Preparing for TMS comes down to four jobs: gather your treatment history, get through the safety screening and insurance approval, plan for a daily appointment over several weeks, and show up to the first session rested, fed and free of metal around your head. The checklists below walk through each stage in order.
The TMS team will give you its own instructions, and those come first. Use this as a way to arrive organized and ask better questions.
Weeks before: records and history
TMS for depression is FDA-cleared for adults whose depression has not improved enough with antidepressant medication in the current episode. Insurers usually want proof, so your medication history is the single most useful thing to prepare.
- ☐ Every antidepressant you have tried: name, highest dose, roughly how long, and why it stopped (no effect, side effects, partial help).
- ☐ Other psychiatric medications: mood stabilizers, antipsychotics, sleep medications, stimulants.
- ☐ Therapy history: type (for example CBT), roughly when and for how long. Medicare's Brooklyn policy requires a trial of evidence-based psychotherapy before TMS.
- ☐ Past treatments such as ECT, ketamine or esketamine, or an earlier TMS course and how you responded.
- ☐ Current medication list, including supplements and over-the-counter products.
- ☐ Contact details for your prescriber and therapist, and permission for them to share records.
Pharmacy printouts and patient-portal records are a good way to fill gaps in memory. For what the first appointment covers, see the TMS consultation: what happens and what to bring.
Safety screening: what you will be asked
Before any session, the team screens for conditions that change the risk. Expect questions on each item below, and gather details in advance where you can.
| Screening topic | Why it matters |
|---|---|
| Metal in or near the head (for example aneurysm clips or coils, stents, metal fragments) | Conductive or magnetic-sensitive metal within 30 cm of the coil is a contraindication in FDA guidance |
| Implanted devices: deep brain or vagus nerve stimulators, cochlear implants | Listed as contraindications in FDA guidance |
| Pacemakers and implantable defibrillators | A labeled warning in FDA guidance, regardless of distance from the coil |
| Seizures, epilepsy, stroke, head injury or severe headaches | FDA guidance asks for close monitoring of these patients |
| Bipolar disorder or psychotic symptoms | FDA guidance lists these among groups where evidence of safety or effectiveness is lacking, a precaution |
| Pregnancy or breastfeeding | A precaution in FDA guidance, not a contraindication |
Dental fillings, braces, tattoos and similar items raise their own questions; TMS with fillings, braces, implants or tattoos covers them in detail. If you have an implant card or operative report, bring it. Implants that are MRI safe are more likely to be TMS safe, according to the IFCN safety guideline, but the team will decide case by case.
TMS is also not the right first step for everyone. Expert consensus suggests people with psychotic symptoms or acute suicidal thinking be considered for treatments with established efficacy in those situations, such as ECT. If you are thinking about suicide or are in crisis, call or text 988 (the 988 Suicide & Crisis Lifeline) or go to the nearest emergency room.
Insurance and authorization
- ☐ Call your insurer and ask whether TMS needs prior authorization, and what documentation it requires.
- ☐ Ask how many sessions an approval covers and whether a mid-course review is needed.
- ☐ Ask about your deductible, copay or coinsurance per session.
- ☐ Do not start treatment until you have written approval, unless you have agreed to pay yourself.
Requirements differ a lot by plan. The guides on whether insurance covers TMS and TMS prior authorization step by step explain the process.
Planning for the schedule
A standard course is a weekday commitment. Expert consensus says a standard acute course of 20 to 30 sessions over about 6 weeks will very likely be needed. One common device label describes 5 sessions a week for 6 weeks, then a 3-week taper, for 36 sessions in total. Session length depends on the protocol: a standard 10 Hz session can run from about 19 to 37.5 minutes, while a theta-burst session takes about 3 minutes of stimulation.
- ☐ Block the same time slot every weekday for the full course.
- ☐ Tell your employer or school what you need, if you choose to. See working, studying and driving during a TMS course.
- ☐ Plan your route and a backup. Fitting daily TMS sessions into a Brooklyn week has transit ideas.
- ☐ Avoid booking a vacation in the middle of the course.
- ☐ Ask who to call if you are sick or running late.
A support person
You do not need anyone with you for most sessions, but a support person helps in other ways. Ask someone to come to the consultation or first session, to help with transport in the first week if you feel unsure, and to notice changes in your mood or energy. Supporting a loved one through TMS is written for them.
The night before the first session
- ☐ Sleep your usual amount. Sleep deprivation is a recognized seizure-threshold factor.
- ☐ No heavy drinking, and do not suddenly stop if you drink daily; alcohol withdrawal is also a named factor.
- ☐ Keep caffeine at your usual level; more detail is in caffeine, alcohol and sleep during TMS.
- ☐ Take your regular medications unless told otherwise.
What to wear and bring on day one
- ☐ Comfortable clothes; you stay seated and awake throughout.
- ☐ No metal hair clips, pins, headbands or barrettes; leave hair loose or use a fabric tie.
- ☐ Remove earrings, other head and facial piercings, and hearing aids if asked. Removable metal objects should come off if they can interact with the magnetic field.
- ☐ Glasses may need to come off during treatment.
- ☐ Clean, dry hair, without heavy product.
- ☐ Earplugs: clinics normally supply them, and they are required. FDA guidance calls for hearing protection rated at 30 dB of noise reduction.
- ☐ Your ID, insurance card, medication list and implant cards.
- ☐ Something to eat and drink afterward.
What to expect at the first session
The first appointment is longer than later ones. The team finds your motor threshold, usually by watching for finger movement, sometimes with recorded muscle signals, and uses it to set your dose. They also locate the treatment spot on your head. The first TMS session: mapping, motor threshold and dose explains each step, and what TMS feels like describes the tapping and clicking.
Speak up during the first week. Seizures are rare, but when they happen they are most likely within the first few exposures, so report anything unusual promptly. Scalp discomfort and headache are the most common side effects and usually ease with time.
One-page summary
- Medication and therapy history written down.
- Implant and device details ready.
- Insurance approval in writing.
- Weekday slot and route planned for the full course.
- A support person briefed.
- Night before: sleep, no binge, usual caffeine.
- Day one: no metal in hair, piercings out, ID and lists in hand.
For an overview of the treatment, see the TMS therapy page, or browse the full patient's guide to TMS.
Sources
- FDA 510(k) K160703 (NeuroStar TMS Therapy System). U.S. FDA, 2016. accessdata.fda.gov
- Transcranial Magnetic Stimulation (LCD L33398). CMS Medicare Coverage Database, 2026. cms.gov
- Class II Special Controls Guidance Document: Repetitive Transcranial Magnetic Stimulation (rTMS) Systems. U.S. FDA, 2011. fda.gov
- Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: Expert Guidelines. Clinical Neurophysiology, 2021. europepmc.org
- Consensus Recommendations for the Clinical Application of Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Depression. Journal of Clinical Psychiatry, 2018. pmc.ncbi.nlm.nih.gov
- K231926 510(k) Summary – NeuroStar Advanced Therapy System. U.S. FDA, 2024. accessdata.fda.gov
- K173620 510(k) Summary – MagVita TMS Therapy System w/Theta Burst Stimulation. U.S. FDA, 2018. accessdata.fda.gov
- K220177 510(k) Summary – Magnus Neuromodulation System with SAINT Technology. U.S. FDA, 2022. accessdata.fda.gov
- Seizures from transcranial magnetic stimulation 2012-2016: Results of a survey of active laboratories and clinics. Clinical Neurophysiology, 2019. europepmc.org
- Transcranial magnetic stimulation in the treatment of major depressive disorder: a comprehensive summary of safety experience from acute exposure, extended exposure, and during reintroduction treatment. Journal of Clinical Psychiatry, 2008. europepmc.org
FAQs
Do I need someone to drive me home after TMS?
TMS does not involve sedation, and most people go about their day afterward. Some people like company for the first session. Ask the TMS team about your situation, especially if you feel unwell after treatment.
Can I wear makeup to TMS?
Usually yes. The concern is metal around the head, such as hair clips and piercings, not cosmetics. Ask the TMS team if you use products with metallic particles.
Should I stop my antidepressant before starting TMS?
Not on your own. Many people continue their medications during TMS, and stopping suddenly can cause problems. Discuss any change with your prescriber.
How early should I arrive for the first session?
Allow extra time. The first visit includes paperwork, safety questions and motor threshold mapping, so it takes longer than routine sessions.
What if I miss a session?
Tell the clinic as soon as you can. Ask how the team handles missed days, and plan the course to keep gaps rare.
