Patients tell us the same thing again and again in reviews: they want clear evidence that treatment is working. At Inspire TMS Denver, we take that request literally - we don’t rely on impressions alone. We measure, record, and act on standardized outcome scores (like the PHQ-9) so every treatment decision is informed by data. That’s why our clinic reviews - the patient stories and high ratings you see online - are paired with hard numbers in our records: we translate “I feel better” into measurable change, and we use those numbers to shape treatment, follow-up, and long-term care. Why measurement matters TMS is powerful because it changes brain circuits. But brain change doesn’t always track neatly with how someone says they feel, especially early in treatment. Standardized scales give clinicians a consistent, sensitive way to detect meaningful clinical change, monitor safety, and decide whether to continue, adjust, or remap a course. At Inspire, we routinely use validated tools ( most commonly the PHQ-9 for depression, and condition-specific measures where appropriate ) before treatment, during the course, and at follow-up. These measures let us answer the crucial questions: Is the patient improving, and by how much? Is the current protocol producing the expected signal? Do we need to remap, change pacing, or offer a maintenance/rescue plan? Collecting and reviewing scores is not paperwork - it is how we turn patient experience into reproducible clinical decisions. What your scores actually mean (PHQ-9 primer) A few PHQ-9 facts are useful for patients: PHQ-9 range: 0–27. Lower is better. Common interpretive bands: 0–4 (minimal), 5–9 (mild), 10–14 (moderate), 15–19 (moderately severe), 20–27 (severe). Clinical response is often defined as a ≥50% reduction in PHQ-9 score from baseline; remission is typically a score in the minimal or near-minimal range. These guidelines let clinicians quantify improvement and compare progress across visits. Research and clinic reports commonly show robust response and remission rates when TMS is delivered to completion - published and clinic-level data often cite response rates in the 60–75% range and remission rates approaching ~45–51% among full-course completers. Those benchmarks help us set realistic expectations and evaluate our own results. How Inspire uses scores day-to-day Here’s how outcome tracking informs care at Inspire: Baseline & goals. We collect a baseline PHQ-9 (and other relevant scales). Dr. Clinch and the team set realistic targets and timelines — e.g., a 50% score reduction by week 4–6 — and share those with the patient. Frequent measurement. We repeat scores at scheduled intervals during treatment (weekly or at clinically meaningful points) so we can detect early signals that predict longer-term response. Data-driven adjustments. If scores plateau or worsen, we don’t guess - we review: does mapping need refinement? Is a medication interaction or a sleep problem present? Should we change protocol pacing, remap, or consider a rescue/maintenance plan? Remapping or protocol changes are common, evidence-driven steps when the data suggest they’re needed. Shared results & transparency. We show patients their numbers over time so they can see the progress (or lack of it) and participate in decisions. This transparency is part of why many patients report a better experience at Inspire - they understand how clinical choices are made and why. Outcome scores and patient reviews - how they match up Patient reviews are invaluable : they capture nuance, meaning, and quality of experience. But reviews are subjective and influenced by many non-clinical factors (appointment flow, staff warmth, travel ease). Outcome tracking gives a reproducible, objective counterpart. At Inspire, we regularly compare patient-reported outcomes with review themes. When a patient posts a high-rating review that mentions life improvements, we can show the corresponding PHQ-9 change in the record. Conversely, when review feedback suggests a problem (e.g., persistent symptoms or side effects), our scores often highlight the clinical trajectory that underlies that feedback. This two-way verification - reviews and scores - helps us continuously improve care and confirms that good experience usually follows measurable clinical benefit.
When patients ask what makes TMS precise, the answer is: mapping . At Inspire TMS Denver, Dr. Samuel Clinch and the team treat mapping not as a quick formality but as the clinical step that determines where we stimulate and how strongly - two things that have a direct effect on outcomes. Below, we walk through what mapping is, why it matters, how small changes can improve results, and what patients can expect when Dr. Clinch creates their individualized TMS map. What is motor-threshold mapping - and why do we do it? Motor-threshold mapping is the clinical process used to find the stimulation intensity and the precise coil position that reliably activates a known brain response (usually a small, measurable twitch of a hand muscle). That response tells the team how much magnetic energy reaches the brain at a given location and helps set a safe, effective dose for therapeutic targets. Mapping lets us: Personalize the dose. Everyone’s skull thickness, cortical anatomy, and responsiveness are different; motor-threshold mapping determines the appropriate stimulation intensity for your brain. Find the best coil location. Small shifts in coil position or angle change, which brain circuits get stimulated - mapping helps us locate the spot that best connects to the circuit we want to influence. Increase safety and predictability. Mapping is performed before any therapeutic session (standard or accelerated ), so we deliver a dose matched to your physiology, reducing risk and improving reproducibility. Dr. Clinch’s clinical priorities during mapping Dr. Clinch’s mapping approach emphasizes three things: precision, comfort, and context. Precision: mapping is done by a clinician-trained team under physician oversight, so coil position and intensity are documented and repeatable. This means we don’t “guess” - we measure and record. Comfort: mapping and initial sessions are paced with patient comfort in mind. If a patient is anxious or uncomfortable, we adjust breaks and pacing while maintaining diagnostic integrity. Contextual decision-making: Dr. Clinch interprets mapping data in the context of a patient’s history, current medications, prior TMS (if any), and treatment goals. That lets him recommend standard vs. accelerated schedules, conservative dosing for medically complex patients, or remapping when prior TMS results change. How small changes in coil position or dose matter It’s tempting to think “a few millimeters won’t change much,” but in TMS , a small positional or angle change can alter which connected brain circuit receives the strongest stimulation. Practically: A slight anterior/posterior shift may move stimulation onto cells with different functional connections. A small rotation of the coil changes the vector of induced current and can alter effectiveness or side-effect profile. A modest intensity adjustment (a few percent of motor threshold) can change how reliably synaptic pathways are recruited. Because of this sensitivity, the Inspire team documents coil coordinates and intensity on every mapping so treatment sessions reproduce the same physiological conditions each time. If outcomes aren’t as expected, the team often remaps and makes micro-adjustments - a step that frequently clarifies whether dose or position needs refinement.
Pros & cons One-Day (ONE-D) Pros: Fastest way to deliver a full course; convenient for travelers ; intensive physician supervision. Cons: Long day in clinic (8–12+ hours), often self-pay, greater short-term fatigue; requires careful monitoring and individualized dosing. iTBS Pros: Very short sessions; efficient biologic dosing; often better tolerated per session; flexible scheduling. Cons: Requires devices and protocols compatible with iTBS; not every patient or clinic will prefer iTBS for every indication - clinical tailoring is needed. Two-session or other compressed schedules Pros: Can balance clinic time and speed; may be covered by insurers in selected cases (e.g., Medicare/Cigna coverage for two sessions/day in certain circumstances). Cons: Coverage varies; still requires repeated clinic visits; may take longer overall than true ONE-D. Logistics & patient experience Consult & mapping first. Inspire requires a physician consult and motor-threshold mapping before any accelerated schedule, so dose and coil position are individualized. This step is essential regardless of whether you choose ONE-D, iTBS , or another compressed plan. Device capability. Accelerated plans are delivered on devices capable of compressed schedules (Inspire’s materials reference use of equipment that supports accelerated regimens). Device choice affects pacing and options. Travel & day planning. ONE-D patients should expect a long clinic day and plan for rest after their visit. Inspire helps traveling patients with scheduling, lodging suggestions, and a clinician-written summary to take home. Insurance & cost. Many ONE-D packages are self-pay; modified two-session/day schedules may be covered in some cases. Inspire runs a benefits check and provides itemized estimates before treatment. Safety, monitoring & outcomes Accelerated regimens require careful safety systems: seizure-risk screening, motor-threshold mapping, physician oversight, and ongoing outcome tracking. Inspire emphasizes these steps for all accelerated care and adjusts pacing or intensity to protect comfort and safety. For medically complex patients, a more conservative accelerated plan or extended monitoring is often recommended. Patient reports and clinic experience show that people travel to Inspire for physician-led accelerated options because of this oversight and comfort; Inspire documents and tracks outcomes to understand who benefits most from each approach.
There’s a lot of excitement in the brain-stimulation world right now about ways to boost plasticity - the brain’s ability to change - so that treatments like Transcranial Magnetic Stimulation (TMS) work faster and more reliably. One of the ideas getting attention is called an “AMPA-cap” (a shorthand clinicians are using to describe interventions that increase AMPA-receptor activity or otherwise prime synapses for plastic change). Sam Clinch recently shared a useful discussion about this concept on LinkedIn, and we wanted to translate what it could mean for patients considering accelerated or One-Day TMS at Inspire TMS Denver . What is an “AMPA-cap” - in plain language? AMPA receptors are one of the main receptor types on brain cells that mediate fast excitatory signaling. When AMPA receptors are more active or more numerous at a synapse, that synapse is more ready to strengthen - a core mechanism of learning and long-term change (neuroplasticity). An AMPA-cap isn’t a single drug or procedure - it’s a shorthand for approaches that temporarily increase AMPA receptor function or otherwise “prime” the brain so stimulation produces larger or faster plastic changes. In practice, this could mean pairing TMS with: short-acting medications that enhance AMPA signaling behavioral or neuromodulatory steps that transiently increase cortical excitability timing stimulation to moments when the brain is naturally more plastic. This is still an emerging area of research - but the basic logic is straightforward: if TMS nudges circuits to change, a brain that’s already more plastic might change more quickly and more strongly. Why AMPA-caps matter for accelerated TMS Accelerated protocols (including One-Day or other highly compressed schedules) deliver many stimulation sessions in a short window. The clinical promise of accelerated TMS is obvious: faster biological effect, fewer clinic visits, and more convenient care for patients who travel or need rapid relief. But accelerated dosing raises two challenges: Biology vs. time. Delivering many sessions closely together assumes the brain will consolidate each dose quickly enough so the next dose continues to drive benefit rather than adding noise. Comfort & safety. Compressed courses must preserve safety and tolerability while still producing durable change. If AMPA-type priming safely increases the brain’s responsiveness to each session, an AMPA-cap could make each stimulation session more effective - meaning fewer sessions (or a highly compressed course) could achieve the same or better clinical change. In short, AMPA-based priming is conceptually ideal for accelerated regimens because it directly targets the mechanism (plasticity) that accelerated TMS is trying to exploit. How this could change clinical outcomes and the patient experience If the early science proves robust and safe in clinical trials, patients could see several practical benefits: Faster onset of benefit. Some patients respond slowly to standard TMS . An AMPA-cap paired with accelerated TMS could shorten the time to measurable improvement. Shorter treatment burden. For people who must travel, have job constraints, or prefer rapid courses, achieving similar outcomes in a One-Day or 1–2-day plan would be a major advantage. Inspire already sees patients travel for physician-supervised accelerated options , and better plasticity would make those visits even more effective. Potential for higher response/remission rates. If priming increases the proportion of sessions that produce meaningful change, average response and remission rates could improve. That said, we’ll need controlled clinical data to quantify this reliably. Individualized care. Some patients may be ideal responders to priming; others might not need it. Ultimately, it could become another tool to personalize TMS courses.
Quick summary Accelerated TMS compresses many sessions into a short window so patients can complete a therapeutic course in days instead of weeks. Prices vary widely - Inspire TMS Denver lists an all-inclusive accelerated package at $7,000, while some other clinics publish prices above $12,000 for similar “week” or accelerated packages. The smartest way to shop isn’t the lowest sticker price: it’s comparing what’s included, clinician oversight, device/protocol quality, outcome transparency, and aftercare. This guide walks you through exactly what to look for and how to compare clinics fairly. What is “Accelerated TMS,” and why does price vary? Accelerated TMS (also called compressed or intensive TMS) delivers many short TMS sessions across a few days (for example, 50 sessions across 5 consecutive days) rather than one session per weekday over several weeks. Protocols differ (iTBS, SAINT-style, other accelerated regimens), and clinics may also test single-day compressed options (20 sessions in 1–2 days). These clinical differences - plus physician involvement, device brand, and whether medications or advanced devices (AMPA-capable) are used - explain much of the price variation. Accelerated options and experimental/augmented protocols are commonly self-pay, while standard TMS has more routine insurer coverage. Market price snapshot (what patients are seeing) Inspire TMS Denver - example all-in price: $7,000 (evaluation, mapping, 50 sessions, follow-ups, and touch-ups within a stated window). Higher-end example: Some clinics list $12,000–$13,000+ for comparable accelerated packages (verify inclusions on each site). Typical market range for full packaged accelerated weeks: ~$7,000–$13,000, depending on what the clinic bundles and how it positions the service. Read More: Pricing Why this matters: A lower price can look attractive, but it may exclude important items (mapping, physician oversight, touch-ups, follow-up) that affect both outcomes and long-term value. What an “all-inclusive” accelerated price should include When comparing accelerated quotes, insist on a written, itemized list. An honest “all-inclusive” package should cover: Comprehensive physician evaluation (psychiatric consult, review of prior treatments). Motor-threshold mapping & individualized targeting before the first session. Proper mapping is essential for safety and efficacy. All treatment sessions for the accelerated week (e.g., 50 sessions / 5 days). Standard safety monitoring and trained staff during every session. Follow-up visits and outcome tracking (PHQ-9 or similar) to measure response. Touch-up / rescue sessions included or discounted within a defined period (e.g., free/discounted touch-ups within 3–6 months). Insurance documentation (if you want the clinic to attempt coverage or appeals). Many clinics will run benefits checks and submit prior authorizations. If any of these are missing from a quote, ask why. An extra $1–4k upfront for a truly inclusive package often saves money and stress later.
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
