You've tried the medications. This is what comes next.

The standard FDA-approved course is 30 to 36 sessions, given five days a week over about four to six weeks. The final six sessions are usually tapered over another two to three weeks — three one week, two the next, then one. Your psychiatrist tailors the plan to how you respond.

It depends on the protocol. Standard rTMS on our Magstim Horizon 3 system runs about 37.5 minutes, an accelerated protocol runs about 19 minutes, and intermittent theta burst stimulation — which is FDA-cleared — takes as little as three minutes. Your physician chooses the protocol that fits your case.

No sedation and no anesthesia — TMS is done entirely on an outpatient basis and you stay awake the whole time. You can drive yourself to and from the clinic and go straight back to work or your normal day afterwards.

TMS has minimal side effects. The most common are mild scalp discomfort or headache at the treatment site, which are usually temporary. Unlike antidepressants, it does not circulate through your body, so it does not cause weight gain, sexual side effects or gastrointestinal problems. The risk of a seizure is extremely low, and safety protocols are followed at every session to keep it that way.

TMS may not be suitable if you have a history of seizures, or metal implants or objects near your head — cochlear implants, aneurysm clips or deep brain stimulators, for example. Dental fillings and braces are generally not a problem. Your evaluation screens for all of this before anything is scheduled, and if it rules TMS out we will talk you through what else there is.

Both are brain stimulation treatments, but they are not alike. TMS uses focused magnetic pulses while you sit awake in a chair, with no anesthesia, no induced seizure and no memory loss as a known effect. ECT requires general anesthesia and a deliberately induced seizure, and memory effects are a recognised risk. We offer both, so we can tell you honestly which one your case calls for.

No referral is required to schedule with us. If a physician or therapist is already involved in your care, we are glad to coordinate with them so everyone stays aligned.

Patience matters here. In the first two weeks you may notice small changes such as better sleep or a little more energy. Distinct improvement most often shows up in weeks three and four — sometimes noticed by family before you notice it yourself. The largest changes usually come in weeks five and six, as the effect of the sessions accumulates. It is important to finish the full course even if you feel better early.