How it works
What actually happens, from the first call to the last session
Most people arrive at TMS after years of medication trials, and the thing they want is not a brochure. It is a straight description of what they are walking into. Here is the whole sequence.
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Step 1. The phone call, about 10 minutes
You tell us what you have tried and what happened. We tell you whether TMS is likely to fit, what it costs, and what the schedule would look like. If you are not a candidate, or if the drive from where you live would make a daily treatment schedule unrealistic, we say so on this call. Nobody books you into something that will not work.
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Step 2. The clinical evaluation
A licensed provider reviews your diagnosis, your medication history, and your medical history. This is where contraindications get caught: non-removable conductive metal in or near the head, a seizure history, implanted devices. You will also be asked about your current prescriber, because TMS works alongside your existing treatment rather than replacing it.
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Step 3. The mapping session, about an hour
This one is different from the rest. Your provider finds your motor threshold, which is the pulse strength that produces a small involuntary movement in your hand. That measurement sets your treatment dose. They also locate the exact coil position for you. Every head is a slightly different shape, so this is measured rather than assumed. You will feel tapping.
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Step 4. Treatment sessions, about 19 minutes each
You sit in a chair, fully clothed and fully awake. The coil rests against the left side of your head. The machine delivers pulses in short bursts with pauses in between, and it sounds like a rapid clicking. You can read, listen to something, or talk to the technician. When the timer ends you stand up and leave. No sedation, no IV, no downtime, no restriction on driving.
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Step 5. The course, 36 sessions
Five days a week for six weeks, then a short taper. Consistency matters. Missing scattered days weakens the result, which is why we ask about your commute and your work schedule before you start rather than after. Information for patients ages 15 to 21 is on the adolescent TMS page.
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Step 6. Tracking, throughout
Your symptoms are re-scored during the course, so improvement is measured rather than guessed at. According to NeuroStar, many people see their depression symptoms improve after 4 to 6 weeks of treatment. Some notice earlier. Some only near the end. Some do not respond, and if that is happening we will tell you rather than run out the remaining sessions.
What it feels like
The most common side effect is pain or discomfort at or near the treatment site. These events are transient; they occur during the TMS treatment course and do not occur for most patients after the first week of treatment. There is a rare risk of seizure with NeuroStar TMS, under 0.1% per patient. Your provider will go through the full risk profile with you before you consent to anything.
How it is different from ECT
People conflate these constantly. Electroconvulsive therapy induces a seizure under general anesthesia and carries memory effects. TMS uses focused magnetic pulses, you stay awake the entire time, and you drive yourself home. Different treatments, different risk profiles, different aftermath.