Transcranial Magnetic Stimulation (TMS)

Who is TMS a good fit for, and who should not have it?

TMS tends to fit adults and adolescents with depression that has not improved enough after one or more antidepressants. It is also FDA-cleared in adults for obsessive-compulsive disorder (OCD) and for depression with anxious distress. People also turn to it when medication helped only part way, when the side effects were hard to live with, or when they would rather not add one more daily prescription.

You may be a good fit if any of these are true:

• Antidepressants you have tried have not helped enough.
• You could not tolerate antidepressant side effects.
• You would rather not add another daily medication.
• You have already completed prior medication trials, which insurance usually requires before it will approve TMS.

TMS is not right for everyone, and a few situations are firm reasons to avoid it or to proceed only with extra care. Your treating psychiatrist screens for these before you start:

• You have a non-removable metal or electronic implant in or near your head, such as a cochlear implant or an aneurysm clip. That is a firm reason not to have TMS.
• You have a history of seizures or a significant neurological condition. TMS is sometimes still possible after careful review, but with added caution.

Does insurance cover TMS?

Most major plans cover TMS for treatment-resistant depression, almost always after a prior authorization that documents past psychiatric history, including the antidepressants you have already tried and some other details like psychotherapy history. Our staff verify the specific requirements of your plan, gather what your insurer needs, and handle the authorization.

What if you cannot come in five days a week?

For some people a shorter timeline matters: to fit a work or school schedule, to finish treatment during a visit from out of the area, or simply to feel better sooner. Alongside the standard course, we offer two accelerated protocols that deliver the full treatment in days rather than weeks.

The accelerated protocol delivers 50 sessions over 10 days, about five sessions a day. The single-day protocol delivers 20 sessions in one day, each lasting roughly three minutes.

D-cycloserine is offered selectively and can be administered by mouth prior to sessions. It may improve the brain's response to stimulation.

Which one fits you, the standard course or one of the faster protocols, is a decision your psychiatrist makes with you during the evaluation.

What happens during a TMS appointment at our office?

Here is how it works, from the first visit through the full course.

Before you start. You meet with a psychiatrist who reviews your diagnosis, the treatments you have already tried, your current medications, and your medical history, including any implants or seizure history. This visit confirms TMS is a safe, sensible option and sets clear expectations about the time it takes. We verify your insurance and handle the prior authorization most plans require.

A typical session. You sit in a chair, awake and alert the whole time. A coil rests against your scalp and sends brief magnetic pulses to a targeted spot of the brain (for depression the target is the prefrontal cortex, an area involved in mood regulation). Most people feel a tapping sensation during the session, which is well tolerated, and people can read, listen to something, or simply rest. A standard session runs about 20 minutes. A psychiatrist supervises your treatment and is available during every session.

Returning to your day. There is no anesthesia or recovery period. You can drive yourself, and most people go straight back to work, school, or their usual routine.

The schedule. A standard course runs about five days a week for six to nine weeks. We also offer accelerated protocols, described above.

What about side effects and risks?

Most side effects are mild and ease over the first week. Scalp discomfort under the coil, facial twitching during the treatment or a short-lived headache after the session are the most frequent side effects.

The one serious risk, a seizure, is very rare, and the screening before you start is designed to lower that risk further. Your psychiatrist will go over the risks and benefits for your specific situation before you decide.

Is TMS the same as shock therapy?

No. TMS is not electroconvulsive therapy (ECT), which is a separate treatment we also offer. TMS involves no anesthesia, no sedation, and no effects on memory. You are awake and alert the whole time, most people feel a tapping sensation on the scalp, and you can drive yourself home afterward.

What does the research on TMS show?

TMS helps a meaningful share of people whose depression has not responded to medication, though not everyone, and it is not an overnight fix.

The FDA first cleared TMS for depression in 2008, and the protocols have been studied and refined ever since.

If a full course has not helped, we will talk through your other options. During your evaluation, your psychiatrist will walk you through what the evidence suggests for someone in your situation.

How does TMS compare to your other options for the treatment of depression?

TMS is one of several paths for depression that has not responded to medication. For some people, adjusting medication, adding psychotherapy, or another interventional treatment such as ketamine-based care or ECT is a better fit, and these are sometimes combined.

Your psychiatrist will talk through which option, or combination, makes sense for your history, your preferences, and what your insurance will cover.