Anyone considering Transcranial Magnetic Stimulation (TMS) will likely have a ton of questions about what to expect during their treatment series. Here is a quick overview of the process, as well as what occurs during your daily appointments.
Overview
An average TMS treatment series includes 30 to 36 treatments spaced out over six to nine weeks. Each out-patient treatment lasts about 19 minutes. Patients can drive themselves to and from their appointments and continue with daily activities, such as work or school.
For the first six weeks, treatment is administered five days a week. After treatment number 30, most TMS providers will recommend tapering treatments for the last six visits over a period of three weeks.
The first appointment is usually the longest, lasting about one hour. This allows the TMS psychiatrist time to perform the brain (cortical) mapping, which determines the treatment location and the power or “dose” that the device will be set to. The first treatment is performed immediately after the brain mapping and generally follows the same pattern as the remaining sessions. The TMS psychiatrist will be present with the technician to make sure you are comfortable and to answer any questions.
Pre-treatment
After check-in, patients are admitted to a treatment room and their temperatures are checked. The TMS technician will ask a series of 12 questions to identify any changes in sleep, mood, medication, nutrition or other metrics your physician has identified. TMS is most effective when performed on a “consistent brain,” and these questions help technicians identify any major changes.
Things like lack of sleep, excessive alcohol consumption or a significant change in caffeine intake may throw off that consistency and lead to an “irritable brain,” one that is not prepared to receive that day’s dose. In some cases, appointments may be rescheduled if there are dramatic inconsistencies. This usually does not detract from the overall treatment progress.
Every five sessions, the TMS technician will ask patients to complete rating scales that are used to measure progress.
Four weeks into treatment, psychiatrists will perform a second brain mapping to ensure the integrity of the treatment location and settings and make any necessary changes.
During treatment
Patients will sit in the TMS chair and be reclined to a comfortable position. The technician will adjust the device settings and place the treatment coil on the location determined by the TMS psychiatrist during the brain mapping process.
A TMS treatment session lasts 19 minutes and generally consists of 75 trains that will deliver a total of 3,000 pulses. Each train lasts just a few seconds and is followed by an 11-second rest period before the cycle begins again.
The Magstim device is one of the quieter TMS devices available and emits a repeated tapping sound when active. Patients will feel a tapping or pulsing sensation at the treatment site, described by some as sounding like a woodpecker.
TMS should never be painful, but it can be uncomfortable for some. Luckily, patients become use to treatment over the first five to 10 sessions. Some patients choose to read books or watch TV during treatment, while others prefer to meditate or have a conversation with the TMS technician. Patients are monitored throughout their entire treatment session to ensure their comfort and safety.
After treatment
Because TMS is an out-patient procedure, patients are free to return to their usual activities.
Some may experience a slight headache that resolves in less than 30 minutes, but the majority do not. Others may also feel tired immediately following treatment, but it is recommended that they stay awake for at least an hour afterward to keep the brain engaged and working. This helps increase the effectiveness of the treatment.
Any side effect usually improves over the course of treatment. Many patients start to notice improvements in their depressive symptoms around four weeks into treatment, which they are encouraged to share with their TMS technician or psychiatrist.
