Grace Liestman and Mocica Alcasid, Community Psychiatry technicians discuss the TMS patient experience and what TMS feels like to patients.
It feels like a woodpecker.
That’s the most common description Grace Liestman, a Community Psychiatry technician in San Jose, hears from her patients about their experience with Transcranial Magnetic Stimulation (TMS).
Liestman’s own experience with TMS, however, was different.
Out of curiosity and an interest to know more about a patient’s experience, she opted to receive TMS during her training on the Magstim device she administers.
While her colleague described it as irritating, for her it felt “like someone was tickling my brain.” Others have described it as someone gently bonking their head with a child’s toy.
“Everyone experiences it differently,” she said. “It’s a unique sensation that you’ve probably never felt before.”
Many people seeking TMS have been unable to resolve their depression through traditional methods such as psychotherapy or antidepressants. Fortunately, two-thirds of patients who have undergone TMS enjoy full remission of their symptoms or experience noticeable improvements.
And while it is a safe and non-invasive treatment for those 18 years or older, patients are still curious and concerned about the procedure.
“The biggest concern patients have is whether or not it’s safe, and it definitely is,” said TMS technician Monica Alcasid, who operates a BrainWay’s device at the Community Psychiatry office in Calabasas. “Most patients come not really knowing what to expect with TMS.”
A complete TMS treatment regimen consists of roughly 36 sessions scheduled over nine weeks. Patients come in every day, Monday through Friday, for the first six weeks and then taper off in weeks seven through nine. While the first treatment lasts about one-and-a-half hours to allow for brain mapping, subsequent treatments last for about 20 minutes apiece.
During a session, patients experience 55 to 75 “trains” or cycles, depending on the kind of device used. For about two seconds, the machine will make a loud “rat-a-tat-tat” sound as it pulses highly focused magnetic fields onto a localized area of the brain. This is followed by an 11- to 20-second break before the cycle begins again.
“We never say it’s painful. Never, ever,” said Liestman. “But we do say that it can be uncomfortable.”
Technicians are there the entire time to guide patients through the process. They may provide a countdown before each pulse session, guide a patient through breathing exercises or just talk to them.
For patients unsure what to expect, the first session can be a little jarring. After all, the machine is loud. Patients can often feel it pulsing on their scalp, and it may cause their jaw to clench or eyebrow to twitch during the active portions of treatment. Technicians can provide neck pillows, a stress ball, and mouthguards as needed.
Technicians are trained to make adjustments and take their cues from patients. Rather than crank the TMS device to the fully prescribed treatment dose, technicians will work up to it.
“We take it at your pace,” Alcasid said. “We won’t turn it up until you are ready, and that’s the thing that makes patients feel better.”
The goal is to get patients to accept treatment at 120 percent of their motor threshold as quickly as possible because that’s when TMS starts to become most effective.
“We talk to our patients a lot through treatment,” Liestman said. “A good tech will know what a patient needs at that moment.”
The good news is that treatment usually gets better with time as patients build up a tolerance. Eventually, most patients are able to watch TV, read a book or chat with their technician during treatment.
While some “late responders” don’t see results until after treatment is complete, many start to see and feel results after about four weeks. This encouragement is usually all that’s needed to help patients to finish strong with their treatment sessions.
“It does get better over time,” said Alcasid. “Once patients understand what TMS is and what to expect, they are less nervous about coming in. It gets easier.”