How to Prepare for Your First rTMS Treatment Session

Repetitive Transcranial Magnetic Stimulation (rTMS) is a safe, drug-free procedure that uses magnetic pulses to stimulate specific areas of the brain involved in mood regulation. It’s commonly used as part of a TMS treatment plan for depression, especially when antidepressants and therapy haven’t provided enough relief.

Unlike electroconvulsive therapy (ECT), rTMS does not require anaesthesia, has no cognitive side effects, and can be done in an outpatient setting.

This treatment is commonly recommended for people who:

• Have been diagnosed with major depressive disorder
• Have tried at least one or more antidepressant medications without success
• Prefer non-pharmaceutical alternatives or experience side effects from medication
• Want to explore additional support alongside therapy

Your psychiatrist will assess your mental health history, current symptoms, and treatment response to determine if you’re a good candidate.

Medical Assessment

Before your first rTMS treatment, you’ll meet with a psychiatrist or mental health specialist for a detailed evaluation. This usually includes:

• Review of your psychiatric and medical history
• Discussion of previous treatments and medications
• A physical exam to rule out any health conditions that may affect treatment

You may also undergo basic cognitive testing to establish a baseline.

During the first visit or pre-treatment session, the clinic will determine your motor threshold—this is the minimum strength of magnetic stimulation needed to create a response in your motor cortex. It’s an essential step that ensures the right dose of stimulation is applied to your brain during treatment.

The technician will place a magnetic coil over your scalp, and your finger or hand will be observed for slight movements. This data is used to calibrate the strength of pulses for your upcoming sessions.

There’s no need for hospital gowns or special attire. Wear loose, comfortable clothing and avoid jewellery or metal accessories near the head, including earrings, hairpins, or hearing aids (unless advised otherwise).

Have a light meal or snack before your session. While the treatment is non-invasive and doesn’t require fasting, feeling lightheaded or hungry can make the experience less comfortable.

Unless instructed by your psychiatrist, continue taking your prescribed medications as usual. Inform your care team about all medicines and supplements you’re currently using.

The clicking sound of the magnetic pulses can be quite loud. Clinics often provide disposable earplugs to reduce noise, but you can bring your own if you prefer.

Your first treatment session will last about 30 to 45 minutes. Here’s what typically happens:

• You’ll sit in a reclining chair similar to those in dental clinics.
• A magnetic coil is placed against your scalp, typically over the left prefrontal cortex, the area most associated with depression.
• The device will emit short magnetic pulses. These pulses feel like tapping on your scalp.
• You’ll remain awake and alert throughout the session.

The experience isn’t painful, though some people describe the sensation as strange or mildly uncomfortable during the first few sessions. This usually improves with time.

• Mild scalp discomfort or tingling
• Slight headache
• Fatigue or drowsiness
• Lightheadedness

These effects are typically short-lived and lessen as the body adjusts to the treatment. You can usually resume normal activities straight after your session, including driving, working, or socialising.

rTMS treatment for depression is not a one-time procedure. Most treatment plans involve:

• Five sessions per week
• For a total of 4 to 6 weeks, sometimes longer depending on your response

Your mental health provider will track your mood and adjust the protocol as needed. Some individuals notice improvement in mood or energy levels after just a few sessions, while for others, it may take a few weeks.

Keep a Journal

Track how you feel each day, including your mood, energy, sleep, and appetite. This helps your provider identify patterns and adjust treatment if needed.

Skipping sessions can reduce effectiveness. Try to maintain the full treatment schedule for best results.

rTMS works well alongside talk therapy or medication. Discuss with your psychiatrist whether you should continue therapy or add additional support during your treatment period.

Like any treatment for depression, results may take time. Some people notice gradual improvement, while others experience a more sudden shift.

Preparing for your first rTMS treatment session can help reduce anxiety and give you a sense of control. This safe, non-invasive therapy offers an effective option for those who haven’t found relief through traditional antidepressants or want to reduce their reliance on medication.