TMS
Transcranial Magnetic Stimulation
A non-invasive, targeted treatment that provides rapid and durable relief from symptoms of depression, anxiety, and OCD for many people
Advanced Targeted Treatment
TMS uses magnetic pulses to target specific regions of the brain to treat depression, anxiety, OCD and other conditions
Non-Invasive
TMS is non-invasive, well-tolerated, and has few side effects
Patients can eat as normal and continue to drive after treatment. During breaks between treatment sessions, you are free to read, watch TV, or do whatever is most comfortable
Rapid Relief
We offer One-Day and One-Week Accelerated TMS
Limited studies show Accelerated TMS to be highly effective — more effective than other forms of TMS
One-Day TMS
One-Week TMS
Treatment Duration
1 day
5 days
Session #
20 sessions
50 sessions
Total Pulses
Approximately 36,000
Approximately 90,000
Enhancements
D-cycloserine and lisdexamfetamine to enhance neuroplasticity
N/A
Protocols
Depression
Depression, Anxiety, OCD
What is TMS?
Transcranial Magnetic Stimulation, or TMS, is a non-invasive procedure that uses targeted magnetic pulses to stimulate neurons in specific areas of the brain. Originally developed and approved to treat severe or treatment-resistant depression, TMS has also shown effectiveness in alleviating symptoms of anxiety, PTSD, and other mood disorders. We use an accelerated protocol. Accelerated TMS is very rapid, and limited studies show it be far more effective than other forms of TMS.
TMS can be an excellent treatment option on its own or with other treatments.
Why choose TMS?
TMS may provide significant relief even for individuals who have not found success with multiple medications or other treatment interventions
TMS is non-invasive, does not require anesthesia or sedation, and is generally well-tolerated with side effects that are generally mild and transient
TMS can provide rapid relief from negative symptoms and its results can be extended over time with the use of maintenance treatments and other treatment modalities
The Procedure
pROTOCOL
Evaluate your accelerated treatment protocol.
One-Day TMS involves 20 treatment sessions in a single day with the use of adjunct medications to increase neuroplasticity. It may be used to treat depression.
One-Week TMS involves 50 treatment sessions over the course of 5 days. It may be used to treat depression, anxiety, and OCD.
SET-UP
We begin by calibrating the TMS machine to your unique anatomy and motor threshold. A headband with sensors will be secured around your forehead and you will be given a fabric cap for sanitation.
Motor threshold (MT) refers to the amount of electromagnetic stimulation required for your finger to twitch when the TMS coil is targeting your brain’s motor strip. Your MT will determine the strength of electromagnetic stimulation that is used throughout treatment.
TREATMENT
The TMS coil is positioned on your head to target the mental health condition being treated. After we turn on the TMS machine, you will feel a tapping sensation and clicking noise as electromagnetic pulses are delivered to your brain. We start at a low intensity and increase between treatments as you become acclimated to the stimulation.
One treatment session lasts 3-10 minutes, dependent on the condition treated and protocol being used. During this time you may talk, watch TV, or sit quietly as you receive treatment. Breaks between sessions last 30-50 minutes and can be spent however you like. In all, a treatment day in our clinic lasts about 10 hours.
RELIEF
With accelerated TMS, you may start seeing results as soon as the first few days or first week of treatment. It may take several weeks to see the full benefit.
MAINTENANCE
Research into the long-term benefit of TMS treatment is still developing. Some patients benefit from regular maintenance treatment, while others report indefinite improvements to their mental health symptoms following TMS Treatment.
To sustain the results, we suggest occasional maintenance with treatments of a single TMS session. We suggest starting with these maintenance treatments around twice a month and extending the time between treatment according to your symptoms.
Book your course of TMS
Schedule now or reach out to learn more
Exceptional Care that Makes a Difference
At Wells Medicine we lead with practical, effective treatments – focused on the best-available and most-current evidence-based care to benefit our patients. We work to provide compassionate care and personalized treatment plans. We offer flexible scheduling, a convenient location, and comfortable setting. We are an excellent choice and we’d be glad to work with you if appropriate.
Common questions
You may start seeing results as soon as half-way through a treatment series. For accelerated TMS, this may occur within a few days.
Some studies on TMS, and related studies on neuroplasticity, show that results may be expected to both persist and increase over time following a TMS treatment series. While there is a lot more work to be done in studying this, this probable attribute of TMS treatments — that the results may improve over time after even a single week or a single day of treatments — is extremely welcome.
Compared to the initial and short-term benefits of TMS, there is far less research and published clinical data on the medium- and long-term benefits. How long TMS lasts seems to vary significantly from one person to another, with some people who respond to TMS returning for regular maintenance treatments to sustain results, while other people report indefinite improvements to their symptoms following a TMS treatment series.
It is probably most realistic to expect that results may be sustained with occasional maintenance treatments starting about twice a month (and extending out longer as feasible), and that you may benefit an additional series or short series from time to time.
Accelerated TMS is specifically designed to shorten treatment durations, improve response time, and improve results for patients.
Conventional TMS typically includes about 36 sessions over about 6 or 7 weeks, with one session a day. Accelerated TMS typically includes 50 sessions over 5 days or 20 sessions over a single day.
Accelerated TMS is TMS on a more rapid schedule, is far more convenient, and may result in more rapid results. Accelerated TMS also aims to provide better results by using some combination of more sessions, closer spacing, higher dosing, and other techniques. Limited studies to date show far better results for accelerated TMS relative to conventional TMS in the small sample sizes studied.
Please see these posts for more information on One-Week Accelerated TMS (often referred to simply as accelerated TMS) and on One-Day Accelerated TMS.
One-week TMS provides 50 sessions of TMS over 5 days. One-week TMS is well established, has FDA approval for certain protocols and certain indications, and provides more total sessions of TMS than conventional rTMS or than one-day TMS.
One-day TMS provides 20 sessions of TMS over 1 day. One-day TMS is far newer and there are less established protocols available for treatment — with the most notable focus being on treating depression. One-day TMS employs adjunct medications toward better efficacy with the limited treatment window.
Limited studies to date show excellent results for both one-week and one-day TMS.
Please see these posts for more information on one-week accelerated TMS (often referred to simply as accelerated TMS) and on one-day accelerated TMS.
Multiple protocols, on different machines and for different indications, are FDA approved. Many others are not FDA approved. It is commonplace in medicine to use an FDA approved machine, medicine, procedure, or protocol in an off-label way. The procedures provided at Wells Medicine are typically off-label and not FDA approved at this time.
TMS is generally not painful. Side effects from TMS may include scalp discomfort and headaches. TMS may also cause involuntary twitching of muscles in the face during treatment sessions. Your TMS providers can work to limit these things during treatment. Discomfort from TMS is generally mild and typically fades quickly following treatment.
TMS and ECT are not the same thing.
ECT, which people sometimes call ‘electric shock therapy’ relies on sending electric currents through the brain using electrodes placed on the head. ECT may produce rapid and effective results in some cases, however it has significant downsides. It requires sedation with general anesthesia (which has its own risks), and it may cause side effects including memory loss, headaches, confusion, and muscle tension.
In general, yes you can eat and drink and take medications as normal before and during your TMS treatment. You can also resume normal activities immediately following treatment if you’d like, including driving yourself home from treatment.
More on TMS
What does TMS treat?
How does it work?
TMS uses a focused series of electromagnetic pulses to stimulate targeted areas of the brain (or, in some cases, neurons in other areas of the body). The charged magnetic fields generated by the magnet alter the action of the neurons in the target areas. Appropriate stimulation over repeated sessions can induce positive changes in the connections between neurons and the activity of the neurons. This neuroplastic change is generally believed to be a principal factor in the therapeutic effect of TMS to treat conditions such as depression.
In practice, TMS involves receiving repeated sessions of electromagnetic pulses that lasting from about 3 to 15 minutes. For each session the patient sits in a comfortable chair while the provider places a coil against their head using the specifics of their anatomy to position the machine. The provider then runs the session while the patient sits still in the chair. The time between sessions may be a few minutes or a few days – depending on the protocol used.
What is accelerated TMS?
At Wells Medicine we provide accelerated TMS. The accelerated protocol is much more rapid than the standard protocol (often referred to as rTMS, for repetitive TMS) which typically takes about 30 treatment sessions over 6 weeks. Studies have also shown the accelerated protocol to be more effective than the traditional protocol.
The accelerated protocol was originally developed at Stanford University and is often referred to as the SNT Protocol, SAINT, or SAINT Protocol, for Stanford Accelerated Intelligent Neuromodulation Therapy. This innovative approach was designed to deliver a high-dose, high-frequency regimen of TMS over a compressed timeframe, producing rapid and significant improvements in symptoms. While the researchers behind the protocol have commercialized their work and trademarked the SAINT acronym, the core principles of the protocol are derived from well-established and extensively-published TMS research and techniques, and others can implement accelerated TMS methodologies within the scope of existing evidence-based practices.
At our clinic, we offer an accelerated protocol that adheres to the established principles of intensive neuromodulation therapy. The key aspects of this approach are multiple sessions per day over a condensed period, targeting specific areas of the brain to achieve rapid symptom relief. This approach is grounded in the scientific literature and mirrors the rigorous protocols outlined in the original SAINT studies, while incorporating current best practices and details specific to each patient for efficacy, safety, and patient comfort.
Comparing Accelerated TMS and Traditional TMS
Traditional TMS, often referred as repetitive or standard TMS, typically takes place over 6-9 weeks. This treatment is covered by most insurances, meaning the dosing and sessions are often mandated and identical for each patient. These strict guidelines encourage patients to complete 36 sessions, consisting of daily sessions for the first 6 weeks followed by a 3 week taper period. This protocol is based off of the original research conducted in 2008 and requires clinics to follow a specific FDA-cleared setting, regardless if the patient would benefit more from a different magnetic frequency or total number of pulses.
Accelerated TMS is generally considered an “off label” protocol and many insurers will not cover the treatment regardless of the research supporting it as more effective and less burdensome on patients. Many providers will offer Accelerated TMS because they want the best and most innovative treatment options for their patients, especially those struggling with treatment-resistance and severe symptoms. Wells Medicine offers both a One-Day and One-Week Accelerated TMS protocol to target areas of the brain that play a major role in depression, anxiety, and OCD. Instead of daily week-long sessions, patients can control their treatment and decide which protocol better fits their needs and schedule.
Traditional TMS (rTMS)
One-Day aTMS
One-Week aTMS
Duration
6-9 weeks
1 day
5 days
Session #
30-36 sessions
20 sessions
50 sessions
Session Duration
19 minutes
3 minutes
3-10 minutes
Approximate Total Pulses
108,000 pulses
36,000 pulses
90,000 pulses
Enhancements
N/A
D-cyclocerine & Lisdexamfetamine to enhance neuroplasticity
N/A
Indications
Depression, Anxiety, OCD, & others
Depression
Depression, Anxiety, OCD
Response Rate
40.9% after 6 week treatment
71.2% at 6 weeks
86.4% after 1 week treatment
Benefits of TMS
Non-Invasive Treatment:
TMS is a non-invasive procedure. No anesthesia, sedation, or surgical intervention is required.
Targeted & Personalized:
TMS targets specific areas of the brain responsible for mood regulation, offering precise and effective therapy for the conditions being treated. The treatment are personalized for the patient for strength, anatomy and response for comfort and effectiveness.
Minimal Side Effects:
Unlike many medications, TMS does not have systemic side effects such as weight gain, sexual dysfunction, or other issues. Side effects are typically transient and diminish quickly, allowing patients to resume their normal activities immediately following treatments.
Rapid Results:
TMS can provide rapid results, especially when an accelerated or rapid protocol is used – helping many people see results in as little as a few days.
Sustained Results:
Results may last for weeks, months, or longer. In some cases patients report complete remission. Results may be improved and sustained with periodic maintenance treatments or additional treatment series.
Efficacy:
TMS is effective for many people with depression, including for people with acute, chronic, difficult-to-treat, or treatment-resistant symptoms. It may also substantially reduce symptoms for anxiety, OCD, PTSD, and some other mood disorders and pain conditions. It provides substantial and lasting relief for many people.
Risks & Side Effects
As with any medical procedure, TMS comes with potential risks and side effects. The most common side effects are transient. These include headaches, nausea, and minor itching or irritation of the scalp. These side effects generally resolve shortly after treatment.
Alternatives to TMS
Alternative treatment options to TMS may include medications that address the target symptoms, psychotherapy or talk therapy treatment options, electroconvulsive therapy (ECT), and infusion treatments. Each alternative has its own set of benefits and considerations, and the best choice will depend on individual patient needs and medical history. TMS is often pursued by people after other interventions or treatment options have proven ineffective – studies consistently demonstrate effective improvements in symptoms with TMS, and it generally has a favorable side effect profile compared to many medications and treatment such as ECT.
TMS has few contraindications and does not conflict with or prohibit the use of most other treatments or therapies. It is often appropriate to continue your existing medications while receiving TMS treatments. It may also be appropriate to pursue some other treatments while receiving TMS treatments. It can be especially helpful, for instance, to pursue psychotherapy while receiving TMS infusion therapies. Initial research also shows that combining TMS treatments with infusion treatments can be an especially good treatment combination.
Learn more about TMS
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