Transcranial magnetic stimulation treatment involves highly concentrated electromagnetic pulses directed at specific regions of the brain that regulate mood. In more technical terms, during an rTMS session an electrical current passes through a small coil placed close to the scalp. This current induces a magnetic field. The magnetic field can travel through the skull and pass into the brain.

The first appointment is called the TMS “induction” and includes brain mapping, motor threshold determination, and an initial treatment session. At this appointment, the treating psychiatrist will begin by mapping out a region on your scalp that correlates to the dorsolateral prefrontal cortex (DLPFC). We will then test the minimum energy needed to stimulate your brain, also known as your resting motor threshold. This determines the dose of magnetic stimulation you’ll need during your transcranial magnetic stimulation therapy series. Motor threshold determination is performed by stimulating the left scalp over an area of the brain (pre-motor cortex) that controls your right hand. Stimulation with the TMS magnetic wand in this location will cause your hand to have a single muscle jerk or twitch. Once brain mapping and motor threshold determination are complete, we proceed with the initial treatment.

TMS sessions are held usually 3–5 times per week, and antidepressant effects may be noticed within the first 10–20 sessions. Up to 20–35 sessions are typically needed to consolidate the antidepressant effects. A full course of TMS therapy treatment can be completed within 1–2 months. This makes TMS a fast-working treatment program for patients seeking an alternative to medications.

The severity of depression is assessed in several ways. The most common approach is to examine the depressive symptoms experienced by a patient at the time of their evaluation. This is done using objective ratings (including DASS, GAD7, and MADRS) and by reviewing all medications and psychotherapy the patient has undergone. This helps assess how resistant the patient is to conventional therapy. Although the severity of symptoms does not always predict worse outcomes, it is generally believed that greater treatment resistance and more failed attempts with conventional treatments may reduce the potential benefits of TMS therapy for depression. However, even those who’ve tried several treatments without success may still respond well, particularly when accessing specialised TMS therapy in Sydney and other major centres. Your individual history is always worth discussing with your care team.

Our TMS team will work closely with you and your referring providers to choose the next best treatment if you do not respond to transcranial magnetic stimulation therapy. The clinic may also provide you with leads on other ongoing treatments that could be helpful.

Unfortunately, yes. TMS isn’t a guaranteed cure, and it does not eliminate symptoms for everyone. All available psychiatric treatments work for some, but not all, patients—TMS is no exception. Research has shown that patients with psychotic depression, those who have failed electroconvulsive therapy (ECT), or those with severe comorbid mental health conditions such as schizophrenia or panic disorder may not benefit as much from standard depression TMS protocols. That said, every case is different, and the decision to begin transcranial magnetic stimulation treatment should always be made in collaboration with your clinician.

TMS may not work for everyone. There is a risk that clinical symptoms of depression would worsen if they are not adequately treated. In some patients, particularly those with underlying bipolar disorder or severe anxiety, TMS can be overly stimulating to the brain and induce worsening anxiety, panic, or insomnia.  The clinicians here in Mind Oasis Clinic will be assessing your progress each treatment day and obtaining mood rating scores once weekly to closely monitor for these symptoms.

Our team will review your current medications and treatment plan before you begin TMS therapy in Sydney. In general, you can keep taking your usual medications during treatment. However, certain medications may need to be reduced or stopped before starting TMS to reduce the risk of seizures or other side effects.

TMS is considered a durable treatment for depression, with many patients experiencing long-term benefits after a successful course. Like other treatments, some individuals may require maintenance sessions. There is limited research into long-term maintenance for transcranial magnetic stimulation in Sydney, but our team will help monitor your symptoms post-treatment. If needed, we’ll work with you to develop a personalised maintenance plan.