What to Expect: How Does TMS Therapy Work

The FDA first authorized a TMS device for depression in October 2008. TMS devices are cleared for major depressive disorder in adults who have not improved enough on antidepressant medication in the current episode.

In 2010, the American Psychiatric Association's practice guideline for major depressive disorder listed transcranial magnetic stimulation as a treatment that "could also be considered" for patients whose symptoms have not responded adequately to medication. (Some insurance companies require at least 4 failed medication/therapeutic trials.)

The accelerated TMS protocol refers to multiple sessions that are given on the same day (rather than 1 session per day).

Between each session, there is a rest period of approximately 50 min.

In September 2022, the FDA cleared the Magnus Neuromodulation System with SAINT Technology, which delivers the Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) protocol. In a 2020 open-label study of the fMRI-guided SAINT protocol, 19 of the 21 participants who finished the 5-day course met remission criteria, and neuropsychological testing showed no negative cognitive side effects; the authors said sham-controlled trials were needed to confirm the remission rate. A 2022 sham-controlled trial of 29 participants found a 52.5% average drop in depression scores with SAINT, compared with 11.1% with sham treatment, four weeks after treatment. This protocol requires the use of the Magnus Neuromodulation System with SAINT Technology, through which the stimulation site is located based on functional MRI targeting.

Our accelerated, SAINT-inspired TMS protocol is completed in as little as two weeks 5 sessions/day for 10 days (M-F for 2 weeks). Able does not use the SAINT system: we use the MagStim TMS machine, and the stimulation site is located from measurements on the scalp rather than fMRI. Treatment cost is $5950. Self-pay only.

Please note that this accelerated protocol is not covered by insurance.

It feels like someone is lightly tapping on your head with their finger very quickly, similar to the frequency of a woodpecker. The tapping is caused by a magnetic coil that is precisely positioned next to the scalp. If the treatment is not considerately delivered, it may be painful, like a rubberband snapping exposed skin. Our treatments are delivered in such a way that it is painless while retaining efficacy. The intensity of the tapping depends on the machine level and can always be adjusted to ensure comfort. You direct the level.

You won’t notice any major changes in awareness, thoughts, or mood immediately after treatment. Some people have reported difficulty sleeping. Because your head muscles have been lightly stimulated, you may experience a very mild headache which is typically only an issue during the first 2-3 treatment sessions, until you adapt.

At Able Psychiatry you have options in terms of your treatment duration.
For insurance coverage, the standard course is 30–36 sessions performed 5 times per week over a 7–8 week course.
For self-pay, we can shorten the duration of TMS treatment by utilizing an accelerated protocol. Such an option can reduce the total treatment length by half.

Before beginning treatment it can be helpful to have an idea of the different areas of life that can be impacted on the road to feeling better.

Nope! You can perform your normal daily activities prior to and after the treatment with no restriction of eating, drinking, or driving.

If you are on regular medications make sure you keep the same schedule whether they are psychiatric or non-psychiatric medications. If you take medications as needed for anxiety or pain, make sure you mention it to the doctor prior to treatment; there are typically no restrictions.

This issue should be addressed on a case by case basis and discussed with your medication provider.

We keep up with the latest research on TMS findings, led by a literature-competent, TMS-experienced psychiatrist. As a private practice in Chicago, we are able to allow for greater appointment flexibility and treatment customization based on need. Such adjustments may allow us to do an accelerated protocol.

We believe in delivering high performance, versatile TMS solutions so you receive the best treatment possible. We go through the TMS journey with you, ensuring that each day and treatment guides the next, because we know a one-size-fits-all approach does not always yield the best results for everyone.

Standard TMS for depression stimulates the left dorsolateral prefrontal cortex. There are alternate treatment protocols we can add, in addition to your treatment and at no additional cost, if we feel one could help. If you'd like to see the space and machine, feel free to come in. We can discuss day-to-day logistics such as parking, etc.

Yes, a provider will be nearby at all times, monitoring your session and checking in to make sure you’re comfortable.

Just let your provider know. We can pause, adjust the coil position, or lower the intensity to make things more comfortable.

It’s best to stay still during treatment for accuracy, but if you need a break or feel uncomfortable, we can pause anytime.

You can typically drive, work, or resume daily activities right away. Some people have reported difficulty sleeping.

TMS devices are FDA-cleared for major depressive disorder, and European treatment guidelines rate TMS as definitely effective for depression. The American Psychiatric Association's 2010 depression guideline says TMS "could also be considered" for patients whose symptoms have not responded adequately to medication.