TMS can be intimidating for some, but we’ve noticed that this is largely due to unfamiliarity with TMS itself. Understandably, no point in the process is more intimidating than the first day– to ease any nerves, we’ll walk you through what to expect, and what’s actually happening behind the scenes.
As a part of the onboarding process, you’ll usually chat with us twice (typically virtually, though you’re welcome to visit one of our offices in Columbia, Silver Spring, or Towson). The first of these conversations is your consultation. In your consultation, we orient you to TMS; walking through what we need from you, what you can expect from us, and what TMS can do for you. We answer any questions you may have, and –if you’re in the office– we’ll show you the TMS machine! During the consultation, we’ll also get any insurance information we don’t yet have to make sure TMS is covered and affordable for you.
The second of the two chats is your intake, which is done with one of our providers (Dr. Christine Ro, Dr. Samantha Rogers, or Dr. Pamela Nazarov). Here, we get more of a clinical picture– asking about diagnoses, prescribed medications and your experience taking them, and scanning for any safety-related red flags that might disqualify someone for treatment (e.g., cochlear implants, since they can’t be near the magnet).
Once these are squared away, we get you on the schedule for your first day… your mapping!
Before we do any mapping or treatment, we’ll show you around our office. We always have coffee, snacks, water, and other goodies for you to help yourself to, as well as waiting rooms and games if you’re bringing a kiddo along with you (which many do)!
Once acquainted, we start the mapping process.
Before we can target the correct region of the brain, we have to find it! All brains are slightly different, so we want to make sure we’re being safe and effective by guaranteeing we’re on the right spot.
To do so, we use the motor cortex (pictured below) as a reference point; we’ll send low-strength pulses across the dorsal (top) area of the brain until we find the motor strip. We know we’ve found it when the pulses make your fingers twitch! This is certainly a novel experience for patients, but it’s totally comfortable and safe– most folks think it’s quite interesting.
Once we’ve found the right spot, we just need to determine the strength of the magnetic pulse necessary to reach the target region. Over a minute or two, we just test a few different levels to see which is right in the sweet spot (too weak of pulses may make TMS less effective, and too strong of pulses may make TMS uncomfortable).
After finding both location and power, we simply move 5cm forward, where we can find the exact region of the brain that’s largely responsible for the regulation of negative mood (left dorsolateral prefrontal cortex, pictured below in blue).
Since we’ve now, at this point, found the target area of treatment, the last step of mapping is to adjust the way the magnet rests on your head to ensure pulses aren’t too uncomfortable. Here, we ask you to be vocal (and picky)! There are numerous adjustments we can make to make the sensation more tolerable, and we’re happy to help do so at any time.
With these adjustments, most patients end up reporting a discomfort level of around three out of ten on their first day. While this can vary, most people are down to a one (and often zero) by treatment #5-10. Even after the first day, the treater who’s with you during sessions will be there to make any changes that may help.
While you’re still in the chair for mapping, you’ll go right into your first treatment. This’ll be an extra 15-20 minutes, but it helps get the first one under your belt!
Though it can vary, the mapping usually takes around 20 minutes, and the treatment takes 19 minutes for most people. If the magnet needs a particularly high strength to reach your brain, this 19 minutes can be a bit longer (frankly, though, this is only the case for roughly 10% of patients).
So all in all, the first day is around an hour, while the rest of the days are (usually) 25 minutes or so. Lots of patients are able to make it into the office during their lunch break and return to work right after!
After having two conversations (usually Zoom meetings) with us, you’ll come in and be shown around, we’ll set you up in the TMS chair, we’ll make your hand twitch a bit, we’ll make sure everything’s reasonably comfortable, and we’ll start your first session. Not much is needed from you aside from your presence and vocalness!
If you’d like to begin this process, or have questions about TMS, fill out the “We Want to Help” form on this page or give us a call. First contact to first treatment is usually around 2 weeks… we’d love to hear from you!
Columbia, MD Location:
8945 Guilford Rd Suite 140, Columbia, MD 21046
Towson, MD Location:
222 Bosley Ave B1, Towson, MD 21204
Silver Spring, MD Location:
8730 Georgia Ave Suite 312, Silver Spring, MD 20910
(DC Metro Accessible)
