TMS Therapy: A Complete Guide to What to Expect

If you've been living with depression that hasn't responded to antidepressants, you may have heard about TMS — Transcranial Magnetic Stimulation. It's FDA-cleared, non-invasive, and has helped thousands of people find relief when medications couldn't.

But what is it actually like? What happens during a session? How long does it take to work?

This guide answers all of those questions honestly, so you can decide whether TMS is right for you.

TMS uses focused magnetic pulses — similar in strength to an MRI — to stimulate specific regions of the brain involved in mood regulation. The most common target is the left dorsolateral prefrontal cortex (DLPFC), an area that tends to be underactive in people with depression.

Unlike electroconvulsive therapy (ECT), TMS:

• Does not require anesthesia or sedation
• Does not cause memory loss
• Does not involve electrical current passing through the brain
• Allows you to drive yourself to and from appointments
• Has no systemic side effects (no weight gain, sexual dysfunction, or fatigue)

It's an outpatient procedure done in a clinical setting, typically five days a week for four to six weeks.

TMS is FDA-cleared for major depressive disorder in adults who have not responded adequately to at least one antidepressant medication. It's also cleared for OCD and has strong evidence for anxiety disorders.

You may be a good candidate if:

• You've tried one or more antidepressants without adequate relief
• You've experienced intolerable side effects from medications
• You want a non-medication option for depression
• You have treatment-resistant depression and are looking for alternatives to ECT

TMS is not appropriate for patients with metal implants in or near the head (cochlear implants, certain aneurysm clips, deep brain stimulators), as the magnetic field can interfere with these devices.

Your TMS journey begins with a thorough evaluation. At Roth Family Medicine & Mental Health, we review your full psychiatric and medical history, current medications, prior treatment trials, and goals.

We'll discuss:

• Whether TMS is appropriate for your specific situation
• What to expect from the treatment course
• How to measure your response
• Insurance coverage and prior authorization requirements

If TMS is a good fit, we'll schedule your first treatment session and walk you through exactly what to expect.

The first TMS session is slightly longer than subsequent ones because it includes a process called "motor threshold determination" — essentially calibrating the device to your brain.

Here's what happens:

1. You sit in a reclined chair — similar to a dental chair, comfortable and upright
2. A technician positions the TMS coil over the left side of your head, held in place by a positioning arm
3. Single pulses are delivered to the motor cortex (the region that controls hand movement) to find the minimum intensity that causes your thumb to twitch
4. This threshold is used to calculate the correct treatment intensity for your prefrontal cortex

The whole mapping process takes about 20–30 minutes. You'll feel a tapping or clicking sensation on your scalp — it's unusual but not painful for most people.

After the first session, your daily appointments typically run 20–40 minutes depending on the protocol used.

Standard TMS protocol:

• 40-minute sessions, 5 days per week, for 6 weeks (30 sessions total)

Theta burst stimulation (TBS) — an accelerated protocol:

• 3–5 minute sessions, 5 days per week, for 6 weeks
• Same efficacy as standard TMS with significantly shorter session times

During treatment:

• You sit in the chair, fully awake and alert
• The coil is positioned over your head
• You'll hear a series of clicking sounds and feel a rhythmic tapping sensation on your scalp
• You can listen to music, watch TV, or simply relax
• No sedation, no recovery time — you can drive immediately after

Most patients describe the sensation as a tapping or knocking feeling on the scalp — like someone gently but firmly tapping with two fingers. Some people find it mildly uncomfortable at first, particularly around the temples.

The most common side effect is a mild headache or scalp discomfort after the first few sessions, which typically resolves within the first week as you adjust to the treatment. Over-the-counter pain relievers like ibuprofen or acetaminophen are effective if needed.

Serious side effects are rare. The most significant risk is seizure, which occurs in approximately 1 in 30,000 treatments — a rate comparable to many antidepressant medications.

TMS is not an immediate fix — it works by gradually changing brain activity over the course of the treatment series.

Typical timeline:

• Weeks 1–2: Most patients notice little to no change. The brain is adapting.
• Weeks 3–4: Many patients begin noticing subtle improvements — better sleep, slightly more energy, moments of feeling more like themselves.
• Weeks 5–6: The most significant improvements typically emerge in the final weeks of treatment.
• After treatment: Benefits often continue to develop for several weeks after the course ends.

Approximately 60–70% of patients with treatment-resistant depression experience a meaningful response to TMS. About one-third achieve full remission.

After completing your initial TMS series, we schedule a follow-up evaluation to assess your response. For patients who respond well, we discuss maintenance strategies — which may include:

• Periodic maintenance TMS sessions (monthly or as needed)
• Continued medication management
• Lifestyle and behavioral strategies to sustain gains

For patients who don't achieve adequate response, we discuss next steps — which may include adjusting the protocol, adding ketamine therapy, or exploring other options.

We offer TMS therapy at our Pocatello clinic as part of a comprehensive approach to treatment-resistant depression. TMS is never a standalone treatment here — it's integrated with thorough evaluation, medication management when appropriate, and ongoing support throughout the process.

If you've been struggling with depression and haven't found relief with medications, TMS may be the next step.

Book a TMS consultation or call us at (208) 904-4705 to learn more.