An rTMS session step by step: what patients can expect
From preparation and calibration to stimulation and leaving the office: this is what an rTMS session looks like.
Knowing in advance how a session unfolds can reduce uncertainty. Although the details vary by center and protocol, the overall experience of repetitive transcranial magnetic stimulation (rTMS) usually follows a recognizable sequence.
1. Check-in and preliminary review
Before starting, the team confirms the necessary information and checks whether there have been any changes in health, medication, or medical history. By the first visit, a clinical evaluation should already have been completed and informed consent explained.
Some centers use symptom rating scales before treatment to establish a baseline for comparison.
2. Preparing the patient
The person sits in a chair. Objects that could interfere are removed, and any measures specified by the center are put in place. Since the coil produces a repetitive sound, earplugs or hearing protection may be offered.
No anesthesia is needed. The patient stays awake and can communicate with the clinician throughout the session.
3. Locating the target area
The team positions the head and determines where the stimulation will be applied. Some protocols use external measurements; others incorporate brain imaging and neuronavigation systems.
The precision of this step matters because rTMS aims to act on a specific region and, through it, on a broader brain network.
4. Measuring the motor threshold
Intensity is personalized through a test known as the motor threshold. Pulses are applied over an area linked to movement, and the response of the hand or another muscle is observed.
That response helps calculate the intensity that will be used during the therapeutic session.
5. Positioning the coil
The coil is placed on or very close to the established point. The clinician adjusts its position and checks the protocol's parameters.
During stimulation, a rhythmic sequence of tapping sounds is heard. Some people describe a tapping or percussive sensation on the scalp. The stimulus is delivered in trains separated by brief pauses.
6. During the session
Duration depends on the protocol. The person remains seated and can speak up if they feel any discomfort. Some centers offer a screen or some form of entertainment during the procedure.
The technician or clinician monitors the coil's position, the equipment, and the patient's tolerability.
7. When the session ends
Once the session is over, the coil is removed and any appropriate follow-up check is performed. In outpatient treatment, the person can usually go on with their activities, following the instructions given.
Some people experience local sensitivity, headache, or transient fatigue. Any unexpected symptom should be reported to the team.
8. Repetition and follow-up
rTMS is delivered as a series of sessions. Conventional protocols may be spread out over several weeks; accelerated protocols concentrate multiple sessions into a single day.
The team tracks progress and may repeat rating scales to compare the initial state with the changes observed. Understanding each step makes it possible to go into a session with more concrete expectations and better questions.
Chapter 6 of “New Hope for Treatment-Resistant Depression Without Medication” offers a detailed walk-through of the rTMS experience and the SAINT protocol.
