TMS (transcranial magnetic stimulation) uses a gentle magnetic pulse, similar to but milder than MRI technology, applied near the scalp to stimulate areas of the brain involved in depression. Unlike medication, which affects the whole body, TMS targets the brain's circuitry directly and has very few side effects.

TMS involves no needles or anesthesia. A plastic coil rests on the head and delivers a light tapping sensation that many patients describe as feeling like a woodpecker tapping. It may feel slightly sore at first, but most people tolerate it well within a few days. The main side effect is mild, localized scalp tenderness.

Is TMS safe? Can it cause seizures?

TMS is considered very safe. Seizures are a rare possible side effect, with a risk comparable to that of antidepressant medication. At BrainWell Psychiatry in Bastrop, Texas, no patient has had a seizure during treatment, and staff take precautions such as monitoring sleep and alcohol use to keep the risk as low as possible.

How is TMS different from ECT?

TMS and ECT (electroconvulsive therapy) are very different. ECT intentionally induces a brief seizure to reset the brain. TMS uses focused magnetic energy at the scalp to gently activate neurons and does not cause a seizure.

How many TMS sessions are needed?

The standard protocol is 36 sessions, once a day, Monday through Friday, over about six weeks. Sessions do not have to be perfectly sequential, so patients can make up missed days as long as they complete the full course.

Do I have to stop my medications during TMS?

Usually not. TMS was studied as an augmentation to medication, so patients often stay on their medication during treatment. For those who cannot tolerate medication, TMS can be used on its own.

TMS Therapy in Bastrop, Texas: Your Questions About Transcranial Magnetic Stimulation, Answered

Q: Who is a candidate for TMS?

Most insurers require a patient to be treatment-resistant, meaning they have tried two or more antidepressant medications without success, or could not tolerate medication side effects. Most people are eligible; a history of brain bleed may require additional evaluation.

Q: What conditions does TMS treat?

TMS is FDA-approved and insurance-covered for treatment-resistant depression (major depressive disorder) and OCD. Off-label uses such as PTSD and bipolar depression are being researched but are not yet FDA-approved or covered by insurance.

Q: Does insurance cover TMS?

Yes. Insurance, including Medicare, covers TMS for FDA-approved conditions. BrainWell Psychiatry in Bastrop, Texas accepts most major insurance plans.

A conversation with Dr. Dunkin of BrainWell Psychiatry in Bastrop, Texas

If you or someone you love has struggled with depression that won't lift — even after trying medication after medication — you may have come across something called TMS. It's one of the newest, most effective treatments in psychiatry, and at BrainWell Psychiatry we're proud to offer it right here in Bastrop, where it used to be available only in big cities like Austin.

Our TMS and Spravato tech, Kyla Green, sat down with Dr. Dunkin, who founded BrainWell Psychiatry in 2019, to ask her some of the questions we hear most often from patients and families considering TMS. Here's that conversation.

What is TMS, in plain language?

TMS stands for transcranial magnetic stimulation. It uses a gentle magnetic pulse — the same kind of magnetic technology as an MRI, just much milder — to treat depression.

"When we think about treating depression, we've always used medications: chemicals you swallow that travel all over your body and change the neurotransmitters in your brain," Dr. Dunkin explains. "TMS bypasses the rest of your body. We use magnetic energy right near the scalp, in the area we know will help wake the brain up. There are very few side effects, and people tolerate it really well."

How is TMS different from antidepressant medication?

Antidepressants target neurotransmitters throughout the body. TMS targets the brain's circuitry directly.

"Different areas of the brain have to communicate with each other. When depression happens, that communication just stops — it gets very rigid and angular, and the brain gets stuck," Dr. Dunkin says. "What TMS does is reboot that circuit so the different parts of the brain start communicating again."

She offers an analogy: "Normally, when a problem comes up in life, we can look at it from all different angles — 'that's bad, but here's some hope.' When people are depressed, they can only see one angle, and it's stuck and hopeless. TMS helps reboot that, so people can start seeing their lives from all the angles again."

TMS is a different way to manage depression compared to medication.

Does TMS hurt? What does it feel like?

There are no needles and no anesthesia. A plastic coil rests on your head, and when the magnet delivers its energy it creates a light tapping sensation.

"People say it feels like a woodpecker tapping on their head," Dr. Dunkin says. "At first that can be a little uncomfortable, and the area may feel a bit sore. But after a few days, almost everyone tolerates it really well."

The main side effect is some localized tenderness on the scalp. A few people get a mild headache early on, which usually responds to Tylenol or ibuprofen.

Is TMS safe? I read that it can cause seizures.

Seizures are listed as a possible side effect, but they are very rare.

"We've never had anyone have a seizure during treatment here," Dr. Dunkin says. "When you look at the actual numbers, the risk is about the same as the seizure risk from an antidepressant — because antidepressants also lower the seizure threshold."

BrainWell takes extra precautions to keep that risk as low as possible, asking patients every day about sleep and alcohol use, since poor sleep or suddenly stopping alcohol can raise seizure risk.

Isn't TMS the same as electroconvulsive therapy (ECT)?

This is one of the biggest misconceptions Dr. Dunkin hears. "People sometimes confuse TMS with ECT and think we're zapping their brain. They're very different."

ECT — an important treatment for some patients — intentionally causes a brief seizure to reset the brain. TMS does not. "With TMS we're using magnetic energy, and magnetic energy doesn't travel far. We put it right at the scalp and send the smallest amount of energy through the skull to gently activate the neurons — basically telling them, 'wake up, wake up,' so they connect better."

Who is a candidate for TMS?

To qualify for insurance coverage, most patients need to be treatment-resistant, which means:

You've tried two or more antidepressant medications that didn't work, or
You've tried medication but couldn't tolerate the side effects.

Most people are eligible. One exception: a history of a brain bleed may require a closer look before starting.

What conditions does TMS treat?

At BrainWell Psychiatry, TMS is FDA-approved and insurance-covered for treatment-resistant depression (major depressive disorder) and OCD.

There is ongoing research into off-label uses — PTSD, trauma, and bipolar depression — but those are not yet FDA-approved or covered by insurance.

Will I have to stop my medications during TMS?

Usually not. In the original clinical trials, TMS was studied as an augmentation — meaning patients stayed on their medication and added TMS on top.

"If medication has been partly helpful but not enough, we keep you on it," Dr. Dunkin says. For people who simply can't tolerate medication, TMS can be used on its own (monotherapy).

Does insurance cover TMS?

Yes. This is one of the most important things to know: insurance, including Medicare, covers TMS for the approved conditions. BrainWell Psychiatry takes most major insurance plans — which can be hard to find in a psychiatric practice.

How many sessions does TMS take?

The standard protocol is 36 sessions, once a day, Monday through Friday, for about six weeks.

That can sound daunting at first. "If you're having a hard time even getting out of bed, coming in every day feels hard," Dr. Dunkin acknowledges. "But what we find is that people start looking forward to it — a lot of that is the relationship they build with our TMS technician, who they see every day. By the end, people often say, 'What am I going to do? I'm going to miss coming here.'"

There's also flexibility: the sessions don't have to be perfectly sequential. If you have to miss a few days for a wedding or an appointment, you simply pick back up — what matters is completing the total number of sessions.

What does a successful course of TMS look like?

Results aren't overnight, but they build steadily. At BrainWell Psychiatry we track progress weekly using the PHQ-9, a standard depression questionnaire.

"Over about two to three weeks, those scores start coming down and down," Dr. Dunkin says. "We see people who were isolating — not leaving the house, not talking to friends — start making plans, finding joy, laughing again. We watch people come alive and find themselves again. They go back to work, reconnect with friends, and enjoy life again."

She shares one story that stuck with her: a patient who'd fallen into a very deep depression, had tried multiple medications through her primary care doctor, wasn't working, wasn't smiling. Her friends were the ones who urged her to get help. "We watched her come back to life. It's wonderful to watch someone get their life back."

How does therapy fit in with TMS?

TMS includes a CBT (cognitive behavioral therapy) workbook that patients work through during treatment.

"When people have been depressed a long time, the brain forms ruts — the same negative thought patterns over and over," Dr. Dunkin explains. "TMS lets the brain rewire, but we also have to train ourselves toward different thoughts and healthier behaviors — getting exercise, eating well, connecting with a friend on the weekend. The workbook guides you through that while your brain is waking up."

She still recommends individual psychotherapy alongside TMS when possible: "The workbook isn't a replacement for working with a therapist. And the therapy is so much more productive when the brain isn't stuck — you can actually internalize the work and make those changes."

Considering TMS in the Bastrop area?

BrainWell Psychiatry has served the Bastrop and greater Central Texas community since 2019. We see patients age 18 and up for depression, anxiety, ADHD, bipolar disorder, OCD, and more — and we're one of the few practices offering cutting-edge treatments like TMS and SPRAVATO close to home, without the drive to Austin. We take most major insurance plans and Medicare.

If medication hasn't given you the relief you hoped for, TMS may be worth a conversation. Contact BrainWell Psychiatry to ask whether TMS is right for you.

This article is for general educational purposes and is not medical advice. TMS is appropriate for specific conditions and patients; talk with a qualified psychiatric provider about your individual situation. Individual results vary.