TMS for Long-Term Depression & Treatment Resistance

Short Answer Yes - most patients can drive after a TMS session because TMS is performed while you’re awake and does not require sedation. If you experience unusual dizziness, severe headache, or are given medication that impairs alertness, don’t drive until you’ve been cleared by the clinic. This short guide explains why driving after TMS is usually safe, how timing and protocols affect daily activities, how TMS compares with in-clinic treatments that do require post-treatment observation, and practical workplace guidance and checklists you can use. Why driving is usually OK after TMS No sedation required. Standard TMS is non-invasive and does not involve anesthesia or sedating drugs, so people are typically able to leave the clinic and drive home after a session. This is a major practical advantage over treatments that require on-site observation. Short, supervised sessions. TMS sessions are brief (a few minutes for iTBS ; session appointments take longer because of prep and setup), and trained staff monitor patients throughout. If you feel unwell, the staff will evaluate you before you leave. Caveat: Always follow your clinic’s instructions. If the team advises you not to drive (for example, after an unusually strong reaction, severe headache, or medication given during treatment), do not drive. Timing and driving by the TMS protocol Standard TMS (1 session/day, weeks): Most patients resume normal activities, including driving, after each session. Schedule sessions before or after work, or at times that minimize disruption. Read More: Standard TMS Accelerated TMS (multiple sessions/day, e.g., 50/5 days): Treatment days are long. Patients often take the day off during an accelerated week. Driving home after each session is usually safe, but because treatment days are lengthy and tiring, many patients arrange transport or plan not to drive the same evening if they feel fatigued. Read More: Accelerated TMS ONE-D / Single-Day (20 sessions in 1–2 days): These compressed visits can be physically and mentally demanding. Expect to need the day(s) off and avoid driving until you feel fully alert and comfortable. ONE-D should be clinician-supervised with clear post-treatment guidance. Read More: One-Day TMS Comparing TMS with Spravato® (esketamine) and ketamine

Quick Summary Headaches are the most common side effect of Transcranial Magnetic Stimulation (TMS) . They’re usually short-lived, mild-to-moderate, and respond to simple self-care (hydration, OTC pain relief, rest). Most important: tell your TMS team if a headache is severe, persistent, or comes with other neurological symptoms - clinics screen for seizure risk and are trained to manage complications. Why TMS can cause headaches (plain language) TMS delivers brief magnetic pulses to areas of the scalp and brain . Those pulses can: Stimulate scalp and neck muscles , causing muscle tension and tenderness. Irritate sensory nerves in the scalp where the coil rests. Cause brief changes in local blood flow or neuronal activity that patients sometimes notice as a headache while the brain adjusts. These mechanisms explain why headaches are common after a session but are usually temporary and manageable. Clinics intentionally screen patients and set stimulation intensity to balance benefit and tolerability. Immediate relief strategies (what patients can do right after a session) Try these first-line, low-risk steps if you get a headache after TMS: Hydrate. Drink water - mild dehydration often makes headaches worse. Rest quietly for 15–30 minutes. Lie down in a dim, quiet room. Over-the-counter analgesics (if appropriate). Acetaminophen or ibuprofen often helps. Check with your clinician if you’re on blood thinners or have medical contraindications. Warm or cool compress. A warm compress can relax tense neck muscles; a cold pack can numb localized scalp pain - use whichever feels better. Neck and shoulder self-stretching. Gentle neck rolls and shoulder stretches relieve muscle tension. Avoid heavy caffeine or alcohol. Small amounts of caffeine sometimes help, but too much can worsen a headache. Alcohol can dehydrate and interfere with recovery. Short walk & fresh air. Light movement and deep breathing reduce tension for some people. Note: If you’ve been prescribed a specific pain plan (for example, the clinic recommended a pre-session analgesic), follow that. Always check with your clinician before taking new medications.

Quick Summary Transcranial Magnetic Stimulation (TMS) is an outpatient, non-drug treatment for depression and related conditions. Most patients can resume normal activities, including driving, after a session, and many return to work during or after treatment. This guide gives clear timelines for common TMS protocols (standard, accelerated, ONE-D), examples of reasonable workplace accommodations, ready-to-use employer letter templates, anonymized success stories, and a downloadable Employer Packet to simplify communications and approvals. Key points up front Most patients can drive and work after a TMS session. TMS does not require sedation, and patients typically resume normal activities the same day. The timing for returning to full duties varies by protocol. Accelerated protocols and ONE-D compress treatment can be completed in days, requiring planning for multi-hour clinic days; standard TMS involves daily visits over 4–8 weeks. Reasonable accommodations - flexible scheduling, remote work, or phased return - usually allow employees to complete TMS while maintaining employment. Communication and documentation (a short clinician note, expected schedule, and estimated downtime) speed approvals and reduce stress. Basic facts employers & HR should know What TMS is TMS uses magnetic pulses to stimulate targeted brain areas involved in mood . It’s non-invasive, done while the patient is awake, and - unlike ketamine or Spravato® - does not require post-treatment observation that prohibits driving. TMS is performed in an outpatient clinic with physician oversight and safety screening. Safety & suitability Clinics screen for seizure history , implanted metal, and medication interactions before starting mapping and treatment. Mapping is used to personalize stimulation parameters. Employers can rely on a clinician’s assessment and return-to-work guidance. Typical return-to-work timelines (by protocol) Use these as guidelines - individual plans should be based on clinician recommendations and job demands. Standard TMS (typical) Schedule: ~1 session/day, Monday–Friday, for 4–6 weeks (some programs 6–8 weeks). Daily impact: Sessions last ~20–40 minutes; no sedation. Most patients return to work the same day after a session. Work plan: Many patients schedule sessions before or after work, or take short breaks. A phased return (reduced hours first week) is sometimes helpful. Learn More: Standard TMS Accelerated TMS (e.g., 50 sessions / 5 days) Schedule: Multiple sessions/day (often 8–10/day) over 5 consecutive days. A full clinic day can be long. Daily impact: Expect long clinic days; most patients do not work during the treatment week and take time off. Work plan: Employers can allow one week of concentrated leave or flexible unpaid leave to accommodate an accelerated week. Learn More: Accelerated TMS ONE-D (Single-Day) or 1–2 day protocols (20 sessions) Schedule: 20 iTBS sessions in a single intensive visit or across two days. Daily impact: Very condensed; patients usually need the day(s) off for the visit and rest afterward. Employers should treat ONE-D as 1–2 days of medical leave with short-term follow-up. Work plan: ONE-D is attractive to travelers and time-limited professionals but requires a short block of leave. (ONE-D is generally self-pay and offered under supervision at select clinics.) Learn More: One Day TMS

Quick Overview If you or a patient feels worse during a course of TMS , that reaction is real - and it doesn’t mean treatment has failed or that the clinician has made a mistake. A temporary worsening (often called the TMS “dip”) happens for some people while the brain is adjusting to stimulation. Most importantly, it is usually transient, manageable, and treatable with clear clinical steps and support. What is the “TMS dip”? The TMS dip describes a temporary increase in depressive or anxiety symptoms during a TMS course. Patients may report mood worsening, increased anxiety, irritability, sleep disruption, or more frequent intrusive thoughts. For most patients, the dip is short-lived and improves with continued care; for a small minority, it may require pausing or adjusting treatment. Clinics that specialize in TMS note this phenomenon and have procedures to respond. When does the dip usually happen? Timing: The dip most commonly appears mid-course (around halfway through a typical protocol), but it can occur at any time during treatment. Duration: In most cases, the dip lasts hours to a few days and resolves as the brain adapts to stimulation; in a few cases, clinicians pause or change the plan if symptoms persist. How often: Only a small percentage of patients report intolerable worsening that leads to stopping treatment; serious long-term worsening is not supported by the evidence when patients are correctly screened and monitored. Why does the dip happen? (simple clinical framing) No single explanation covers every patient, but common reasons include: Neurophysiologic adjustment. TMS actively alters neural circuits; as excitatory and inhibitory balances shift, transient symptom fluctuations may occur while new patterns stabilize. Protocol mismatch. Coil location, dose, or timing may be suboptimal for a specific patient; small differences in targeting can change the effect. Proper motor-threshold mapping is essential and sometimes needs re-checking. Medication interactions or withdrawal. Medication changes or interactions can amplify symptoms during stimulation. Comorbid or misdiagnosed conditions. Undetected bipolar spectrum disorders, PTSD, substance use, or medical issues can cause symptom volatility that looks like a dip. Psychological reaction. Increased self-awareness or brief increases in distress as therapy “opens up” material can feel worse before it gets better. What your clinicians should do - a practical, step-by-step response 1 - Immediate triage (same day) Screen for safety: Assess suicidality, intent, psychosis, or sudden functional decline. If safety is a concern, follow urgent protocols (suicide assessment, crisis plan, ER if needed). Check vitals/physical symptoms if relevant (headache, dizziness, unusual movements). 2 - Rapid medication & history check Confirm timing of meds (including any recent changes). Flag high-risk drugs (bupropion, clozapine, tramadol). If new meds or missed doses are identified, coordinate with the prescriber. 3 - Review TMS delivery Re-check mapping & motor threshold. Small targeting or intensity mismatches can matter; re-mapping may be indicated. Consider protocol changes : reduce per-session dose, increase inter-session rest, change coil location, or switch protocols (rTMS ↔ iTBS ). For patients on accelerated schedules, spacing or dose adjustments can reduce adverse fluctuations. 4 - Pause vs continue (clinical decision) Mild, brief dip: Often continue with enhanced monitoring and supportive measures (hydrate, rest, analgesia). Moderate/persistent dip: Consider pausing or slowing down the course and re-evaluating within 48–72 hours. Severe or safety concern: Stop treatment and escalate psychiatric evaluation. 5 - Symptom-targeted support Address headaches (hydration, OTC analgesic), sleep disturbances, and acute anxiety with evidence-based, short-term strategies and coordination with prescribing clinicians. Consider brief psychotherapeutic support if the dip involves increased rumination or trauma material. Learn More: TMS Pros & Cons 6 - Rescue & maintenance options Rescue/extension: If partial benefit is seen but symptoms fluctuate, clinicians may add extra sessions, extend the course, or offer maintenance/booster sessions later. Many clinics offer retreatment or maintenance schedules for sustaining gains. 7 - Documentation & follow-up Document symptom change, interventions, and rationale. Schedule a short re-check within a few days and continue outcome monitoring (PHQ-9/GAD-7 or other PROMs).

Quick Introduction

Who might be a candidate for ONE-D? ONE-D is typically considered for people who: Have treatment-resistant depression or severe depressive symptoms that warrant intensive approaches Want a very time-condensed option (travelers, people with limited availability) Are medically appropriate after careful screening (no contraindicated implants, controlled seizure risk, no untreated substance issues, etc.) Understand that ONE-D may be experimental and require informed consent about augmentation medications and devices. A skilled clinician must determine candidacy after reviewing history, prior TMS (if any), medications, and a psychiatric evaluation. Inspire’s approach emphasizes physician supervision and a personalized plan. Read More: Is TMS right for me? Safety, side effects & monitoring Common short-term effects: Scalp discomfort, brief headache, transient fatigue -similar to standard TMS. Seizure risk: Extremely rare with properly screened patients; clinics follow strict screening protocols (medication review, seizure history). ONE-D’s increased session density requires vigilance; clinical teams are trained and prepared to manage rare events. Medication interaction/augmentation risks: If medications such as D-cycloserine or stimulants (e.g., lisdexamfetamine) are used to augment, the psychiatrist will monitor for side effects and interactions. Augmentation increases potential benefit but also adds clinical considerations. Always discuss risks and alternatives in detail with your provider. ONE-D should only be delivered in a setting with physician oversight, individualized mapping, and appropriate follow-up. It is not a DIY or consumer treatment. How ONE-D compares to other TMS options Standard TMS: 1 session/day for 4–8+ weeks. Best-studied and commonly covered by insurance. 5-day Accelerated TMS (50 sessions in 5 days): Intensive week-long program showing strong outcomes for many patients. Often self-pay but sometimes covered for semi-accelerated variants. ONE-D (20 sessions in 1–2 days): More condensed; attractive for time-limited patients and those seeking an intensive “reset.” Emerging evidence: may use medication augmentation and AMPA equipment; typically self-pay initially (Inspire’s planned price: $3,000). Read More: TMS Pricing Guide What to expect if you choose ONE-D at Inspire Pre-visit consult & screening - psychiatric evaluation, medication review, seizure risk screening. Mapping & motor-threshold determination - before or at the visit to personalize the dose. ONE-D visit (1–2 days) - repeated iTBS sessions with short breaks; staff monitor comfort and vitals. Immediate follow-up & outcome tracking - PHQ-9 or similar scales, and follow-up calls/visits; touch-ups or maintenance discussed if needed. Patient story: why someone might pick ONE-D Some patients travel specifically for accelerated care because it lets them complete a therapeutic course in days rather than weeks. For people balancing work, family, or long travel, ONE-D’s compressed schedule is appealing - especially when paired with physician oversight and clear aftercare. Inspire’s approach highlights convenience while retaining safety and personalization.

Quick Summary Most psychiatric meds can be continued through TMS , but certain drugs affect seizure risk or response and require review. Careful pre-treatment medication review, mapping, and collaboration with a psychiatrist are essential for safe and effective TMS. Augmentation strategies (e.g., ONE-D with D-cycloserine or a stimulant) may be used under strict psychiatric supervision and add monitoring requirements. General principles Safety first. Screen for medications and medical conditions that increase seizure risk or interact with planned augmentation strategies. If seizure risk is elevated, weigh alternatives or modify the plan. Efficacy considerations. Some sedating medications (high-dose benzodiazepines) can blunt TMS response; consider minimizing sedative load when clinically safe. Individualize. Decisions to continue, taper, hold, or change medications should be individualized and documented in the psychiatry visit. Shared decision-making and informed consent are essential. Collaboration. The treating psychiatrist (or a TMS-trained prescriber ) should make medication decisions in close communication with the TMS team; TMS clinics should require medication lists and med reconciliation at intake. Medication Guidance Generally continue SSRIs / SNRIs (e.g., sertraline, escitalopram, venlafaxine) - usually safe to keep during TMS; no routine stop required. Mood stabilizers (e.g., lithium) - generally continue; coordinate for bipolar cases. Use with caution / consider adjustment Benzodiazepines (e.g., clonazepam, lorazepam) - may dampen response; consider minimizing dose if clinically safe. Antipsychotics (e.g., risperidone, olanzapine) - usually continue; clozapine needs special attention because of seizure risk. Review & adjust if needed (seizure-risk meds) Bupropion - dose-related seizure risk; discuss taper/hold if other risk factors present. Opioids, tramadol, certain stimulants at high doses - evaluate case-by-case; may increase seizure or sympathetic risk. Action: Flag these at intake and discuss with the psychiatrist before treatment. (Clinics should screen for seizure risk and have protocols.) Augmentation / experimental agents (ONE-D) D-cycloserine, short-acting stimulants (e.g., lisdexamfetamine) - used in some ONE-D protocols as augmentation only under psychiatrist supervision, with informed consent and monitoring. Document timing and monitoring plan. Read More - TMS Vs Medication Medications that most commonly affect seizure risk Higher seizure risk: bupropion, clozapine, tramadol, theophylline (rare). Agents that lower seizure threshold modestly or via interactions: some antipsychotics, certain antibiotics (quinolones — discuss if relevant), stimulants in high doses. Agents that raise seizure threshold (often protective): many anticonvulsants (valproate, carbamazepine, lamotrigine) - however, these can affect TMS response. Action: Flag any high-risk meds during screening and consult psychiatry to mitigate risk. ONE-D and augmentation - special considerations Augmentation meds (e.g., D-cycloserine 125 mg, short-acting stimulants) have been used experimentally to enhance ONE-D effects; they require psychiatric oversight, informed consent, and monitoring for side effects and interactions. Document augmentation rationale and monitoring plan. If using stimulants : evaluate cardiovascular status, anxiety history, and seizure risk. Consider holding stimulant dose or using a lower dose on treatment day, depending on risk/benefit. Medication log: Track timing of augmentation relative to stimulation in the chart (useful for outcome interpretation).

How the FDA views affects teen treatment Device- and label-specific: The FDA clears devices and their indications, and those clearances may include age ranges. Because clearance is device- and indication-specific, whether a teenager is “on-label” depends on the device used by the clinic and the diagnosis being treated.  Practical result: Some systems have adolescent labeling, which allows clinics to treat teens consistent with labeling; where devices do not include a teen label, treatment would be off-label and requires extra care and documentation. Inspire explicitly offers TMS to individuals as young as 15 when clinically appropriate and in line with device/label guidance.

Quick summary (the short answers) Medicare: Often covers TMS for treatment-resistant major depressive disorder when the plan’s clinical criteria (such as prior medication trials) are met and prior authorization is approved. Inspire routinely helps patients with Medicare benefits checks and authorizations. Medicaid: Coverage varies by state . Some state Medicaid plans cover TMS with strict medical necessity criteria; others do not. Inspire collects your insurance details and runs a state-specific benefits check. Pre-authorization: Nearly always required. Insurers want documented prior treatment attempts, objective symptom measures (PHQ-9), and a psychiatrist’s letter of medical necessity. Inspire will run the authorization for you once you approve.