolar depression is trickier than regular depression, so we want to be straight with you about what TMS can and can't do, what the research actually shows, and how treatment works if you decide to try it.



Is TMS approved for bipolar depression?


Not yet. Right now, TMS is officially approved by the FDA for regular (non-bipolar) depression, for OCD, and for teens aged 15 and up with regular depression. For bipolar depression, doctors use it "off-label" - meaning it's allowed and widely used, but it doesn't yet carry a formal FDA approval for that specific condition.


There has been a big step forward, though. In 2020, the FDA gave the NeuroStar TMS device - the one we use at Creative Wellness - something called a Breakthrough Device Designation for bipolar depression. That's the FDA saying, in effect: "This looks promising enough that we want to help it move through the approval pipeline faster." It's not full approval yet. But it's nothing either.



Does it actually work?


There's growing evidence that TMS can ease symptoms of bipolar depression - enough that the FDA granted NeuroStar (the device we use) Breakthrough Device Designation in 2020 to formally evaluate it for this use. Results vary from person to person. Some people respond well, some don't. We don't promise outcomes.


What we can say confidently is that TMS is well-tolerated and safe for people with bipolar depression, without the systemic side effects that come with most bipolar medications.



One important note: there's some evidence that TMS can occasionally trigger a manic episode in a small number of bipolar patients. It's rare, but real - which is why we monitor closely throughout treatment.


Before starting, an accurate diagnosis matters. Some patients have been labelled bipolar when the diagnosis isn't entirely clear, and a careful review sometimes identifies regular (unipolar) depression as the better fit, which changes the treatment plan and what insurance will cover.

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How TMS for bipolar disorder is different from TMS for regular depression


The treatment itself looks pretty similar. You come in for short daily sessions, usually five days a week for four to six weeks. Each session lasts about 20 minutes. You sit in a chair, a cushioned device rests against the side of your head, and you feel a light tapping sensation while the pulses are delivered. You can drive yourself home afterwards and go back to normal life right away.


What's different for bipolar patients is everything around the treatment - the screening before, the safety checks during, and how we work with your other doctors.


1. A more careful check-up before we start


Everyone gets a thorough evaluation before TMS, but for bipolar patients, we look at a few extra things. We want to confirm you're in a stable place before starting - not in the middle of a manic episode, not in a mixed state where you're feeling depressed and wired at the same time, and not in an active, rapid-cycling pattern where moods are flipping quickly. Starting from a stable base is a big part of what keeps treatment safe.


2. Your mood-stabilising medication stays on


A common question we get: Do I have to come off my medications for TMS? For bipolar patients, the answer is usually no, and in most cases, we specifically want you to stay on them. Medications like lithium, lamotrigine, and valproate are what keep your mood steady. They're the safety net. Removing the safety net while adding a new treatment isn't something we'd do lightly.


If we think there's a good reason to adjust a medication, that's a conversation your TMS doctor has with your prescribing doctor - not a decision made on its own.


3. Closer watching for mood shifts during treatment


Even though the overall research is reassuring about mania risk, individual people can sometimes start tipping toward the high side during any depression treatment, TMS included. So during your course, we don't just ask how your mood is. We ask how you're sleeping, whether you're feeling unusually wired or irritable, whether your thoughts are racing, and whether you're making impulsive decisions. We also ask your family or partner to flag anything that seems "off" between sessions. If we see something shifting, we respond quickly rather than pushing through.


4. Working with your psychiatrist, not around them


Bipolar is a long-term condition. TMS, even when it works beautifully, isn't a cure - it's a powerful tool within a bigger plan. So we stay in regular contact with your psychiatrist before, during, and after your course. If you don't currently have one, we can help you set that up through our in-house medication management team.



Who is a good fit - and who isn't


You might be a reasonable candidate for TMS if:


  • You've been formally diagnosed with bipolar I or bipolar II, and you're currently in a depressive phase.
  • You've tried at least one or two standard bipolar treatments, and they haven't worked well enough.
  • You're on a mood-stabilising medication, or we have a plan to get you on one before starting.
  • You don't have a history of seizures, and you don't have metal implants in or near your head.
  • You're in a relatively steady place right now - not currently manic, not in a mixed episode, not experiencing psychosis.


TMS probably isn't the right next step if:


  • You're currently in a manic or hypomanic episode. The priority is settling that, not adding TMS on top.
  • Your moods are flipping quickly and aren't currently under control. Stabilising that pattern comes first.
  • You have certain medical conditions that make TMS unsafe (your doctor will check for these during the evaluation).


None of this is a decision anyone should make in five minutes. The proper evaluation visit is where the real answer comes from.


Learn More: TMS Therapy

Interested in learning more?


Schedule a consultation to see if TMS could be right for you.

Visit our contact page or call 253-900-1605 to speak with our team.

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What about insurance?


We want to be straight with you here: insurance coverage for TMS in bipolar depression is hit-or-miss. Because TMS doesn't yet have formal FDA approval for bipolar specifically, many insurance companies don't automatically cover it, even though they'd cover the same treatment for someone with regular depression. Some plans do approve it - especially when there's clear paperwork showing you've already tried and failed several medications. Others won't.


What we do: we check your specific plan upfront, we handle the insurance paperwork when there's a reasonable path to approval, and we're honest about out-of-pocket costs if coverage isn't going to come through. No surprises.


Learn More: Pricing


What treatment actually looks like


Most people find the sessions themselves pretty boring, honestly. You sit in a chair. The device rests against your head. You feel a tapping sensation for about 20 minutes. You talk to your TMS technician or listen to music. Then you leave.


Some people get a mild headache or a sore spot on their scalp during the first week or so. This usually fades. You can drive afterwards, go to work, pick up your kids- there's no sedation, no recovery time.


Improvement tends to come in slowly rather than all at once. Some people notice their sleep gets better first, or their energy comes back before they consciously feel "less depressed." Some people actually feel slightly worse in the first couple of weeks before turning the corner - something we call a TMS dip. We know about this, we watch for it, and we coach you through it if it happens.

  • Can TMS trigger a manic episode in someone with bipolar?

    The risk is low but not zero. In the largest research review so far, TMS didn't trigger mania any more often than a placebo did - a much better safety picture than we see with standard antidepressants in bipolar patients. We still screen carefully, keep your mood-stabilising medication on board, and watch closely throughout treatment.

  • Do I have to stop my bipolar medications during TMS?

    Usually no - we'd rather you stayed on them. Medications like lithium, lamotrigine, and valproate keep your mood steady, and that steadiness is part of what makes TMS safe. Any changes happen in coordination with your prescribing doctor, never separately.

  • Will my insurance cover TMS for bipolar depression?

    It depends on your plan. Because TMS isn't yet FDA-approved for bipolar specifically, coverage is inconsistent - some plans approve it with documentation of failed medications, others don't. We check your coverage upfront and are straight with you about costs either way.

  • How is this different from TMS for regular depression?

    The sessions look the same - daily visits, 20 minutes each, for four to six weeks. The differences are clinical: more careful screening, mood-stabilising medication firmly in place, closer watching for mood shifts, and active coordination with your psychiatrist. Same technology, extra guardrails.

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Therapy for Teens in Olympia, University Place & Yelm: A Parent's Guide

By Ashley Keays • June 30, 2026
Not sure if your teen needs therapy? A parent's guide to the signs, choosing the right therapist, and getting a reluctant teen through the door. Olympia, WA.
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Life Transitions and Therapy: Divorce, Relocation, Career Change & Identity

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Does Regence Cover TMS, Counseling, and Spravato in Washington?

By Ashley Keays • June 30, 2026
Regence plans in Washington commonly cover TMS, counseling, and Spravato when medically necessary. Here's how coverage works and how to check your benefits
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CBT for Adult ADHD: How Therapy Helps Where Medication Falls Short

By Ashley Keays • June 26, 2026
Quick Answer : CBT (cognitive behavioral therapy) for adult ADHD is structured, skills-based talk therapy that targets the daily problems ADHD actually creates - time management, organization, follow-through, and the self-critical thinking that piles up over years. Medication can turn up focus and dial down impulsivity, but it doesn't teach those skills. For many adults, the two work best together. If you've started medication for ADHD and found that you can focus better but still can't seem to get the laundry folded, answer that email, or stop calling yourself lazy, you're not doing it wrong. Medication and therapy solve different parts of the problem. This post covers what CBT for adult ADHD targets, why a pill alone often isn't the whole answer, and how the two fit together. What medication does well - and what it doesn't For a lot of adults, ADHD medication is genuinely useful. It can reduce the core symptoms: the wandering attention, the restlessness, the impulsive decisions. When it works, the volume on those symptoms comes down. But medication doesn't teach skills. It won't build you a system for tracking deadlines, break the habit of starting five things and finishing none, or undo years of believing you're the problem. Those are learned patterns, and learned patterns respond to practice, not chemistry. That gap - between "I can focus now" and "I still don't know how to run my life" - is exactly where CBT comes in. This isn't an argument against medication. Many people do best with both. It's just that they're built to do different jobs. What CBT for adult ADHD actually targets Regular talk therapy often explores feelings and history. CBT for ADHD is more practical and present-focused. It works on the specific ways ADHD shows up in your week. Executive function and the daily logistics This is the heart of it. ADHD makes the "managing yourself" tasks harder: planning, prioritizing, starting boring-but-important things, keeping track of time, and following through. CBT for ADHD builds concrete tools for these - external systems for memory and deadlines, ways to break overwhelming tasks into startable pieces, and routines that don't rely on willpower you can't summon on demand. The goal is structure that works with an ADHD brain instead of fighting it. The thought patterns ADHD leaves behind Most adults with ADHD have spent years missing deadlines, losing things, and being told to "just try harder." That leaves a mark. A lot of people arrive with a running internal monologue - I'm lazy, I'm careless, something's wrong with me — that isn't accurate but feels like fact. The "cognitive" part of CBT is about catching those thoughts, testing them against reality, and replacing them with something truer and more useful. This matters because the shame and the symptoms feed each other. Emotional regulation and sensitivity to criticism ADHD isn't only about attention. Many adults also struggle with intense, fast-moving emotions and a strong reaction to perceived criticism or rejection. CBT can help you notice the spike sooner and respond instead of react, which tends to ease the friction in relationships and at work.
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Therapy in Olympia: Finding the Right Counselor for What You're Going Through

By Ashley Keays • June 26, 2026
Quick Answer: Finding the right therapist in Olympia comes down to matching three things: the kind of help you need (individual, couples, or family work), a therapist whose style and experience fit your situation, and the practical details - location, availability, cost, and whether they take your insurance. This guide walks through how to weigh each of those so you book with someone who's actually a good fit, not just the first name that comes up. Choosing a counselor can feel like one more hard decision at a time when you're already low on energy. The good news is that "the right therapist" isn't a single perfect person you have to hunt down. It's about a reasonable fit on a few specific things, and most of those you can sort out in a phone call or a first session. Here's how to narrow it down. Start with what you're actually looking for Before you compare therapists, get clear on the problem you want help with. "I've been anxious and can't sleep" points somewhere different than "my partner and I keep having the same fight." That clarity makes every later step easier. A few useful distinctions: Individual therapy - for things you're carrying yourself: depression, anxiety, grief, trauma, life transitions, self-esteem, or feeling stuck. Couples therapy - for the relationship itself: communication, recurring conflict, trust, or rebuilding connection. Family therapy - for patterns involving parents, kids, or the household as a whole. You don't need a diagnosis or a perfect description to start. But knowing roughly which category you're in helps you filter quickly, since not every therapist does all three. Types of therapy - and why fit usually matters more You'll see a lot of acronyms when you search: CBT, DBT, EFT, solution-focused, and more. They're real, and they matter, but for most people, the therapist matters more than the method. A quick orientation: Cognitive Behavioral Therapy (CBT) focuses on the link between thoughts, feelings, and behavior, and on changing unhelpful patterns. It's practical and often shorter-term. Solution-focused work zeroes in on the specific change you want and the steps to get there, rather than spending months on backstory. Couples and family approaches look at the patterns between people - how a conversation goes sideways, who shuts down, what each person actually needs. At Creative Wellness, our therapists draw on evidence-based approaches like these and tailor them to your goals rather than forcing you into one method. If you're curious how a session is actually structured, our counseling and therapy page covers what to expect. Questions worth asking before you book A short phone consultation tells you a lot. Most reputable practices offer one. Things worth asking: Do you have experience with what I'm dealing with? Depression, trauma, and relationship conflict each call for different experience. Do you work with individuals, couples, or both? Make sure they cover your situation. What does a typical session look like with you? You're listening for an approach that sounds like something you could actually do. In person, virtual, or both? Decide what's realistic for your schedule. What's the cost, and do you take my insurance or offer self-pay? Get the real number before you commit. If a therapist can't or won't answer these clearly, that's useful information too. Contact us here
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Creative Wellness vs Other TMS Clinics in Washington

By Ashley Keays • June 4, 2026
Quick Answer: Many TMS clinics in Washington offer TMS and very little else. Creative Wellness offers TMS , Spravato, counseling, medication management, and genetic testing under one roof, across our three Washington locations. For most patients, that means fewer providers to coordinate, faster adjustments when something isn't working, and a treatment plan that can flex as their needs change. When you start researching TMS in Washington, you'll find a lot of clinics offering it. On the surface, they look similar - same FDA-approved technology, same general process, similar pitch. The differences are harder to spot from the outside. One of the biggest differences is also one of the easiest to miss: what happens if TMS alone isn't enough. The TMS-only model: what most clinics look like The standard model in Washington is a clinic that does TMS and not much else. Maybe a consultation, maybe Spravato, but the core offering is the TMS course. For patients who respond well to TMS alone, this model works fine. You come in, you do your sessions, you finish your course, you feel better. The problems start when one of these is true: TMS doesn't work as well as hoped. Roughly half of TMS patients respond strongly. Others see partial improvement. Some need a different combination of treatments to get all the way there. You need medication adjustments during or after TMS. Many patients are on antidepressants when they start. The right next step is sometimes a tweak - but who handles that? Therapy would help alongside TMS. Research consistently shows therapy and TMS work better together for many conditions. But your TMS clinic doesn't offer therapy. A different treatment turns out to be a better fit. Sometimes the original plan needs to change — to Spravato, to medication management, to therapy, or to a combination. At a TMS-only clinic, the answer is the same in every scenario: "you'll need to see someone else for that." That means new referrals, new wait times, new intake paperwork, new providers who don't know your history. The Creative Wellness model: services that work together Creative Wellness offers TMS, but we also offer: Counseling and therapy - individual, couples, and family Spravato (esketamine) - for treatment-resistant depression Medication management - full psychiatric prescribing and monitoring Genetic testing- to guide medication choices through Tempus NeuroPsych TMS for teens (15 and up- the only FDA-approved use of TMS in adolescents, available through our NeuroStar device All of these are available through the same clinic, the same team, and the same patient file. That changes what happens when a treatment plan needs to shift.
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Couples Counseling in Olympia, WA: What to Expect and How to Get Started

By Ashley Keays • June 4, 2026
Quick Answer: Couples counseling at Creative Wellness in Olympia is led by Dr. David Simonsen, who has over 25 years of experience working with couples. Sessions are $180 for 60 minutes, available in person or by secure video, and focus on practical work - communication, conflict, trust, and shared goals - without fluff or judgment. Most couples don't come to counseling because everything is fine. They come because something has shifted - communication has gotten harder, the same arguments keep coming back, trust has been damaged, or they've drifted somewhere they didn't plan to be. Some couples are in crisis. Some just want to get back to feeling like a team. When couples counseling makes sense There isn't a single right moment to start. Some common reasons people get in touch: Communication has broken down. Conversations turn into arguments, or stop happening at all. One or both partners feel unheard. The same fight keeps coming back. You've talked about it. You've agreed to change. Nothing actually changes, and you're back in the same place a few weeks later. Trust has been damaged. Infidelity, dishonesty, broken commitments - and you're trying to decide if and how to rebuild. You feel like roommates, not partners. Physical and emotional connection has faded. You're going through the motions. A major life change is straining things. A new baby, a career change, an illness, a move, kids leaving home, retirement. Big transitions tend to expose cracks. You disagree on something fundamental. Money, parenting, intimacy, where to live, whether to stay together at all. You don't need to wait for things to be bad. Couples come for tune-ups too - to strengthen what's working and address small things before they become big ones.
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TMS Therapy Cost in Washington: A Real Breakdown With and Without Insurance

By Ashley Keays • June 4, 2026
Quick Answer: A full course of TMS at Creative Wellness is $5,000 for 36 sessions ($150 per session). With in-network insurance and a successful prior authorization, most patients pay a few hundred to around $1,000 out of pocket. Patients with high deductibles or partial coverage usually land somewhere between $1,000 and $3,000. Without insurance, expect roughly $4,000–$7,000 depending on extras. We do free benefits checks before you commit to anything. Money is one of the first questions people ask about TMS - and it's one of the hardest to get a straight answer on. List prices and out-of-pocket costs are different numbers. What insurance pays varies wildly between plans. And the "average cost" figures you'll find online don't tell you what you, specifically, are going to pay. What you're actually paying for A TMS bill isn't one line item. It bundles several things, and knowing what goes into it makes the final number make more sense. The treatment course itself - daily sessions, usually 30 to 36 in total, over four to six weeks. This is the biggest part of the bill. An initial psychiatric evaluation - your first appointment, $250, to confirm TMS is appropriate and safe for you. Motor-threshold mapping - a one-time clinical step at your first session that personalizes the treatment to your brain. It sets the dose and target. Medication management follow-ups during treatment - $150 per session, covering follow-ups, medication adjustments, and monitoring. Facility and technician time - the chair, the device, the staff running each session. Optional extras - Tempus NeuroPsych genetic testing consultation ($250, with the test itself billed separately by Tempus and generally covered by insurance), Spravato consults if you're combining treatments. Maintenance or booster sessions later on - sometimes recommended after a course wraps up, and sometimes billed separately. A full course at Creative Wellness is $5,000 for 36 sessions - $150 per session . Each session is valued the same whether it's a mapping session to create your personalized protocol or a full treatment session. Learn More: What to Expect How insurance changes the math in Washington Most major commercial insurers in Washington cover TMS for treatment-resistant depression. They generally also require a prior authorization, which is a formal request your clinic submits proving you meet their coverage criteria = usually a documented history of trying multiple antidepressants without enough relief. Each plan handles TMS differently - same insurer, different policies — so the only way to know your specific number is a benefits check. We see Regence often in our patient base, and TriWest covers TMS for military families and dependents (including teens 15+ since the October 2025 expansion). We do these for free, before you commit to anything. You'll get a clear estimate of what your plan covers, what your deductible looks like, and what you'd realistically owe. Any Questions? Contact Us
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TMS for First Responders in Washington State

By Ashley Keays • April 29, 2026
First responders carry something most people don't: the cumulative weight of traumatic events, repeated over years, absorbed as part of the job. The hypervigilance that keeps you sharp on a shift doesn't switch off when you go home. The images don't fade on schedule. Sleep gets harder. Reactions get bigger. Relationships get harder to hold onto. For many first responders, the symptoms build quietly for years before anyone names them. Some people call it burnout. Some call it stress. Clinically, it often meets the criteria for PTSD, treatment-resistant depression, or both. This post is about one treatment option that's increasingly being used for people in this situation: transcranial magnetic stimulation (TMS). This non-drug treatment works directly on the brain circuits driving these symptoms. Why first responders are at higher risk Working in emergency services is a recognised risk factor for PTSD . It sits alongside combat exposure, childhood trauma, and other situations where the brain gets pushed into survival mode repeatedly and struggles to come back down. Roughly 7 to 9% of people will experience PTSD at some point in their lifetime. For people in emergency services roles, the exposure is repeated and cumulative - it's not one big event but the tenth, the fiftieth, the hundredth. The math changes. One more thing to know: PTSD rarely travels alone. Roughly half of the people with PTSD also have depression. Anxiety, sleep problems, and substance use often come into the picture too. What might look like "just depression" or "just not sleeping well" is often something more layered. What's actually happening When you go through something life-threatening, your brain drops into a survival mode - hypervigilant, on edge, ready to react. Normally, once the danger passes, your brain returns to its usual state. With repeated or severe trauma, that reset doesn't fully happen. Certain pathways get stuck on high alert. The practical result is a brain that keeps sounding the alarm when there's no fire. That's the hypervigilance, the startle response, the inability to fully relax. It's not a character flaw or weakness. It's a biological pattern - and that means it's something that can be changed with the right treatment. What PTSD actually looks like The symptoms tend to fall into four groups: Intrusive thoughts - flashbacks, nightmares, distressing memories that show up without warning Negative mood and thinking - persistent fear, anger, guilt, or shame; feeling detached from people you used to feel close to; loss of interest in things you used to enjoy. Being constantly on edge - easily startled, struggling to sleep, trouble concentrating, irritability or aggression Avoidance - steering clear of anything that brings it back Any of these can make normal life harder - holding down a job, keeping relationships intact, making decisions, and getting proper rest. Left untreated, PTSD also raises the risk of depression, suicidal thoughts, and substance misuse. Will insurance cover it? It depends on the diagnosis and the insurer. For treatment-resistant depression, TMS is FDA-approved and covered by most plans when the paperwork supports it . For PTSD specifically, coverage is less consistent - some insurers approve it, others don't. When both are present, there's often a clear path to coverage through the depression diagnosis, with PTSD adjustments added during the same course. We check your coverage upfront and are straight with you about costs either way. No surprises.
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The Insurance Approval Process for TMS: What Happens Behind the Scenes

By Ashley Keays • March 31, 2026
For most patients, the insurance approval process for TMS is a black box. You submit information, wait, and eventually hear yes or no - often without a clear understanding of what happened in between or why the decision went the way it did. That lack of visibility is a problem because what happens behind the scenes matters. A well-prepared prior authorization submission significantly improves the likelihood of approval. A poorly documented one - or one that misses a specific insurer’s criteria - can result in a denial that takes weeks to appeal, delaying treatment the patient genuinely needs. Why TMS Requires Prior Authorization TMS is an FDA-approved treatment, but FDA approval and insurance coverage are entirely separate things. Insurers make their own coverage determinations based on their own clinical policies, which vary by provider and are updated periodically as the evidence base evolves. Most major insurers in Washington now cover TMS for treatment-resistant major depressive disorder, but they require prior authorization - a formal request from the treating clinic that demonstrates the patient meets their specific eligibility criteria before treatment begins. This is standard for any high-cost or specialist treatment, not unique to TMS. The keyword is “before.” Starting treatment without authorization in place is a significant financial risk. If coverage is denied after treatment has begun, the patient may be liable for the full cost. A clinic that allows this to happen is not doing its job. What Insurers Typically Require Each insurer has its own coverage policy, but most share a common set of core requirements. Understanding these in advance helps you arrive at your evaluation with the right history documented. Diagnosis T MS is covered fo r major depressive dis order (MDD) and, with some insurers, OCD . The diagnosis must be formally documented by a qualified clinician. Off-label uses - anxiety, PTSD, and others - are generally not covered, though this varies and is worth checking with your specific insurer. Prior medication trials Most insurers require documented evidence that the patient has tried and failed to respond to a minimum number of antidepressants - typically two to four, from different drug classes, at adequate doses and durations. “Failed to respond” means either no meaningful improvement or side effects that made the medication intolerable. This documentation needs to be specific: drug names, doses, duration, and outcome. Symptom severity Insurers typically require evidence of moderate to severe depression, usually demonstrated through a validated rating scale score. This is part of why the clinical evaluation matters - it generates the baseline data that supports the authorization request. Prior psychotherapy Some insurers also require documented evidence of prior psychotherapy, typically a course of CBT or equivalent. This requirement is not universal, but it appears in enough coverage policies that it is worth checking early. Medical necessity statement The treating clinician must provide a written statement explaining why TMS is medically necessary for this specific patient, given their history and current presentation. Vague or generic statements are a common reason for denials. The documentation needs to tell a clear, specific clinical story.