The first TMS appointment is not a treatment session. It is a consultation and a mapping session, and knowing that in advance removes most of the anxiety people bring to it.
The consultation
A psychiatrist or trained clinician reviews your diagnosis and your full medication history, and screens for contraindications. The main one is ferromagnetic metal in or near the head — aneurysm clips, cochlear implants, certain stents. Dental fillings, braces and titanium plates are generally fine. You will also be screened for seizure risk, including history of epilepsy, significant head injury, and medications that lower seizure threshold.
Motor threshold mapping
This is the part nobody describes well in advance, so here it is. The clinician places the coil over your motor cortex and delivers single pulses while watching your hand. They are looking for a small involuntary twitch in your thumb. The intensity is adjusted until that twitch appears reliably. That level is your motor threshold, and your treatment dose is set as a percentage of it — usually 120 percent.
It feels strange. It does not hurt in any serious way. It takes about fifteen minutes.
The first treatment week
Sessions are daily, Monday through Friday. You sit in a reclining chair, fully awake and clothed. The coil rests against your scalp and you hear a rapid tapping sound. Most people read, listen to something, or talk with the technician.
Week one is the uncomfortable one. Scalp tenderness at the stimulation site and a dull headache afterwards are both common and both usually resolve within the first five to ten sessions as you acclimate. Over-the-counter pain relief before a session is fine and most clinics will suggest it.
When things start changing
Between weeks two and four for most people. It rarely arrives as a dramatic lift in mood. More often it is that you slept through the night, or got through a workday without the fog, or noticed you were interested in something. Family members frequently notice before the patient does.
Clinics that track weekly PHQ-9 scores are worth seeking out for exactly this reason — the graph often shows movement before the feeling catches up.