What to Expect During TMS Therapy, From Consultation to Final Session

True North Integrative Mental Health is a psychiatric and TMS clinic in Greenville, NC, led by Dr. Jamie Rogers, with TMS treatment overseen by our Medical Director, Dr. Marion Wright.

TMS therapy follows a clear path: a free consultation and some paperwork, a longer first visit where we map your treatment spot, then short sessions several days a week for roughly six to ten weeks. You stay awake, feel a light tapping on your scalp, and can drive yourself home afterward.

Knowing each step ahead of time makes it easier to plan treatment around work, school, and family. Below, we walk through every stage of our TMS therapy program in Greenville, what each visit feels like, and how to prepare so your first week goes smoothly.

What Happens at a TMS Consultation?

The consultation confirms whether TMS is a safe and appropriate fit for you, and it starts the insurance paperwork. There is no treatment that day. We talk through your symptoms, your history, and the medications and therapy you have already tried, then answer your questions about the process.

Before or during the consultation, you will complete four short sets of paperwork:

1. Adult TMS Registration. The TMS registration form asks for the same details your insurance company requires for prior authorization, so the more complete it is, the faster your approval can move.
2. TMS Exclusion Criteria. A checklist of implants and devices that make TMS unsafe (covered in the next section).
3. Medication Checklist. A list of common depression medications. Bring your current medication list or records from your previous provider along with it.
4. PHQ-9 and GAD-7. Two standard questionnaires that measure the severity of depression and anxiety symptoms. You can take our free online depression screening before you call.

Most insurance plans require prior authorization before your first treatment. Insurers typically look for a documented depression diagnosis, past antidepressant trials, and a history of talk therapy. Our guide to TMS costs in North Carolina explains how coverage and cash pay work.

Who Should Not Have TMS Therapy?

TMS is not safe for people with certain metal or electronic implants in or near the head, because the treatment coil produces a strong, pulsed magnetic field. That is why every patient completes our exclusion form before starting. If any listed item applies to you, TMS is not a safe option, and we will talk through other treatment paths instead.

Items on our exclusion form include:

• Cochlear implants, aneurysm clips or coils, and implanted electrodes or stimulators
• Deep brain stimulators and vagus nerve stimulators
• Pacemakers and implanted or wearable cardioverter defibrillators
• Cerebrospinal fluid shunts and ferromagnetic eye implants
• Bullet fragments, pellets, or other metal near the head
• Facial tattoos made with metallic ink

Removable items such as jewelry, hair clips, hearing aids, eyeglasses, and your phone simply come off before each session. If you have braces, a permanent retainer, or other metal not on the list, raise it at your consultation so we can review it with you. Mayo Clinic also advises telling your provider if you are pregnant or planning a pregnancy.

What Happens During Your First TMS Session?

Your first session is the longest, usually about an hour, because it sets up every treatment that follows. This visit is called mapping. Its goal is to find the exact spot on your head to treat and the right strength of magnetic pulse for your brain.

Here is how mapping works, based on Mayo Clinic's overview of the procedure:

1. You sit in a reclining chair and wear earplugs.
2. A magnetic coil rests against your head and delivers short pulses, which feel like tapping and sound like clicking.
3. The coil moves until the pulses make the fingers or thumb on the opposite hand twitch slightly.
4. Strong and weak pulses alternate to find your "motor threshold," the energy level needed to produce that twitch.
5. Those measurements are recorded, so later sessions start at your exact position and dose without repeating the process.

The finger twitch only happens during mapping. Your actual treatment spot sits over the part of the brain that helps regulate mood, in a different spot from where the twitch is found.

What Does a Typical TMS Session Feel Like?

How Long Is a Full TMS Treatment Schedule?

How Can You Prepare for Your TMS Appointments?

A little preparation keeps each session comfortable and on schedule. Before your appointments:

• Wear comfortable clothing and leave jewelry and other metal items at home.
• Tell your provider about every medication you take, since some can affect how your brain responds to treatment.
• Avoid alcohol and recreational drugs during your course of treatment.
• Arrive well rested and hydrated.
• If a medication is missing from your checklist, bring the bottle or a photo of the label.
• Write down questions as they come up so you can ask them at your next visit.

Our office sees patients by appointment Tuesday through Friday, 8:30 AM to 6 PM. Choosing a time slot you can keep week after week makes the schedule much easier to stick with. If you are still deciding whether TMS is right for your depression, our page on TMS treatment for depression covers how it targets mood-related brain activity.