What happens during my TMS therapy session? 

Setting Expectations

On arrival at your first treatment, you will be greeted by Dr. Clinch and a TMS technician to do your ‘mapping’ and first treatment to follow. To start, we have you sit in a comfortable office chair. We will walk you through the components of the TMS device so you have a full understanding of how the system works. We review the process of TMS and its use of magnetic pulses to stimulate neurons in areas of the brain that are responsible for depression, anxiety and other mental health symptoms. 

Dr. Clinch will administer a gentle TMS stimulation on his arm and then likewise on your arm, so you can feel a TMS pulse for the first time. It is really cool to feel and see a muscle twitch involuntarily by magnetic stimulation! You can stimulate neurons anywhere along the nervous system, but we of course will be targeting neurons in your brain. A single pulse on the arm helps to give an idea as to what to expect from stimulation, however. We also hope this process alleviates anxiety about the treatment.   

Determine your Exact Treatment Location 

What Can I Do During my TMS Treatment?

Dr. Clinch will then size a cloth cap - similar to a swimmer’s cap in appearance - for you based on your head circumference. This cap will be used to mark specific measurements and will be worn at each subsequent treatment to accurately place the treatment coil. We use a sophisticated algorithm based on a number of tape measurements around your head to determine your exact treatment location. This is called the dorsolateral prefrontal cortex - DLPFC. This is where the treatment coil will be placed to deliver treatment. We also mark another area along your motor cortex that will be used to determine what is called your motor threshold. 

Once this is all complete, you will be asked to make yourself comfortable in a motorized reclining chair which also elevates your legs during treatment. This is similar to a comfortable dentist chair. You are given earplugs to wear during treatment as the magnetic pulse makes a quick succession of tapping noises with each stimulation. You will still be able to hear music, watch TV, and communicate with the treatment provider, however, as these only muffle the noise to a safe level. 

Motor Threshold 'Mapping' Performed

Feel relaxed and confident prior to and during your TMS treatment

A ‘mapping’ will be performed in which Dr. Clinch administers gentle single pulses at different intensities and locations to determine the right amplitude of treatment for you. This is called your motor threshold.  To find this, we stimulate an area near the top of your head along your motor cortex that controls thumb movement. By monitoring the conduction of magnetically stimulated twitches to your thumb, we are able to identify the right treatment amplitude (or motor threshold) that is unique to you.  We then enter this value along with the pre-selected treatment parameters unique to your care into the device. 

Attached to the chair is a headrest and special vacuum pillow that gently holds your neck and head in place during the treatment. The magnetic treatment coil is attached to the back of the chair with an adjustable and weighted arm that makes it easy to manipulate the coil. Every effort will be made to ensure you feel relaxed and confident prior to and during your TMS treatment. The treatment coil is positioned adjacent to the target treatment location (most often the DLPFC) and treatment can begin! 

Starting the TMS treatment 

What does TMS feel like?

We start treatment out at a lower target intensity to get you used to treatment and then gradually increase the amplitude over the first few sessions. Treatments can be paused or stopped completely at any time with a quick press of a button. The treatments will typically last from three to nineteen minutes with additional time for set up and finishing up treatment. The initial session takes a bit longer to also complete the 'mapping' and session time may vary based on individual selected protocols.

Patients typically experience mild scalp discomfort or a headache the first few sessions, but this rarely prevents continuing care. Gradual increase in treatment intensity to target and use of over-the-counter analgesics can minimize this. Most patients have no issues tolerating TMS. The pulses can be difficult to describe without trying, but a sharp tapping and sensation of electrical activity can be felt just a couple centimeters adjacent to the center of the coil. Each stimulation only lasts a couple seconds and involves a rapid burst of pulses followed by a lull between stimulations.

The most appropriate treatment for your condition 

Your TMS therapist

Depending on your mental health history and your primary symptoms, Dr. Clinch will prescribe the most appropriate treatment for your condition and input this into the TMS system prior to care. The system tracks your individual treatment parameters and we record each session and response to treatment over time in our secure electronic health records. We adjust the treatment parameters as needed based on your individual response. You have access to these records and obtain a summary of care and graph of your response to care at the end of care.

Dr. Clinch supervises all subsequent treatments, but after the first mapping, all treatments will be administered by your TMS therapist. Your TMS therapist has been trained by Dr. Clinch in use of the machine and all safety precautions. Your TMS therapist will spend time talking to you prior to and after treatments to discuss progress and discuss other strategies to improve your chance for success. 

Repeat motor thresholds may be checked a couple times during care to ensure the right amplitude for treatment is still being used. Dr. Clinch will perform these checks.  Questionnaires will be filled out along the way to objectively measure how you are doing. A session with Dr. Clinch at the end will be conducted to summarize care and formulate a good follow-up plan.  Additional treatments can be utilized in time if maintenance therapy is needed.

What Makes Us Different

Samuel B. Clinch, M.D

Medical Director

Our shared inspiration is to alleviate mental illness and improve the mental wellbeing of the patients we treat. We respect all backgrounds and cultures and want to hear our patient’s stories to best guide care. During treatment, we reinforce positive wellness practices, help maximize lifestyle modifications, and integrate rTMS therapy into a patient’s overall mental and physical health treatment.