Who Qualifies for TMS Therapy? (TMS Requirements)

Transcranial magnetic stimulation (TMS) is an acute treatment that helps relieve symptoms of depression, obsessive-compulsive disorder (OCD), and a range of other mental health conditions. It can be especially helpful for those who’ve tried traditional treatments, like medication or therapy, but haven’t found them effective. 

But TMS therapy isn’t suitable for everyone. In this article, we’ll walk through what TMS is, what to expect from a typical TMS session, and who qualifies for TMS therapy. 

What is TMS therapy?

Transcranial magnetic stimulation (TMS) therapy is a non-invasive, FDA-approved treatment for depression and certain other mental health conditions. It works by delivering gentle magnetic pulses to specific areas of the brain involved in mood regulation. These pulses stimulate nerve cells that are thought to be underactive in people with severe depression, helping restore healthy brain activity and relieving symptoms over time.  

TMS is often recommended for individuals who haven’t found relief with traditional treatments like antidepressant medications or talk therapy. It can also be a good option for those who experience unpleasant side effects from medication or prefer a medication-free approach to depression treatment. 

You might sometimes see TMS referred to as repetitive transcranial magnetic stimulation (rTMS) because the magnetic pulses are delivered in repeated bursts. These are essentially the same treatment. Another type of TMS is deep TMS (dTMS), which reaches deeper and broader areas of the brain. dTMS is FDA-approved for obsessive-compulsive disorder (OCD) and smoking cessation. 

How does TMS work?

TMS therapy is done in an outpatient setting, with no anesthesia or recovery time required. Each session lasts around 20 to 30 minutes and patients remain awake and alert the entire time. Afterwards, they can return to their usual activities, whether it’s heading back to work, school, or home. 

A typical course of TMS involves five sessions per week over several weeks, followed by a tapering or maintenance schedule if recommended by a mental health professional.

Although the exact mechanism behind how TMS works is still being studied, decades of research and clinical trials show that it’s effective in reducing symptoms of major depression. It’s also generally well-tolerated. Side effects, like scalp discomfort or mild headaches, are usually short-lived and tend to fade as the body adjusts to treatment. 

What conditions can TMS therapy help treat?

TMS is FDA-approved to treat major depressive disorder (MDD) in those aged 15 and above, particularly when standard treatments haven’t been effective (a condition known as treatment-resistant depression or TRD). It’s also approved as an additional treatment for adults with OCD. 

Beyond these approved uses, TMS is also being studied for its potential to help with a range of other mental health and neurological conditions, including: 

• Bipolar disorder
• Generalized anxiety disorder (GAD)
• Post-traumatic stress disorder (PTSD)
• Autism spectrum disorders
• Parkinson’s disease
• Attention-deficit hyperactivity disorder (ADHD) 
• Chronic pain conditions (such as migraines or fibromyalgia) 
• Substance use disorders, including alcohol and nicotine addiction
• Schizophrenia.

Note that, while early research is promising, TMS hasn’t yet been officially approved to treat these conditions. It can still be offered under the care of a qualified provider, but this is considered off-label use and may not be covered by insurance. 

Am I eligible for TMS therapy?

If you’re experiencing depression and wondering whether TMS might be right for you, consider the following: 

• Have you tried at least one or two antidepressant medications without improvement?
• Do you experience side effects that make it difficult to continue taking medication?
• Are you looking for a non-medication treatment option for depression?

If you answered ‘yes’ to any of the above questions, then TMS may be an option for you. Our team at Psychiatry Treatment Centers is here to help you explore your options, so contact us today to learn more or schedule a consultation. 

What to expect during TMS therapy

So, what can you expect during TMS? The first thing to know is that TMS is a safe, non-invasive treatment that doesn’t require sedation. It’s usually performed in a clinical setting and you’re free to return to normal daily activities immediately after your session. 

Here’s an idea of what a typical TMS treatment journey looks like:

Your first TMS session

The first TMS appointment is a little longer than the rest because it involves a process called brain mapping. This helps determine the exact location that needs stimulation and the right level of magnetic dosage for your treatment. 

You’ll be seated comfortably in a chair and may be given earplugs to protect against the clicking sound of the machine. Your technician will place an electromagnetic coil on your scalp and deliver a few gentle test pulses to find your motor threshold. This is the lowest level of stimulation needed to cause a small twitch in your fingers or hand, and it helps guide the rest of your treatment. 

This part might feel a little strange at first, but it’s completely safe and only takes a short time. 

Daily TMS sessions

Once your settings are confirmed, you’ll begin daily sessions (your first session might also begin immediately after brain mapping). Most people will require five daily sessions for four to six weeks, although the exact treatment schedule will depend on each individual. 

Here’s what happens in a TMS session:

• The coil is positioned over the part of your brain involved in mood regulation (called the dorsolateral prefrontal cortex or DLPFC)
• The machine sends repetitive magnetic pulses through your scalp to stimulate brain cells
• You might feel a light tapping or clicking sensation on your scalp and hear a clicking sound as pulses are delivered
• Some people feel mild tingling or twitching in the scalp or facial muscles, especially during the first few sessions. This is normal and nothing to worry about. 

You’ll remain awake and seated for the duration of the treatment, and a technician will check in with you regularly to make sure you’re comfortable. They might adjust the strength of the magnetic pulses if needed. Each session lasts about 20 to 40 minutes, depending on the type of TMS being used. 

After a TMS session

Once the session is over, you can return to your day as usual with no downtime. Most people return to work, school, or other daily activities straight away, and there’s no need to arrange for someone else to drive you. 

Some people experience mild side effects, like scalp tenderness or a temporary headache, but these usually resolve on their own and tend to lessen as treatment continues. 

TMS treatment protocol and follow-up 

TMS therapy works gradually, so it takes a bit of time before you can start to feel the effects. In most cases, other people like close friends and family may begin to notice changes before you do. 

For most people, a typical TMS treatment schedule involves 30 to 36 sessions. Some may benefit from occasional maintenance sessions to help maintain results, and this can be discussed with your provider.

Who qualifies for TMS therapy?

To qualify for TMS therapy, you must: 

• Be 15 years or older
• Have a diagnosis of major depressive disorder (MDD) or treatment-resistant depression (TRD)
• Be currently experiencing a depressive episode. 

Additionally, TMS is usually only considered when someone has:

• Tried at least two different antidepressants from two different classes (such as SSRIs, SNRIs, or MAOIs) without success, OR
• Been unable to take antidepressants due to side effects, OR
• Have a medical condition that makes using antidepressants unsafe or unsuitable.  

TMS is also being explored, and used off-label, for other mental health conditions, including anxiety disorders, bipolar disorder (BPD), OCD, and post-traumatic stress disorder (PTSD). If you have any of these conditions and want to know if you qualify for TMS, don’t hesitate to contact our team at Psychiatry Treatment Centers. We’d be happy to assess your needs and provide personalized advice based on your symptoms and treatment history. 

Who shouldn’t get TMS therapy?

Although TMS therapy is safe and effective for many people, it’s not suitable for everyone. You may not be eligible for TMS therapy if you have: 

• A history of seizures, epilepsy, or certain other neurological conditions
• A traumatic brain injury, tumor, stroke, or serious brain illness
• Substance use issues that are not well-managed
• Certain metallic implants or devices in or near the head that cannot be removed, such as:
  • Aneurysm clips
  • Cochlear implants
  • Pacemakers
  • Vagus nerve or deep brain stimulators
  • Medication pumps
  • Electrodes, metal fragments, or bullet fragments in the skull
• Magnetic or electronic implants that could be affected by the magnetic pulses. 

TMS is also not recommended if you are pregnant or breastfeeding, as there is limited information on how safe the treatment is in these cases. 

It’s important to understand that, even if you meet the general eligibility criteria outlined in the previous section, you may not be a suitable candidate for TMS if any of the above apply to you. 

How to prepare for TMS

The first step towards TMS therapy is scheduling a thorough medical and psychiatric evaluation to make sure the treatment is safe for you. This might include:

• A physical exam and possibly lab tests
• A mental health assessment to review your depression symptoms, treatment history, and overall well-being. 

During this process, be sure to let your provider know if: 

• You’re pregnant or planning to become pregnant
• You have any metal or implanted medical devices
• You’ve had seizures or have a family history of epilepsy
• You’re taking any medications, vitamins, or supplements
• You have other mental health conditions, such as bipolar disorder, psychosis, or active substance use
• You experience frequent or severe headaches
• You’ve had TMS therapy in the past, and whether or not it was effective for you. 

This information is useful as it helps make sure that TMS is a safe and appropriate option for you based on your unique needs and circumstances. 

What are the benefits of TMS therapy?

TMS therapy has many advantages, especially when compared to other depression treatments like antidepressants. Some of the benefits of TMS include: 

High success rate

TMS therapy has shown impressive results for people with treatment-resistant depression. According to Harvard Medical School, more than half of patients who didn’t respond to medications experienced significant improvement with TMS, and about one-third of these individuals experienced complete remission. 

Long-lasting relief

The effects of TMS can be sustained in the long-term. In one study, 62.5% of patients whose symptoms improved with TMS were still feeling better a year later. What’s even more encouraging is that 84.2% of those who didn’t go into remission the first time did so during a second round of treatment. 

Minimal side effects

TMS has few side effects, most of which are mild. The most common side effects reported with TMS are temporary scalp discomfort, mild headaches, tingling or twitching in facial muscles, and light fatigue after sessions. These symptoms usually go away within an hour or two and often disappear completely after the first few weeks of treatment. 

Non-systemic

While medication affects the whole body, TMS only targets specific regions of the brain without affecting other organs or systems. This means it avoids many of the common systemic side effects seen with antidepressants, such as weight gain, sexual dysfunction, or digestive issues. 

Personalized treatment

TMS therapy can be customized to each person’s unique needs and preferences. The intensity and frequency of magnetic pulses can be adjusted when required to reduce discomfort and improve outcomes. It can also be used alongside other treatments, including medication or psychotherapy.  

What are the risks involved with TMS?

TMS is generally safe and well-tolerated, but like any treatment, it can come with side effects. These are usually mild and temporary, but rare and more serious side effects might include: 

• Seizures (extremely rare, occurring in less than 0.01% of patients without epilepsy)
• Temporary hearing issues if ear protection isn’t used
• Mania in people with bipolar disorder. 

To make sure TMS is safe for you, your provider will perform a full medical and psychiatric evaluation before recommending treatment. If you have any questions or concerns, reach out to our team at Psychiatry Treatment Centers and we’ll be happy to help. 

Explore TMS therapy at Psychiatry Treatment Centers

If you’re struggling with depression or another mental health condition and want to explore whether TMS is an option for you, we offer this treatment at our locations in California and Georgia. Contact us today to learn more about TMS or schedule a consultation.