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Frequently Asked Questions
TMS Therapy
Transcranial Magnetic Stimulation, or TMS, is a process that uses magnetic pulses to stimulate neurons in the areas of the brain known to regulate a variety of neuropsychiatric conditions. This magnetic stimulation gently corrects abnormal brain circuitry.
TMS treats depression at its source. A patient sits in a chair similar to that in a dentist’s office, and a paddle containing a magnetic coil is positioned over the left dorsolateral prefrontal cortex on a patient’s head (the left side just above the forehead). That is the area of the brain known to be involved in mood regulation. In depressed patients, that area is shown to be underactive compared to non-depressed patients.
The coil transmits magnetic pulses that gently correct abnormally firing circuits in the brain. By targeting a major hub for mood, the left dorsolateral prefrontal cortex, TMS affects the entire brain’s mood network, generating positive, long-lasting results.
Is TMS Right for Me?
TMS Therapy is for those who…
Have been diagnosed with treatment resistant Major Depression Disorder (MDD)
Have not benefitted from the use of antidepressants and/or had side effects from them
Are searching for a non-invasive, drug-free depression solution
TMS Therapy is generally well-tolerated, but there are two absolute contraindications:
Seizure disorders: A history of seizures poses a significant risk during treatment.
Permanent ferromagnetic metal implants near the treatment site: This includes implants such as cochlear implants, aneurysm clips or coils, stents, implanted stimulators, pacemakers/ICDs, electrodes, metallic implants in the ears or eyes, shrapnel or bullet fragments, and facial tattoos with magnetic-sensitive ink. The risk is that these objects could heat up, move, or malfunction during treatment.
It’s worth noting that while TMS can sometimes be safely administered in cases like schizophrenia or even in patients with pacemakers (with special precautions), insurance coverage is typically limited to patients without these contraindications. Prior to treatment, your doctor or psychiatrist will carefully review your medical history and any implanted devices to ensure that TMS is safe for you.
TMS Therapy is a non-systemic, non-invasive treatment that avoids injections, anesthesia, or sedation—nothing circulates through your bloodstream. Most people experience only mild discomfort or a tapping sensation on the scalp during treatment, typically subsiding after the first week. Adjustments can be made to enhance comfort if needed. Importantly, there are no sustained side effects. You remain awake and alert throughout your sessions, free to enjoy music, an audiobook, or a book during treatment. You are also able to drive yourself to and from treatment.
TMS Therapy is primarily an outpatient treatment provided in our clinics, though it can occasionally be administered in hospitals. The FDA protocol typically involves about 30 treatments, usually performed five days a week over six weeks, with consecutive sessions and weekends off to allow a break. Depending on your insurance coverage, additional taper sessions may be included and spread over two to three weeks.
Each appointment is approximately 45 minutes long, which includes time for machine calibration and the actual treatment lasting about 37 minutes. There are additional, faster protocols for TMS, including iTBS (intermittent theta burst stimulation) that can be as short as 3 minutes per treatment, as well as protocols involving multiple sessions per day, although not all insurances cover these options.
It’s natural to feel uncertain when starting TMS, especially since every patient responds a little differently. Many people begin noticing small shifts (i.e. improved sleep, increased energy, or less frequent crying spells), within the first few weeks. For others, progress may be more gradual and noticeable later in the series.
At Junction Brain Health, we monitor your progress throughout treatment using regular check-ins and depression rating scales. This helps both you and your care team see measurable changes and determine how the therapy is working for you. While no treatment is a guarantee, most patients begin to feel meaningful relief before the end of the initial treatment series.
Spravato
Spravato® is an FDA-approved nasal spray for adults with treatment-resistant depression (when two or more antidepressants haven’t worked) and for adults with major depression with suicidal thoughts or actions, taken alongside an oral antidepressant.
You self-administer Spravato® as a nasal spray at the treatment center, always under the supervision of a healthcare provider. After each session, you’ll be monitored for at least 2 hours before going home.
Most patients begin with two treatments per week for the first month, then move to once per week in the second month. After that, you and your provider decide the right schedule for your ongoing care.
You’ll spray Spravato® yourself under supervision, then stay at the clinic for monitoring. Because of possible side effects like sleepiness or dizziness, you cannot drive until the next day after a full night’s rest, so arrange for a ride home.
The most common effects include dizziness, nausea, sleepiness, increased blood pressure, feeling “disconnected,” or a temporary drunk-like sensation. These usually happen soon after treatment and fade the same day.
No. Due to safety requirements, Spravato® can only be given in certified treatment centers under medical supervision.
Treatment Comparison: TMS, Spravato®, Medications & ECT
The main differences between TMS Therapy and antidepressant medications include:
Antidepressants are systemic, meaning that the medicine enters the body and blood stream.
TMS is non-systemic and drug-free.
Like many drugs, antidepressants have numerous side effects such as insomnia, blurred vision, dry mouth, fatigue, weight gain, nausea, GI distress, diarrhea, sedation, lack of emotion, and sexual dysfunction.
Some TMS patients have experienced a headache or scalp sensitivity at the treatment site. These symptoms usually subside within the first week of treatment.
TMS is usually prescribed when antidepressants fail, or the side effects are intolerable.
- FDA Approved: Ketamine is another FDA-approved treatment for treatment-resistant depression.
- Administration Methods: It is a dissociative anesthetic that can be administered intranasally (as Esketamine or Spravato®), sublingually, intramuscularly, or intravenously.
- Mechanism of Action: Ketamine acts on NMDA receptors, affecting glutamate functioning throughout the brain.
- Treatment Course: Typically involves 1-2 treatments per week for a total of 6-12 sessions.
- Considerations: Ketamine may involve additional side effects and drug interactions, making it not ideal for every patient. It may also have more limited durability of treatment results compared to TMS.
Combined Protocols: Some protocols are currently studying how TMS and Ketamine might be beneficial when used together.
Both TMS and Spravato® have shown strong effectiveness for patients whose symptoms haven’t improved with traditional antidepressants. At Junction Brain Health, we’re here to help you explore your options and determine the next best step in your treatment plan.
ECT, or Electroconvulsive Therapy, is an interventional treatment that induces therapeutic seizures to address neuropsychiatric symptoms such as depression, catatonia, psychosis, and bipolar disorder.
Treatment Setting and Schedule:
ECT is typically administered in a hospital setting, with treatments generally scheduled three times per week for an average of 12 sessions over about one month. Some patients may require long-term maintenance treatments.
Patient Considerations: Due to the hospital-based nature of ECT, patients are advised not to drive or work during the treatment period. The treatment tends to be more burdensome compared to TMS.
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