Your Questions Answered
We understand that not everyone has heard of Transcranial Magnetic Stimulation (TMS). We also appreciate that the unknown can be frightening. Below, our team of patient advisors have pulled together a list of the questions they are asked most often.
If your question doesn’t appear in our FAQs, please contact the team, who will be happy to talk you through the treatment.
Transcranial Magnetic Stimulation, or TMS, is an MRI-strength magnetic pulse designed to stimulate the brain as treatment for mental health conditions.
The treatment coil creates a focused magnetic pulse that is used to target the relevant area of the brain for the medical condition being treated. As the magnetic fields pulse, small electrical currents are produced. These electrical currents excite or calm activity in the brain centres. This reactivates neural pathways and the cumulative effect results in changes in the way the brain operates.
TMS is a safe procedure with over three decades of intense clinical and scientific research behind it. The National Institute for Health and Care Excellence (NICE) approved TMS as a safe and effective treatment for depression in 2015. The majority of patients do not experience any significant side effects.
You can feel a tapping sensation on your scalp, but most people get used to it quickly. Your practitioner won’t increase the power of the treatment until you’re comfortable with the feeling of the magnetic pulses.
Some patients find that TMS makes their face twitch. This is nothing to worry about and will stop as soon as your treatment is finished.
There can be some mild discomfort in the initial sessions but this soon wears off as you get used to the sensation. The TMS treatment intensity is personalised to you during your first session. Your Smart TMS practitioner will ensure they begin your treatment at a lower strength and work up to your personal maximum as and when you're comfortable.
Your first session will be an hour long, which will include time for your introduction to TMS and for all measurements to be taken by your Smart TMS practitioner. Each session after this will be 30 minutes long.
The amount of sessions required will be prescribed following an assessment with one of our Clinicians, taking the individual’s condition into account. As a guide, approximately 30 sessions can be needed with between 1 and 3 sessions being booked each day.
You lie in a comfy chair while having the treatment, and although you can’t move your head, you can still read or listen to music to help you relax.
Side effects are generally mild and improve shortly after an individual session and decrease over time with additional sessions. They may include:
- Scalp discomfort at the site of stimulation
- Twitching of scalp/face muscles
The risk of seizure about 1 in 50,000 sessions of treatment (which is similar to the risk of seizures from antidepressants). To minimize this risk, patients will be screened for medical contraindications prior to commencing the treatment. If you experience a side-effect during treatment, your Smart TMS practitioner will be on hand and may pause the treatment or reduce the strength of the treatment to make it more comfortable.
Most patients feel completely fine and can get on with their day as normal. A small number (one in ten) have a mild headache after treatment, which can be treated with painkillers as normal. Some patients feel tired after their treatment.
Your practitioner will stay in the room throughout your treatment to make sure you're comfortable and the treatment is running smoothly. Our practitioners are happy to chat or to sit quietly if you prefer to relax completely. Some patients even fall asleep during their treatment!
At Smart TMS, we believe our patients deserve the best value for money, without reducing the levels of personal, caring service. As a result we treat anxiety and depression within the same treatment session. Anxiety and depression tend to see patients entering a vicious cycle of low mood and worry or fear, so our clinicians prescribe TMS treatment for both, if the patient’s symptoms suggest this would be beneficial. We do this at no extra cost to the patient, unlike other TMS providers.
When other conditions are suffered together, our Clinician will use the assessment to determine which is the primary condition. In some cases, patients find treatment for one condition lessens the symptoms of another condition. For example, depression and insomnia may be suffered at the same time and by treating the depressive symptoms, the patient may be able to sleep more soundly, therefore removing the need for insomnia to be treated.
The cost of treatment will depend on the condition being treated, as this determines how many sessions are required. For more information on pricing, please see: TMS Treatment Pricing
Yes! When paying for depression treatment, we're able to offer a payment plan. This will see the cost of the second course of 15 sessions spread over 12 months. For more information visit our Payment Plan page. We would never charge you for treatment that isn’t needed/recommended.
Currently, there are very few NHS Foundation Trusts that offer TMS as a treatment for depression – and those that do tend to have long waiting lists. The treatment is only offered free of charge to a select number of patients who meet strict criteria – including living in the catchment area covered by the NHS Trust.
See NHS Funding for more information.
At Smart TMS, we want to help as many people as we can to achieve an improved quality of life through TMS treatment. We can provide guidance to patients on gaining funding from their NHS trust, so please contact the team if you would like advice.
Many private medical insurance companies are now considering covering the cost of treatment on a case by case basis. If you have private health insurance and you believe it may cover TMS treatment, please get in touch with our team and we can help with booking your treatment and processing your claim. If you are covered by another insurer or unsure as to the position, we recommend calling your insurer in the first instance, to see whether they will cover the cost of your treatment.
Please see Private Health Insurance for the latest information on insurers.
rTMS stands for repetitive Transcranial Magnetic Stimulation and is the type of treatment Smart TMS offer. dTMS stands for deep Transcranial Magnetic Stimulation, which is a term used to describe repetitive TMS using a different coil which penetrates deeper into a much larger area of the brain than rTMS. Repetitive TMS is focused on the precise area of the brain shown in research to cause mental health conditions.
The "magnet" used in TMS is called a coil. The coil used in each type of TMS is different, with rTMS using a coil that is shaped like a figure of 8 and is placed on the scalp. dTMS uses a H-coil, which looks like a helmet and covers the whole head. rTMS sends magnetic pulses 2-3cm into the brain in a precise area, whereas dTMS sends pulses to a depth of 5-6cm in a much less specific and focused area.
Current studies show the remission rate to be 60% when rTMS is used and 40% when dTMS is used.
rTMS is very widely used by the best researchers around the world and so there is a massive evidence base for the safety and efficacy. dTMS is much less widely used and so there is less evidence.
Both treatments have very mild side effects – headache, scalp irritation etc. The biggest difference in side effects is the risk of seizure – rTMS has a 1 in 50,000 risk, whereas the risk is 1 in 12,500 when using dTMS, nearly three times higher.
Following our most recent audit, 82% of patients saw a clinically significant reduction in symptoms, while 60% of patients entered full remission following a full course of treatment.
Of all patients treated for OCD by Smart TMS, 44% of patients entered remission, meaning that they no longer suffer from clinical OCD at all.
We currently treat:
We have also seen positive results in patients who have gained relief from their addictions to gambling, pornography, sex and social media addictions while being treated for other conditions.
According to our most recent audit (December '19), 8 in 10 patients saw their cravings drop to a self scored 0/10. Other addiction treatments are showing similar success rates.
While both rTMS and Electroconvulsive Therapy (ECT) are effective in the treatment of depression, there are many differences in safety and tolerability. Both are designed to treat depression through the application of energy into the brain, but the similarities end there. ECT is a more intensive and invasive procedure than is rTMS as ECT requires an anaesthetic and is designed to stimulate a controlled seizure. The main side effect from ECT is memory loss which does not occur with rTMS. By contrast, rTMS is an outpatient procedure with few side-effects. See TMS vs. ECT for more information
TMS Therapy is a very well tolerated treatment and there are very few limitations as to who can receive it. However, not all patients are appropriate candidates for TMS therapy. Patients who have ferromagnetic metal implants in their head/neck or a cochlear implant aren't appropriate candidates for TMS. A Smart TMS clinician will confirm your suitability prior to writing your TMS prescription.
You can continue your sessions as normal, and should carry on taking any medication prescribed by your GP or psychiatrist throughout your TMS treatment. hough you can refer yourself for TMS, we’ll ask for your permission to tell your GP or psychiatrist about your treatment with us, as being kept informed helps them give you the best possible care.
When your treatment comes to an end, your Smart TMS clinician will arrange a review to talk about your progress. Where your symptoms have reduced, he or she will explain our aftercare programme – Continuous Care – and advise you on the best way to maintain your great results. Your clinician will also share your results with your GP (with your permission).
Most people are suitable to receive TMS treatment. Try our quick 2 minute questionnaire to see whether TMS treatment could help. TMS Suitability Self-Check
Before you can start treatment, there are two stages that need to be completed:
- Completion of your pre-assessment questionnaire. This gives us the information we need on your medical history and symptoms before your assessment with one of our clinicians;
- Our clinician will talk through your medical history and symptoms before arriving at a diagnosis and confirming your suitability for TMS treatment. A prescription for TMS will be written.
To arrange to start this process, please contact us on 0345 222 5678 or submit an enquiry and one of our patient advisors will contact you.
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