If you’re considering TMS therapy for depression, it’s natural to wonder what actually happens when you arrive: Will you be awake? Does the treatment hurt? How long will you be there, and how many visits are involved?
Transcranial Magnetic Stimulation (TMS) is a noninvasive treatment that uses magnetic pulses to stimulate targeted brain networks. You stay awake, and the treatment does not involve anesthesia. A helpful metaphor is a signal sent to a sluggish network: repeated stimulation may help shift activity in circuits involved in mood. It is not a guarantee or an instant reset, but research supports TMS as one option for some people with depression, including treatment-resistant depression.
Here’s a step-by-step guide to TMS treatment in New Haven, from the first conversation through a full course.
Step 1: Talk through your history and goals
Before treatment, a psychiatric provider reviews your symptoms, diagnosis, previous treatments, medical history, current medications, and goals. This helps determine whether TMS is appropriate and which protocol may fit your needs. You can ask about alternatives, expected scheduling, possible side effects, and costs.
At Light-tunnel Behavioral Health Services Inc. in New Haven, Dr. Omolola Aragbada, PMHNP-BC, is one of the psychiatric providers. Care planning is individualized; this article does not determine whether TMS is right for you.
TMS has been studied in randomized controlled trials for major depression. In a multisite sham-controlled trial, active left-prefrontal rTMS produced significantly greater improvement on the primary depression measure at week four than sham treatment (O’Reardon et al., 2007). That result supports TMS as a treatment option, not a promise of a particular outcome for you.
Step 2: Review safety and practical questions
Your care team will ask about factors that can affect TMS safety and treatment planning. Be ready to share your medication list and relevant neurological or medical history, including any seizure history, implanted devices, or metal near your head. Tell the team if your medications change or if you experience new symptoms during treatment.
Before you begin, you can also ask:
- What device and treatment protocol are being considered?
- How long is stimulation, and how long should I plan to be at the clinic?
- How frequently will I need to attend?
- What might my insurance cover, and what would self-pay involve?
The treatment chair, coil, and positioning can look unfamiliar at first. Your clinician should explain what to expect and give you a chance to ask questions.
Step 3: Brain mapping and finding your treatment settings
At the initial mapping appointment, the clinician positions the coil and determines your motor threshold. A personalized measure of how much stimulation is needed to produce a small movement in a hand or finger. This helps guide the treatment intensity. The clinician then identifies the prescribed target and records positioning so it can be reproduced at later appointments.
The mapping appointment may take longer than a typical treatment session because it includes setup and measurement. The magnetic coil makes clicking sounds, and you may feel tapping on your scalp during testing. Tell the clinician if the sensation is uncomfortable; positioning and settings can be checked and adjusted according to the protocol.
Step 4: The treatment session itself
For treatment, you sit awake in a chair while the coil is positioned over the prescribed area. You can communicate with the clinician during the session. You may hear repeated clicks and feel tapping or pressure; some people experience temporary scalp discomfort or a headache. The team can check in with you and discuss any symptoms.
How treatment time compares by system
The time you spend receiving stimulation differs by device and protocol. These are examples, not a guarantee of how long your own appointment will take:
| Treatment approach | Approximate stimulation time | What to keep in mind |
|---|---|---|
| Traditional 10-Hz rTMS | Often about 30–40 minutes | In a large trial, the stimulation portion was about 40 minutes, while the full appointment was about 50 minutes (George et al., 2010). |
| BrainsWay H1 Deep TMS for depression | About 20 minutes | In a randomized trial, stimulation lasted about 20 minutes and the overall session about 30 minutes (Levkovitz et al., 2015). BrainsWay is one of the most researched Deep TMS systems. |
| Some theta-burst protocols | As short as about 3 minutes of stimulation | A standard iTBS dose can take about three minutes. Short stimulation time does not mean the whole appointment, or an entire accelerated course, takes only three minutes. |
In the pivotal BrainsWay Deep TMS depression trial, participants received a course of treatment over several weeks, and the active group had greater improvement in depression ratings than the sham group (Levkovitz et al., 2015). Your provider can explain whether that system and protocol are appropriate for your situation.
Accelerated treatment needs a little clarification: Some accelerated protocols schedule multiple short stimulation sessions in a day. A session lasting about three minutes may be one part of a larger daily schedule; it should not be mistaken for the total time commitment of the treatment course.
Step 5: Return for a course of treatment
TMS is usually delivered across repeated visits rather than as a one-time procedure. Many depression protocols involve weekday appointments over several weeks, though the number and timing of sessions depend on the system, clinical plan, and your response.
You and your team can monitor how you’re doing as the course progresses. Some people notice changes gradually; others may not respond as hoped. If symptoms worsen or you have concerns, contact your provider instead of waiting for the next scheduled check-in.
TMS protocols also vary by condition. For example, an OCD randomized trial used Deep TMS targeting medial prefrontal and anterior cingulate-related circuitry, with individualized symptom provocation before treatment; that is a different protocol from depression treatment (Carmi et al., 2019). Ask which target and protocol are being recommended for your specific diagnosis.
What to do, and what to avoid
Do:
- Tell your clinician about medication changes, new symptoms, or concerns between visits.
- Ask for a clear estimate of appointment length and the full treatment schedule.
- Let the team know if the tapping or coil position is uncomfortable.
- Keep follow-up appointments so your care team can review progress and next steps.
Avoid:
- Changing or stopping medication without discussing it with your prescriber.
- Assuming a short stimulation protocol means a short overall visit or course.
- Treating TMS as emergency care if you cannot stay safe or need immediate help.
TMS care and self-pay options in New Haven
At Light-tunnel Behavioral Health Services Inc. in New Haven, TMS is one of several possible depression treatment options. The practice offers psychiatric care, and its TMS services can help you learn more and discuss whether an evaluation may be appropriate. The practice accepts a wide range of major insurance plans, though coverage and authorization requirements vary.
Self-pay clients can also ask about care options. If you’re paying out of pocket, contact the practice to discuss available services and request clear information about fees before beginning. You can ask about the evaluation, treatment schedule, and expected costs so you can make an informed decision.
Medical safety disclaimer
This article is for general education only. It is not medical advice, a diagnosis, or a recommendation that you begin TMS. TMS requires an individualized assessment by a qualified healthcare professional. Side effects can include scalp discomfort or headache; serious complications are uncommon but may occur. Your own risks and treatment options should be discussed with your provider.
If you or someone else is in immediate danger, call 911 or go to the nearest emergency department. In the United States, call or text 988 to reach the Suicide & Crisis Lifeline. Do not wait for a TMS consultation or appointment if you need urgent help.
References
- O’Reardon, J. P., et al. (2007). Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: A multisite randomized controlled trial. Biological Psychiatry, 62(11), 1208–1216. https://doi.org/10.1016/j.biopsych.2007.01.018
- George, M. S., et al. (2010). Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: A sham-controlled randomized trial. Archives of General Psychiatry, 67, 507–516. https://doi.org/10.1001/archgenpsychiatry.2010.46
- Levkovitz, Y., et al. (2015). Efficacy and safety of deep transcranial magnetic stimulation for major depression: A prospective multicenter randomized controlled trial. World Psychiatry, 14(1), 64–73. https://doi.org/10.1002/wps.20199
- Carmi, L., et al. (2019). Efficacy and safety of deep transcranial magnetic stimulation for obsessive-compulsive disorder: A prospective multicenter randomized double-blind placebo-controlled trial. American Journal of Psychiatry, 176(11), 931–938. https://doi.org/10.1176/appi.ajp.2019.18101180