Preparing for Noninvasive Brain Stimulation & What To Expect

Noninvasive Brain Stimulation Treatment Process

Specialists at the Berenson-Allen Center for Noninvasive Brain Stimulation at Beth Israel Deaconess Medical Center (BIDMC) provide noninvasive brain stimulation treatments, including transcranial magnetic stimulation (TMS), for select neurologic and behavioral health conditions.

This page explains how to prepare for treatment, what to expect during TMS and what patients should know about both conventional TMS and one-day accelerated TMS.

Our Referral Process

Once we receive completed paperwork from your referring physician, our neuromodulation coordinator will review the forms. We will contact you by phone within one week to discuss next steps, including scheduling and payment or insurance options.

Patients may be referred by a psychiatrist, primary care provider, neurologist or other clinician. Self-referrals may also be considered.

Your Initial Consultation and Evaluation

Initial consultation appointments are typically available within one to three weeks. During your visit, you'll meet with members of our care team, which may include a psychiatrist, neurologist and other specialists. Together, we'll review your symptoms, medical history and previous treatments to determine whether noninvasive brain stimulation is an appropriate treatment option for you. Each evaluation takes about one hour.

During this visit, your team will review:

• Your symptoms and diagnosis
• Your treatment history, including prior medications
• Your current medications
• Your medical and neurological history
• Your goals for treatment
• Safety considerations
• Possible treatment options, including conventional TMS and one-day TMS

We may also complete diagnostic testing or ask additional questions to ensure that treatment can be provided safely. When appropriate, we will coordinate with your other providers to develop a treatment plan tailored to your needs.

Getting Started with TMS Treatments

If the care team determines that TMS is an appropriate treatment option, we will discuss the recommended treatment plan with you.

For conventional TMS, the team will work with your insurance company to seek approval when applicable. After coverage is confirmed, the TMS team will schedule your first treatment. Treatment sessions are typically scheduled two to four weeks in advance.

For one-day accelerated TMS, the team will review eligibility, scheduling, cost and payment information with you before treatment is scheduled.

What to Expect During TMS Treatment

TMS does not require surgery or anesthesia. You will be awake during treatment and seated in a comfortable, reclined chair.

A member of the treatment team will position a coil, shaped like a figure eight, near your head. As current passes through the coil, it creates a magnetic field that stimulates targeted areas of the brain.

People receiving TMS often describe feeling a repetitive tapping or pulsing sensation on the head. The TMS coil also produces a loud clicking sound. We provide earplugs during treatment, and our welcome packet includes a list of approved earplugs if you prefer to bring your own.

After treatment, most patients can resume normal daily activities, including driving. TMS does not affect your ability to drive. If you are unable to drive for other medical reasons, please arrange for someone to bring you to and from your sessions.

What to Expect with Conventional TMS

Conventional TMS is typically delivered over several weeks. Acute treatment usually involves daily treatment sessions, Monday through Friday, over a four- to six-week period. Depending on your treatment plan, this may involve approximately 36 visits.

After the initial acute treatment period, your care team may recommend a taper or continuation phase with less frequent sessions. Your doctors will discuss these options with you during follow-up evaluations and determine whether additional treatments may be helpful based on your response.

What to Expect with One-Day Accelerated TMS

BIDMC offers a one-day accelerated transcranial magnetic stimulation (TMS) treatment for eligible adults with depression. Instead of completing approximately 36 treatment sessions over several weeks, patients receive 20 TMS sessions during a single full day. Treatment also includes neuroplastogen augmentation. For some patients, this approach may be a more convenient alternative to a traditional multi-week treatment schedule.

Before treatment, you'll meet with our care team for a consultation to determine whether one-day accelerated TMS is right for you. We'll review your depression history, previous treatments, medical history, safety considerations, treatment schedule, costs and other available treatment options.

On the day of treatment, you should plan to spend most of the day at BIDMC. You'll receive a series of TMS sessions with scheduled breaks between treatments. During each session, you'll remain awake while targeted magnetic pulses are delivered to specific areas of your brain. Some patients notice a tapping sensation on the scalp, clicking sounds during treatment, mild headache or temporary scalp discomfort. Our care team will monitor you throughout the day to help keep you comfortable and answer any questions.

One-day accelerated TMS is an out-of-pocket service and is not FDA-cleared. Before you decide whether to proceed, your care team will explain the potential benefits, limitations, costs and alternative treatment options so you can make an informed decision.

Bringing a Support Person or Service Animal

You are welcome to bring a family member, friend or caregiver to your appointment. Visitor access follows BIDMC's outpatient visitor policies.

If you have a service animal, you may bring it to your visit. However, for the animal's safety, service animals are not permitted in the treatment room during TMS sessions. Please bring someone who can stay with your service animal while you receive treatment. If you need assistance, our Volunteer Services team may be able to help. Let your care team know before your appointment if you plan to bring a service animal so we can discuss available options.

Cost and Insurance Coverage

Insurance providers generally cover conventional TMS treatments when criteria are met, though each insurance plan differs. If you have not been preapproved, we will work with you to try to obtain reimbursement from your carrier.

You may choose to pay out of pocket for treatments if your insurance does not cover the procedure.

One-day TMS is an out-of-pocket service and is not FDA-cleared. The current cost is approximately $2,750. For more information about current rates and payment options, please contact our team.

Risks and Side Effects of TMS

TMS is generally well tolerated, but it is not the right treatment for everyone, and side effects can occur.

The most common side effects are mild headache or scalp discomfort after treatment. These symptoms usually improve over time and can often be relieved with an over-the-counter pain reliever, such as Tylenol. Some patients may also experience ringing in the ears during or after treatment. To help reduce this risk, we provide earplugs during every treatment session.

There is also a very small risk of seizure. This is a rare complication, occurring in fewer than 1 in 30,000 people. Before treatment begins, our care team carefully reviews your medical history and overall health to help determine whether TMS is a safe option for you.