Here are some questions that frequently come up for people who are starting TMS.
Do I have to stop my meds?
No, I would recommend that you do not. TMS has been shown to work best in conjunction with at least one antidepressant, which also seems to help preserve the benefits of TMS even after you’ve finished treatment. We aim to minimize changes as much as possible during the course of the treatment. I will work closely with your primary psychiatrist.
Does TMS hurt?
No. Many people describe the sensation as a woodpecker pecking on your head. It should not be painful, and if it is then there are many adjustments we will make until you feel comfortable. In some people the first few sessions can be jarring because your scalp nerve cells have likely never been stimulated in this particular way. These nerve cells are able to quickly habituate or adapt to the sensation, and we find that by week 2 of treatment there is rarely an issue.
What can I expect on my first day of treatment?
Before even entering the TMS treatment room, you will sit down with me in my office. I will walk you through all the details and technicalities of TMS – what to expect, what different options we have if you aren’t responding strongly enough, what else you can do during the course of treatment to help it work. I will answer any questions you have and make sure you are comfortable and prepared before we get started. Then we’ll move into my TMS treatment room (picture of both in the virtual tour!) I will take some measurements of your head and fit you for your charmingly attractive white treatment cap. You wear this at each session and it is how we ensure that we are treating at the exact same location every time. Next I will use my tester TMS coil to deliver small pulses to your motor cortex (the part of your brain that controls your right hand. By finding the minimum energy that makes your fingers twitch, I determine what exactly is your energy threshold for activating your unique neurons (brain cells). Having found the perfect location and energy for treatment, we get you set up in our comfy treatment chair. We apply the treatment coil to the location we’ve determined, and give you a single set of pulses at a low energy to make sure it feels okay and make necessary adjustments. If you feel comfortable, we proceed with your full treatment.
When can I expect changes?
TMS rarely shows instant results. Instead, it helps your brain to make small incremental changes over time, which results in a more robust and long-lasting remission from depression. This can be frustrating but in the long run it is what makes TMS such a powerful tool against treatment-resistant depression. Most common is to see a response somewhere between sessions 20 and 30. Sometimes this response is subtle, other times people wake up one day to find their depression has vanished. Some people feel benefits of TMS from week 1. Others feel small changes accumulate over time such as increased energy and concentration, while their depression takes a bit longer to respond.
How often will I see the doctor?
As often as you need! We will meet at your initial session, and then I will follow up with you every 10 sessions at a minimum, whether in the office during your treatment or by video at a convenient time. Any time you need to consult with me in between those meetings I will be available to you. Throughout treatment I will be very closely tracking your progress and will contact you if there is a modification that needs to be made to your treatment plan.
Who administers the treatments?
TMS is such a safe and also standardized treatment that it does not require a physician to administer subsequent treatments after the initial mapping. You and I will determine your treatment plan at your first session, and your treatments will be administered by one of my highly qualified and experienced technicians following the exact protocol we have designed for you. You can read more about them here. Most of my technicians are graduate or undergraduate students on a pre-med or pre-health track. I have found these types of treaters to be the most accomplished, compassionate, eager and detail-oriented, of anyone I have hired in the past.
I’ve heard about different types of TMS and different TMS machines – how do I choose?
The great news is that TMS works. Multiple research studies have tried to prove that one type of TMS is better, or one machine manufacturer is better. No major differences have been found. TMS seems to work no matter how it is specifically delivered.
What can you treat with TMS?
TMS is FDA-approved for the treatment of depression, OCD, and smoking cessation. I have the capability to treat any of these conditions in my practice. I have also seen patients find symptom relief from anxiety. TMS has shown benefits in ADHD, PTSD, and migraine as well.
