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Patient Guide

Your TMS treatment
journey.

From first consultation to lasting results — what to expect at every stage of your 6-week TMS treatment course.

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6
Weeks
30–36
Sessions
5/wk
Cadence

The 6 phases of treatment

A typical TMS course unfolds across six distinct stages — from initial evaluation through long-term follow-up.

  1. 1

    Consultation & Evaluation

    Week 0
    1–2 appointments ~2–3 hours total
    • Psychiatric evaluation and diagnosis confirmation
    • PHQ-9 / HAM-D baseline assessment scores
    • Review of medical history, medications, and prior treatments
    • Discussion of TMS mechanism, expected outcomes, and treatment timeline
    • Insurance pre-authorization (1–2 weeks typical)
    • Review of contraindications and safety screening
    Is TMS right for me? What outcomes can I expect?
  2. 2

    Motor Threshold Finding

    Day 1
    1 calibration session 45–60 minutes
    • No treatment pulses are delivered during this session
    • Coil placed over motor cortex (M1) — area controlling hand movement
    • Intensity gradually increased until a visible thumb twitch is observed
    • This "motor threshold" sets the treatment intensity (typically 80–120% MT)
    • Coil repositioned to treatment target (DLPFC) for the remaining sessions
    • You may feel mild tapping sensations on the scalp — this is normal
    Will it hurt? What's the motor threshold?
  3. 3

    Early Treatment Phase

    Weeks 1–2 (Sessions 1–10)
    5 sessions per week 20–37 minutes per session
    • Daily sessions, Monday through Friday
    • Each session: seated in a recliner, coil positioned on scalp
    • You hear rhythmic clicking sounds and feel a tapping sensation
    • Most patients read, watch, or use a phone during sessions
    • Resume normal activities immediately after — no downtime
    • Early side effects may include: mild headache, scalp tenderness, fatigue
    • No immediate mood change expected — this is normal
    Will I feel anything right away?
  4. 4

    Building Response

    Weeks 3–5 (Sessions 11–25)
    5 sessions per week 20–37 minutes per session
    • Most patients notice first signs of improvement between weeks 2–3
    • Common early improvements: better sleep, more energy, improved concentration
    • Mood may gradually lift — progress is often subtle at first
    • Side effects (headache, tenderness) typically diminish
    • Week 10 checkpoint: PHQ-9 reassessment, medication review if applicable
    • Continue daily sessions — consistency is key for optimal outcomes
    • Some patients experience temporary worsening before improving — discuss with your provider
    When will I start feeling better?
  5. 5

    Consolidation

    Week 6 (Sessions 26–36)
    5 sessions per week 20–37 minutes per session
    • Continued improvement in mood, energy, and cognition
    • PHQ-9 score reassessed — often significantly reduced from baseline
    • Side effects minimal to none at this stage
    • Discussion of maintenance plan — some patients benefit from periodic booster sessions
    • Transition planning: what happens after the acute treatment phase
    • Discuss long-term follow-up schedule (1-month, 3-month, 6-month check-ins)
    Is treatment complete? What about maintenance?
  6. 6

    Maintenance & Follow-up

    Month 2+
    As needed Variable
    • Optional maintenance sessions: 1–2 per month for 6–12 months
    • Regular follow-up assessments (PHQ-9, clinical interview)
    • Long-term outcome tracking — most patients maintain gains for 6–12+ months
    • If symptoms return, discuss options: booster TMS, medication adjustment, therapy
    • Lifestyle factors: continued exercise, sleep, therapy to support gains
    • Some patients require retreatment — TMS can be safely repeated
    How long do results last?
Interactive

Track a simulated treatment journey

Explore a sample 36-session TMS course — click sessions, view details, and see how response builds week by week.

What happens at each session

A typical TMS appointment takes about 30 minutes from arrival to departure.

Before the session
  • Arrive with clean, dry hair
  • No conditioner or hair products
  • Remove metal jewelry near head
  • Inform provider of any changes since last session
  • Brief check-in with TMS technician
During the session
  • Seated comfortably in recliner
  • Coil positioned on scalp
  • Rhythmic clicking sounds (~10 Hz)
  • Gentle tapping sensation on scalp
  • 20–40 minutes of stimulation
  • Read, watch, or relax during session
After the session
  • Resume normal activities immediately
  • No driving restrictions
  • Mild headache possible (responds to Tylenol)
  • Most patients return to work same day
  • Track any side effects to discuss with provider

Frequently asked questions

Common questions from patients starting TMS treatment.

Will I feel anything during TMS?
Most patients feel a tapping sensation on the scalp where the coil is placed. You will hear rhythmic clicking sounds — this is the magnetic pulse being generated. The sensation varies from person to person; some describe it as a mild knock or tapping, others barely notice it. Pain is not typical — if you experience significant pain, inform your TMS technician immediately.
Can I drive after a TMS session?
Yes. TMS does not require sedation or anesthesia, and there are no driving restrictions after treatment. You can resume normal activities including driving, working, and exercising immediately after your session.
What if I miss a session?
Missing an occasional session (e.g., once per week) is generally acceptable and unlikely to significantly impact treatment outcomes. However, consistent daily attendance is associated with better response rates. If you need to miss multiple sessions, discuss a plan with your provider — some clinics offer weekend catch-up sessions.
Will I need maintenance TMS sessions?
Many patients benefit from periodic "booster" TMS sessions after completing the initial 36-session course. The maintenance schedule varies: some patients come monthly, others quarterly, and some not at all. Your provider will discuss a maintenance plan based on your response and long-term goals.
How long do TMS results last?
Clinical studies show that most patients maintain significant improvement for 6–12 months after completing TMS. About 30–40% of patients eventually experience a return of symptoms and may benefit from retreatment. Ongoing therapy and medication management can help sustain gains.
Does insurance cover TMS?
Most commercial insurance plans cover TMS for treatment-resistant depression (typically defined as failure of 1–4 antidepressants). Medicare covers TMS for depression. Medicaid coverage varies by state. Your clinic will typically handle insurance authorization before treatment begins.
Is TMS safe for everyone?
TMS has an excellent safety profile, but is not appropriate for people with metal implants in or near the head (pacemakers, cochlear implants, aneurysm clips), a history of seizures, or other conditions. Your provider will conduct a safety screening before treatment.

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This page is for educational purposes only and does not constitute medical advice. TMS treatment decisions should be made in consultation with a qualified healthcare provider. Results vary by individual. Always consult your physician before starting or changing any treatment.