TMS: treatment steps, candidacy, and comfort tips

Everything You Need to Know About TMS Therapy

5 min read

Understanding TMS Therapy: A Promising Treatment for Depression

Transcranial Magnetic Stimulation (TMS) has emerged as a safe, effective, and non-invasive option for individuals suffering from treatment-resistant depression and other mental health conditions. Approved by the FDA since 2008, TMS utilizes magnetic fields to stimulate specific areas of the brain involved in mood regulation, offering hope to those who have not responded well to conventional treatments. This article explores the key aspects of TMS therapy, including how it works, the treatment process, patient candidacy, comfort tips, and post-treatment considerations.

What Is TMS Therapy and How Does It Work?

Learn how focused magnetic pulses can rebalance brain activity in depression.

What is TMS therapy and how does it work?

Transcranial Magnetic Stimulation (TMS) is a non-invasive treatment that uses magnetic fields to stimulate specific parts of the brain. The procedure involves placing a small, coil-shaped device on the scalp, targeting areas involved in mood regulation, most often the dorsolateral prefrontal cortex.

During a typical session, the TMS device emits magnetic pulses that pass through the skull and induce small electrical currents in the brain. These currents activate neurons and influence neural circuits responsible for mood and emotional regulation. The process helps normalize brain activity patterns that are often disrupted in conditions like depression.

TMS is usually administered in a series of daily sessions over several weeks, with each session lasting about 20-40 minutes. The repetitive magnetic pulses help promote the release of neurotransmitters such as serotonin and dopamine, which play vital roles in mood stabilization.

Although the exact biological mechanisms are still being studied, current evidence suggests that TMS improves symptoms by modulating synaptic activity, enhancing neuroplasticity, and restoring healthy brain network functioning. This makes TMS an effective option for individuals with depression that does not respond to traditional medications or psychotherapy.

In summary, TMS therapy is a safe, outpatient procedure that stimulates brain regions involved in mood control through focused magnetic pulses, helping to improve mental health conditions with minimal side effects.

The Step-by-Step TMS Treatment Process

Understand each stage of your TMS journey for optimal outcomes.

Initial consultation and medical review

The TMS treatment journey begins with a comprehensive evaluation by a trained psychiatrist or specialist. During this consultation, the medical team reviews the patient's medical history, current symptoms, previous treatments, and medication use. The goal is to determine if TMS is suitable, especially for those with treatment-resistant depression or other mental health conditions like OCD or PTSD. The doctor also discusses the expected benefits, potential side effects, and answers any questions to set clear treatment expectations.

Brain mapping and motor threshold calibration

Before the first treatment session, a critical step involves brain mapping and calibration. Using neuronavigation technology, the provider accurately locates the area of the brain to stimulate, commonly the dorsolateral prefrontal cortex (DLPFC). Simultaneously, they determine the motor threshold by stimulating the area responsible for hand movement, which helps set the safe and effective intensity level for ongoing treatments. This personalized calibration ensures the magnetic pulses are delivered precisely and safely.

Treatment sessions and duration

During each session, the patient remains awake and seated comfortably in a reclining chair. The clinician places a soft, adjustable coil on the scalp over the predetermined brain region. The patient may listen to music, watch videos, or simply relax while the machine delivers focused magnetic pulses. Typical sessions last about 20 to 40 minutes, with most patients undergoing 5 sessions per week over 4 to 6 weeks — totaling around 36 treatments. The magnetic pulses produce a tapping or tingling sensation on the scalp, which diminishes as patients become accustomed to it.

Monitoring progress and side effects

Throughout the treatment series, clinicians monitor improvements and any side effects. Common mild side effects include scalp discomfort, headaches, or fatigue, which usually resolve within days or after the initial sessions. Patients are encouraged to keep track of mood changes and report any concerns. Most find that the side effects decrease over time, and the benefits of improved mood can last for months, sometimes requiring maintenance sessions. Regular follow-up appointments ensure ongoing progress and help adjust treatment plans if necessary.

Typical Protocol and Variations in TMS Treatment

What is the typical protocol for TMS treatment?

A standard TMS treatment involves applying focused magnetic pulses to specific areas of the brain, particularly the dorsolateral prefrontal cortex (DLPFC), which plays a role in mood regulation. During each session, a small electromagnetic coil is positioned on the scalp, often above the left eye, to deliver these pulses. Patients sit comfortably in a reclining chair, fully awake, and can relax, listen to music, or watch videos.

Most treatments are scheduled five times weekly over 4 to 6 weeks, amounting to about 30 sessions. Each session lasts approximately 20 to 40 minutes, during which patients typically experience sensations like tapping or tingling sensations on the scalp, along with clicking sounds from the equipment. These sensations are normal and usually diminish as treatment progresses.

The procedure is painless and well tolerated, with patients remaining alert throughout. No anesthesia is necessary, and individuals can resume their normal daily activities immediately after sessions. The treatment is generally personalized, with initial brain mapping to optimize coil placement and determine the appropriate stimulation intensity.

Protocol durations and intensities

The length and intensity of TMS sessions can vary based on the protocol used. The traditional treatment involves daily sessions over 4 to 6 weeks, with each session lasting approximately 20-30 minutes.

More intensive schedules, known as accelerated protocols, condense the treatment into 1 to 3 weeks, often with multiple sessions per day. Such protocols aim to shorten treatment duration while maintaining high efficacy.

Emerging faster protocols like TBS

Recent innovations include Theta Burst Stimulation (TBS), a faster form of TMS that completes in about 3 to 5 minutes. TBS delivers bursts of magnetic pulses in rapid succession, simulating natural brain wave activity. Studies have shown that TBS is as effective as traditional TMS treatments for depression.

These advancements help improve patient convenience without compromising therapeutic outcomes. Regardless of the protocol, follow-up or maintenance sessions may be recommended to sustain benefits, tailored to each patient’s response.

Protocol Type	Duration	Frequency	Session Length	Notes
Standard TMS	4 to 6 weeks	5 sessions per week	20-40 minutes	Usually effective for treatment-resistant depression
Accelerated TMS	1 to 3 weeks	Multiple daily sessions	20-30 minutes	Suitable for quick treatment courses
Theta Burst Stimulation	About 3-5 minutes per session	Typically daily	3-5 minutes	Faster, equally effective, newer protocol

Understanding these variations enables personalized treatment approaches, maximizing the potential benefits of TMS therapy for each individual.

Comfort Tips and Preparing for a TMS Session

Tips to stay comfortable and relaxed during your TMS treatment.

What should I do to prepare and stay comfortable during TMS sessions?

Proper preparation can make your TMS experience more comfortable and effective. Before each session, aim to get a good night’s sleep to help your brain relax and respond well to the treatment. Staying well-hydrated by drinking plenty of water is also recommended, as hydration can improve comfort and reduce scalp sensitivity.

Eating nutritious meals beforehand provides the energy needed for your session and can help minimize feelings of fatigue or discomfort. You might want to bring headphones or earbuds so you can listen to music or watch videos during treatment, which can distract you from sensations of tapping or clicking sounds.

Relaxation techniques like deep breathing or mindfulness exercises can reduce anxiety and help you stay calm during the procedure. It's advisable to avoid alcohol, recreational drugs, and caffeine before your appointment, as these substances can affect your response to treatment or increase side effects.

During the session, try to remain alert but relaxed. Avoid sleeping through the treatment so your brain stays engaged and the stimulation remains effective. If you experience any discomfort or side effects, don't hesitate to communicate with your provider—they can adjust the machine's settings or offer coping strategies.

Maintaining a regular schedule and staying in touch with your healthcare team will help you stay comfortable and get the most benefit from TMS therapy.

Post-Treatment and Long-Term Considerations

What are the post-treatment considerations and follow-up steps after TMS?

After completing TMS therapy, it is important for patients to remain attentive to their mental health and to stay in regular contact with their healthcare team. Follow-up appointments are essential for evaluating the persistence of treatment effects and addressing any ongoing symptoms. These visits may involve assessments of mood, energy levels, and overall well-being.

Maintaining mental health benefits can often be supported through additional therapies, such as cognitive-behavioral therapy (CBT), and lifestyle modifications. Patients are encouraged to adopt routines that promote mental wellness, including regular exercise, healthy eating, sufficient sleep, and mindfulness practices. Building and nurturing social connections can also play a valuable role in sustaining improvements.

Some individuals might need maintenance TMS sessions to prevent symptom relapse. This is particularly true for those whose depression tends to recur months after the initial treatment course. Your provider can help determine if ongoing or booster treatments are appropriate based on your progress.

It is vital to monitor mood and energy levels and communicate any changes or concerns with your doctor promptly. Early reporting of symptoms allows for timely adjustments, whether through additional sessions or other supportive measures.

Integrating TMS therapy with ongoing support and daily self-care strategies enhances the likelihood of long-term success. This comprehensive approach helps solidify the gains made during initial treatment, promoting sustained mental wellness and reducing the risk of relapse.

Embracing a New Hope with TMS Therapy

TMS therapy stands out as a revolutionary treatment for those battling depression and related conditions that have not responded to conventional methods. Its non-invasive nature, coupled with proven effectiveness, makes it a compelling choice for many patients seeking relief. Understanding the treatment steps, assessing candidacy carefully, and following comfort tips can significantly enhance the experience and outcomes. As research advances and protocols evolve, TMS continues to offer hope and long-lasting benefits, transforming lives one session at a time.