Putting this together, we see that we are using a magnetic field to stimulate brain tissue across the skull. This magnetic field is created by passing electricity from your typical wall outlet to a small transformer, through the TMS machine to set the frequency and additional parameters of electrical activity, and finally on to wrapped magnetic wiring that is encased in a plastic shell.  The plastic shell is placed tangentially to the scalp and the fluctuating electric current induces an electromagnetic field as it passes through the wiring in a perpendicular direction, 2-3 cm into the outer cortex of the brain. These magnetic pulses can excite or depress neurons depending on the protocol.  In other words, we are using a magnetic field to safely transmit a small amount of electrical activity to a small area of the brain.

The brain communicates and forms functional circuits through electricity. Billions of electrical connections communicate to conduct voluntary and involuntary life functions including things as simple as breathing, up to more complex actions like language, thought, memories and actions. Complex and connected ‘circuits’ also cause emotions and, in turn, the way we respond to and manage these emotions.  Sometimes these pathways can become awry and the electrical activity is not functioning as it should. Research and brain imaging studies have shown that some areas become dormant or deficient in activity and others excited and hyperactive - such as in depression or anxiety, respectively. 

Read more: TMS therapy for anxiety →

As noted, TMS-Transcranial Magnetic Stimulation, utilizes magnetic fields or pulses, somewhat similar to a MRI, to stimulate electrical connections within the brain.  There are many theories as to different ways that TMS benefits brain activity in those with depression, anxiety, or other conditions, but we know for sure that TMS changes neuronal activity. Depending on the type of stimulation that is administered, TMS can ‘wake up’ sleepy neurons that are low in electrical activity (such as in depression) or inversely ‘calm’ agitated neurons that are overactive (such as in anxiety). 

Learn more about How TMS Works on our TMS Therapy page under Common TMS Questions.

What does a Treatment Involve?

A certified TMS Psychiatrist will then determine the right intensity of treatment unique to a particular individual through a process called ‘mapping’ - or motor threshold determination. This determines just the right amount of energy to cause electrical firing, but not more than is necessary. The magnetic treatment coil can then be placed at the DLPFC and a full treatment session can begin. The protocol entered into the TMS device is started and pulses occur every few seconds (depending on the protocol) and then involve a lull in stimulation for ten seconds or so for neurons to reset. There are different times for treatment, but most commonly this takes 18.5 to as little as three minutes to complete. Typically treatments that are excitatory involve higher frequency (10 Hz or more) and intermittent stimulation while those that are aiming for inhibition of neurons use lower frequency (1 Hz) and more continuous stimulation. 

Read more: Your first TMS treatment visit →

Regardless of treatment protocol, the TMS team monitors tolerability to the treatment and can adjust aspects of treatment to limit discomfort. There are no systemic side effects to treatment, but occasionally patients experience scalp tenderness at the stimulation site or headache. This typically resolves with adjustment to treatment and dissipates over the first few sessions. Earplugs are worn for precaution as there is a tapping noise during magnetic pulses.  It is not extremely loud and different devices have a more vs less prominent noise level (Inspire TMS Denver uses a device with lower decibel readings). 

Read more: TMS therapy pros and cons →

The treatment is done in a comfortable outpatient office setting. Patients do not require any medication or sedation prior to, during, or after treatment and simply lie in a reclining chair while receiving treatment and can even watch TV, listen to music, relax or meditate, or talk with their TMS therapist. After a treatment session, patients can drive and return to work or back home with no limitations. A course of TMS treatments is typically around 36 sessions and takes place over six weeks with an additional several weeks for tapering off treatment.  Response typically takes a few weeks, but time to improvement varies from patient to patient.

Somewhere in the range of 60-70% of patients typically respond positively to TMS treatment for depression with 40-50% achieving full remission. Two thirds of patients maintain this response after one year. The one third that may need retreatment tend to respond well again with 80% or more of these patients re-responding. 

Read more: TMS therapy success rate →

Maintenance treatment can be utilized for some patients when indicated.  This typically involves less frequent sessions (eg once weekly).  Maintenance treatment is not covered by insurance at this time, while the full treatment courses as described above are for certain indications - currently Treatment Resistant Major Depression, OCD, and Smoking Cessation most recently.  Research is ongoing and additional conditions will clearly be added in time. Inspire TMS offers competitive rates for patients seeking care outside insurance coverage and reduced rates for patients that may need maintenance treatment. Rates are disclosed prior to any visit requiring payment and we have a dedicated billing team with years of experience working with insurers to ensure coverage when applicable.

Read more: TMS therapy cost →

Can anyone utilize TMS?

There are few contraindications to TMS, some of the most important are:

A screening evaluation is always performed to review all contraindications. Additional contraindications are listed in our review of insurance coverage criteria in the Pricing Guide section.

TMS was given FDA clearance for treating Treatment Resistant Major Depression in 2008 and more recently for for OCD and smoking cessation. It is non-invasive as it uses electromagnetic fields to change electrical activity of neurons at the surface of the brain. This prevents systemic side effects and makes the procedure well tolerated and generally safe for use. It provides a great treatment option for individuals suffering from treatment resistant psychiatric conditions or intolerance to medications. 

Learn more about how TMS stacks up compared to other treatments in

TMS vs Medications and TMS vs ECT. 

Inspire TMS Denver is proud to offer this treatment to our patients, hope you learn more from this website, and consider utilizing TMS if is the right next step for you or a loved one.  Browse our other pages for additional information and resources regarding TMS therapy, our approach at Inspire TMS, and why you should contact us if considering TMS treatment. Consider utilizing our free phone consultation pathway here or call to schedule today.