What’s It Like to Get TMS for Depression?

What is TMS anyway?

TMS — aka rTMS for repetitive transcranial magnetic stimulation — is a noninvasive type of brain stimulation treatment. It’s used for treating depression, migraine, and OCD, among other conditions.

During TMS, magnetic pulses repeatedly stimulate nerve cells in your brain. The pulses are aimed at specific areas of your brain thought to be involved in mood (typically the frontal cortex).

While the way it works and how it can help people with depression (and other conditions) isn’t completely understood, essentially, the pulses excite or inhibit certain neurons. In turn, some people find relief from their depression symptoms.

TMS is usually prescribed to people who haven’t found success with other treatments, such as antidepressants for depression.

Some people get it confused with ECT (electroconvulsive therapy) and other brain stimulation therapies, but they’re not the same. Unlike ECT, you don’t need to be sedated, and it doesn’t involve seizures. And in TMS, nothing is implanted or surgical.

So TMS is one of the most noninvasive of all brain stimulation therapies.

What getting TMS was like for me

I have treatment-resistant depression, so finding treatments that work (and keep working) has not been an easy road. On my good days, I try to look at it as a process that will continue to evolve. And who knows what new scientific discoveries will bring?

So when TMS was presented to me as an option, I said “yes” without really knowing what it would be like.

Before

The first step before TMS treatment can begin is getting it prescribed.

For me, I already had a psychiatrist, so I didn’t have to go through the process of finding a new doctor or establishing a relationship — you might need to meet with a doctor a few times before they know enough about you and your treatment history to prescribe TMS.

My psychiatrist knew my full medication history and was the one who first brought up the option. When I agreed, it was time for the approval process.

The approval process will vary based on many factors, such as accessibility in your area, your insurance, and the availability of the clinics.

You may also want to reach out to your insurance to find out what they cover. Mine covered the cost and just involved a copay, but the cost of TMS may be steep for others — one study mentions between $6,000 to $12,000.

Your insurance might also have different requirements before approving TMS. Mine defines treatment-resistant as having tried at least two antidepressants, but other insurances vary, so you might need to prove you’ve taken more medications than that.

My doctor completed the paperwork, so that was one burden off my shoulders. Then I waited for the clinic to contact me.

I had to wait about a month and a half from the time my psychiatrist filled out the paperwork until the time I walked through the door for my first appointment.

The first appointment (or intake appointment)

The first appointment when starting TMS is different from other appointments, not just because you have to fill out the office’s paperwork. The first session sets you up for the rest of your sessions and takes about an hour.

In the intake appointment, they figure out where the device needs to be positioned, so it’s targeting the ideal part of your brain, as well as the power level (or motor threshold).

The technician started by taking measurements of my head to make sure the device (TMS coil, specifically) was properly positioned.

When I first started TMS, the machine they were using was huge, and the coil was in a giant helmet. By the end of my treatments, they’d gotten a new machine where the coil looked more like a shower head and was far less claustrophobic.

The technician adjusted (and adjusted again) as they figured out exactly where to position the coil. But for me, it was just a lot of staring at a wall while wearing earplugs.

Then they tested my motor threshold. The motor threshold is the minimum amount of power needed — it’s sort of like figuring out the “dose.”

I can’t think of a better way to describe TMS than it feeling like you’re being vigorously tapped on the head over and over again.

When they tested my motor threshold, they found it by seeing how much power it took to make my thumb twitch. It felt like someone was gradually tapping more forcefully until the desired twitch was achieved.

Honestly, the first appointment was strange. It felt like I’d never get used to the sensations (I did), and it was kind of frustrating just sitting there while they made the tiniest of adjustments.

And while I never had side effects in the future, I did get dizzy after that first appointment and had to sit and sip water until the tunnel vision went away. Dizziness is a known side effect.

During a typical appointment

After that first appointment, it started feeling more like a routine. There was less adjustment, less time involved, and I never felt lightheaded again (just one or two headaches).

But appointments were definitely an investment of time — you need to have treatment 5 days a week for the first 4 to 6 weeks. The sessions were only 20 minutes, but if my job hadn’t been flexible, I wouldn’t have been able to manage.

Every weekday for 4 weeks, I’d come in, take my glasses off, put in my earplugs, and sit with my eyes closed for 20 minutes. The technician usually gave me a blanket if I forgot a jacket since the fans blowing from the machine blow right on you and make the room cold.

I started trying to meditate since sitting with my own thoughts for 20 minutes could turn into a negative thought spiral that I’d recommend to no one.

Once a week, I’d fill out a questionnaire to monitor my symptoms before, during, and at the end of treatment.

After the 4 weeks were up, I continued treatment. But I went from 5 days a week to 3, then 2, then 1, before stopping.

After TMS

I want to be 100% honest — I don’t think TMS was incredibly effective for me. I think some part of me, however small, wanted to believe the news articles that touted it as a miracle cure-all, even though I know that most mental health conditions are about management, not cures.

I felt a bit more energy after the sessions, but my other depression symptoms were unchanged.

Still, many people have found it effective, and it’s incredibly well tolerated (especially compared with antidepressant side effects). If I had the chance, I’d try it again because I will never stop trying to improve my symptoms and manage this condition.

Everyone is different, so if you think TMS might work for you, I would say give it a shot.

Takeaway

If you end up trying TMS, your experiences may be different from mine. Besides the fact that we all respond differently to treatments and have varying symptoms to begin with, the location you go to, the technicians, the advancing research, and other factors will all affect your experience.

I hope my story at least offers you a glimpse into what it’s like and helps relieve any pre-TMS anxiety.