A Deep TMS course at Stedfast Psychiatry is 36 sessions over 6 to 9 weeks, weekdays, about 20 minutes each. Day one includes motor threshold mapping and takes about an hour. You stay awake, feel tapping on the scalp, and drive yourself home. We track your PHQ-9 weekly and taper the final sessions.
The short version: you sit in a reclining chair, a cushioned helmet rests on your head, and for about 20 minutes you hear a series of rapid clicks and feel a tapping on your scalp. Then you get up and drive yourself to work or home. You do that on weekdays for six to nine weeks, we measure your depression score every week, and the first day is the only one that takes longer than half an hour.
Who it is for
This guide is for anyone who has been scheduled for Deep TMS or is deciding whether to start, and for family members who want to understand the commitment. It applies to the depression protocol, which is the course most of our patients receive, and notes where the OCD and smoking cessation protocols differ. If you have not yet had a consultation, our candidacy page covers who qualifies; this page assumes you have been cleared to start and want to know what the next six to nine weeks look like day by day.
How it works
Deep TMS uses a helmet-mounted coil to deliver brief magnetic pulses through the skull into the prefrontal cortex, the region that regulates mood and is underactive in depression. The pulses are delivered in short trains, each lasting a couple of seconds, separated by pauses. Over a course of daily sessions, the repeated stimulation strengthens the activity and connectivity of those circuits, which is why a single session does nothing and the benefit builds over weeks. The intensity is set for each patient relative to their own motor threshold, measured on day one, so the dose is individualized rather than fixed. Nothing enters the body, there is no anesthesia, and you are fully awake and able to talk throughout.
In the pivotal multicenter Deep TMS trial, each session delivered 1,980 pulses at 18 Hz in about 20 minutes, with intensity set at 120 percent of the individual's motor threshold.
Source: Levkovitz et al., World Psychiatry, 2015
Headache and scalp discomfort are the most common side effects of TMS, each reported by roughly a third of patients, and typically diminish over the first week of treatment.
Source: Rossi et al., Clinical Neurophysiology, 2021
The estimated risk of seizure with repetitive TMS is well under one per 10,000 sessions when standard screening and safety guidelines are followed.
Source: Lerner, Wassermann and Tamir, Clinical Neurophysiology, 2019
Weekly measurement-based care with the PHQ-9 improves depression outcomes compared with care without routine symptom tracking.
Source: Guo et al., American Journal of Psychiatry, 2015
What to expect
Day one is the mapping visit and takes about an hour. Your technician and psychiatrist fit the helmet, then find your motor threshold: they deliver single pulses over the motor cortex and gradually adjust until your right thumb or hand twitches slightly about half the time. That twitch marks the minimum intensity your brain responds to, and your treatment dose is set as a percentage above it, typically 120 percent. The helmet is then moved forward a set distance to the prefrontal target and marked so it can be placed identically every day. You receive your first full treatment the same visit.
Every session after that follows the same pattern. You check in, sit in the reclining chair, put in earplugs, and the technician positions the helmet using the day-one markings. Treatment lasts about 20 minutes for depression: trains of pulses about two seconds long, followed by a 20-second pause, repeated. During each train you hear loud clicking and feel a firm tapping or knocking on the scalp, and some patients notice their jaw or eyebrow muscles twitch. It is uncomfortable for the first few sessions and most people stop noticing it within the first week. You can talk, listen to music or sit quietly, but you cannot sleep or move your head. When the session ends the helmet comes off and you leave. There is no recovery period and you drive yourself.
The schedule is Monday through Friday for the first six weeks, which covers the 30 acute sessions, followed by six taper sessions spread over the next one to three weeks, typically three sessions one week, two the next and one the last. Missing an occasional day does not undo progress, but we ask you to avoid gaps of more than two or three days in the acute phase. Each week you complete the PHQ-9, a nine-question depression scale, and your psychiatrist reviews the trend; many patients see their score begin to fall around session 10 to 15, with the largest changes in weeks four to six.
Benefits
- Each session is about 20 minutes and you drive yourself to and from the office
- No anesthesia, no sedation and no recovery time, so work and daily life continue
- Dose is set individually from your own motor threshold on day one
- Weekly PHQ-9 tracking means you and your psychiatrist can see the trend rather than guess
- The taper at the end reduces the chance of a sudden drop-off in benefit
- Your current medications continue, so nothing has to be stopped to start
Risks and side effects
The most common experiences are scalp discomfort or tenderness at the site and a mild headache after the session, each affecting roughly a third of patients in the first week and fading with time; over-the-counter acetaminophen or ibuprofen before the session helps. Jaw or facial muscle twitching during the pulse trains is common and harmless. Some patients feel briefly lightheaded on standing. Hearing is protected with earplugs, which are required. The serious risk is a seizure during stimulation, which is rare, estimated at well under one per 10,000 sessions, and is why we screen for seizure history and seizure-threshold-lowering medications and ask you to avoid sleep deprivation and heavy alcohol use during the course. A small number of patients with bipolar disorder can experience a switch toward hypomania, which we monitor for at each weekly review.
Cost and insurance
Deep TMS for major depressive disorder is covered by Medicare and most commercial plans with prior authorization, which our TMS coordinator obtains before day one. Commercial plans typically authorize the 36-session course in one approval; some require a progress review after 20 sessions, which the weekly PHQ-9 data satisfy. Your copay or coinsurance applies per session, so ask the coordinator for an estimate of the full-course out-of-pocket cost before you start. Self-pay rates are available for patients without coverage. There is no separate charge for the day-one mapping beyond the session itself.
Day one: the mapping visit, step by step
- Check-in and final screening. Your technician confirms your medication list, asks about sleep and alcohol in the past 24 hours, and checks that nothing metallic is in your hair or on your head.
- Helmet fitting. The Deep TMS helmet is a cushioned, adjustable cap containing the coil. It is fitted snugly so it does not shift, and a measuring system records its position.
- Motor threshold determination. Single pulses are delivered over the left motor cortex while the technician watches your right hand. Intensity is raised until your thumb or fingers twitch, then adjusted until the twitch appears on about half of pulses. That intensity is your motor threshold.
- Setting the treatment location and dose. The helmet is moved forward to the prefrontal target by a standardized distance and the treatment intensity is set, usually 120 percent of threshold. These settings are recorded and used every session.
- First treatment. You receive a full 20-minute session the same day. The psychiatrist is present for mapping and the first treatment.
The daily routine from session two onward
Arrive, check in, and complete the PHQ-9 if it is your weekly tracking day. In the treatment room you recline in the chair, insert earplugs, and the technician places the helmet using your recorded settings, confirming position before starting. The session runs about 20 minutes. You will feel the trains of tapping, each about two seconds, with roughly 20-second pauses. Talking is fine between trains; during trains most people find it easier to be still. The technician stays in the room throughout. When the session ends, the helmet comes off, you check your schedule for the next day, and you leave. Door to door, plan on 30 minutes.
The weekly check-in
Once a week you complete the PHQ-9, and your psychiatrist reviews the score, your side effects and your sleep. We graph the scores so you can see the trend. A score that drops by half from baseline is called a response; a score below five is remission. We also ask about any increase in energy or activity that outpaces mood, which in patients with a bipolar history can signal a switch toward hypomania and prompts an adjustment. Medication changes are usually avoided during the course so that the effect of TMS can be judged cleanly, but your prescriber remains available.
How the schedule breaks down
| Phase | Sessions | Frequency | Duration |
|---|---|---|---|
| Mapping and first treatment | 1 | Day one | About 1 hour |
| Acute phase | Sessions 2 to 30 | Monday through Friday | Weeks 1 to 6 |
| Taper | Sessions 31 to 36 | 3, then 2, then 1 per week | Weeks 7 to 9 |
Practical tips from our patients
- Book the same time slot every day; the routine makes the course far easier to keep.
- Take a headache reliever before the first few sessions rather than after.
- Keep your sleep schedule steady; poor sleep raises seizure risk and blunts response.
- Tell the technician immediately if a session feels different from usual; small helmet position changes matter.
- Keep a one-line daily note on mood and energy; it makes the weekly review more accurate than memory.
Deep TMS at Stedfast Psychiatry, Palm Beach Gardens
All TMS at Stedfast Psychiatry is delivered at our Palm Beach Gardens office, 11641 Kew Gardens Ave, Suite 209, close to PGA Boulevard and I-95, with free parking at the building. Patients drive in from Jupiter, West Palm Beach, Royal Palm Beach, Boynton Beach and Stuart, and the 20-minute session fits before work or at lunch for most. Call (561) 437-2199 to schedule a TMS consultation or to ask the coordinator any question about the schedule. If you are already a Stedfast patient, your current provider can refer you internally and the coordinator will handle insurance authorization and your treatment calendar.
Frequently asked questions
What does TMS actually feel like?
A firm, rapid tapping on the scalp, like someone drumming their fingers hard on your head, in bursts of about two seconds with pauses between. It comes with a loud clicking sound, which is why you wear earplugs. The first few sessions are uncomfortable and some patients get a headache afterward. By the end of the first week most people describe it as an odd but tolerable 20 minutes. It is not painful in the way a procedure is painful, and you are awake and alert the whole time.
What happens on day one and why does it take longer?
Day one includes motor threshold mapping. We deliver single pulses over the part of your brain that controls your hand and adjust the intensity until your thumb twitches about half the time. That number is your motor threshold, and your treatment intensity is set from it. We then position the helmet over the prefrontal target and mark it for every future session. The mapping plus your first full treatment takes about an hour; every session after that takes about 30 minutes door to door.
Can I drive myself to and from sessions?
Yes. TMS involves no sedation or anesthesia and does not impair alertness, reaction time or coordination, so you drive yourself. Most patients come before work, at lunch or on the way home. If you feel lightheaded or have a headache after a session, sit in the waiting area for a few minutes before leaving, but there is no requirement for a companion and no restriction on driving.
What should I bring and how should I prepare?
Bring nothing in particular. Come with your hair clean and free of products, clips, pins or extensions in the treatment area, and remove earrings and hair accessories with metal. Eat normally, take your regular medications, and avoid heavy alcohol the night before and skipping sleep, because both raise seizure risk. You may bring your own music and headphones to use under the earplugs. If you get headaches, taking acetaminophen or ibuprofen 30 minutes before the session helps.
How many sessions and how long is the whole course?
The standard depression course is 36 sessions over six to nine weeks: 30 acute sessions on weekdays for six weeks, then six taper sessions spread over one to three weeks. The OCD protocol runs about 29 sessions over six weeks and the smoking cessation protocol about 18 over six weeks. The exact schedule is set with your psychiatrist, and the total time commitment is roughly 30 minutes per weekday for the acute phase.
What if I have to miss a day?
Missing an occasional session for illness, travel or a conflict is fine and does not reset your progress; we add the session at the end. What matters is avoiding long gaps, so we ask patients to keep breaks to no more than two or three consecutive weekdays during the acute phase. Planned travel is best scheduled during the taper or after the course. Tell the coordinator as early as possible and we will adjust the calendar.
When will I start to feel better?
Most patients who respond notice the first changes between sessions 10 and 20, often as better sleep, more energy or a slight lifting of the heaviness before mood itself changes. The largest improvements usually appear in weeks four to six. A minority improve early, some improve only in the final weeks or during the taper, and some do not respond. Your weekly PHQ-9 scores let your psychiatrist track the trend, and we review progress with you at least every two weeks.
What is the taper and why does it matter?
The taper is the last six sessions of a 36-session course, spread over one to three weeks rather than delivered daily. Stepping down gradually rather than stopping abruptly appears to help consolidate the gains and reduces the chance of an early relapse, and it gives your psychiatrist a chance to watch how your mood holds as the frequency drops. After the taper, you continue regular follow-up with your prescriber and we discuss whether maintenance sessions make sense for you.
Where this treatment is offered
Conditions this treats
If you are in crisis, call or text 988 or go to the nearest emergency room. Educational content; individual results vary. Reviewed by Dr. David Husted, board-certified psychiatrist.