What is TMS?

Transcranial Magnetic Stimulation, or TMS, uses a pulsating MRI-strength magnet to non-invasively stimulate regions of the brain that when under-active have been shown to cause depression. It involves placing the magnetic coil against the outside of the head over the left dorsolateral prefrontal cortex, or L DLPFC. When active, the coil pulses at a high frequency and directly stimulates the neurons through a process called electromagnetic induction. This treatment continues for 18 minutes and when done at a frequency of five times per weeks for at least six weeks, it should drastically improve activity in that region of the brain and significantly reduce or stop symptoms of depression. TMS is used most commonly on people with treatment-resistant depression that can’t find relief from medications or psychotherapy because of the reduced activity in the L DLPFC.

If you would like to read more about TMS, please browse our blog or read our FAQ’s.

What to Expect:

Every TMS protocol begins with a consultation with Shauna Hahn, PMHNP. She is the clinic director and the lead provider that will be in charge of your care with us. The consultation is free and will look to establish if you are a safe candidate for TMS and answer any questions you have. If you are a candidate for treatment and would like try and bill your insurance, there are a few steps that Shauna will explain to you and then we can work on submitting a prior-authorization to your insurance provider.

The first session of treatment is the Motor Threshold Determination and will take ~1 hour. This is where Shauna will use a diagnostic version of the TMS coil to determine the correct location and intensity to administer treatment. Once she maps out the correct location and intensity, the findings will be drawn on to a cap that you will wear during treatment so that each session will be consistent.

The second part of the Motor Threshold Determination will be the first TMS treatment. You will be reclined in a chair with your cap on and a vacuum pillow that cradles your head, holding it in the correct position. Shauna will position the TMS coil tightly against your head to ensure full contact and then start the machine.

TMS can cause some discomfort or pain during the first few sessions so Shauna will begin with a treatment intensity lower than your goal intensity to improve tolerability. We will slowly work up towards the goal over several treatments at a pace that you are comfortable with. During treatment the coil will pulse and sound like what some people describe as a “woodpecker”. Treatment will last for 18 minutes, during this time you can rest with a blanket or watch a show on the TV in the treatment room. We try to make it as relaxing of an experience as possible.

After you’re done with the Motor Threshold Determination, standard treatment appointments will only take 30 mins. We can book you for the entirety of your treatment protocol to make it easy on your schedule. The standard treatments will be administered by an experienced technician but will be overseen by Shauna.

Twice during your treatment protocol you will have another ~1 hour appointment called the Motor Threshold Redetermination. This will be with Shauna and will be nearly identical to your initial Motor Threshold Determination. The reason for these appointments is to determine if there has been any adaptation to treatment in the brain that would change the optimal intensity or location for treatment. It is common for the goal intensity to change slightly and these appointments will make sure we are providing the best treatment possible.

If you would like to read more about TMS, please browse our blog or read our FAQ’s.