Inside the mind of a TMS patient—from skepticism and side effects to subtle shifts and breakthrough moments.
What If This Is the Thing That Finally Works?
For people living with treatment-resistant depression (TRD), a form of depression that hasn’t improved with traditional treatments like antidepressants or talk therapy, every new option can feel like a last-ditch effort. At Geode Health, we often meet patients who’ve tried multiple medications, switched therapists, and done the hard work of healing without getting real relief. They’re exhausted. Understandably skeptical. And cautiously hopeful.
Transcranial Magnetic Stimulation (TMS) is a non-invasive treatment that uses magnetic pulses to stimulate areas of the brain involved in mood regulation. It’s FDA-approved specifically for major depressive disorder that hasn’t responded to at least two antidepressants, and it’s increasingly offered at outpatient clinics like ours. Most insurance providers require documentation of prior treatment attempts before approving TMS.
But beyond the clinical guidelines, what is it actually like to go through TMS?
We asked two Geode psychiatrists, Dr. Ana Segarra-Brechtel, a child, adolescent & adult psychiatrist in Georgia, and Dr. Oladele Adebogun, an adult psychiatrist in Texas, to walk us through the typical patient experience. They’ve treated hundreds of individuals with TMS, and they’ve heard it all, from the doubts on Day One to the breakthroughs in Week Six.
Week 1: Hope Meets Hesitation
The first week of TMS is all about setting expectations and calming nerves.
“During the initial TMS consultation, many patients admit they are fearful of side effects that are not associated with TMS treatment at all. It is my experience that they often confuse TMS with other treatment modalities such as Electroconvulsive therapy (ECT)”, explains Dr. Brechtel. “It is important to understand that there are no ‘memory gaps’ or an altered mental state with TMS. TMS patients are fully conscious during treatment. There is no sedation necessary with TMS, so patients can drive themselves to and from treatment. Many patients choose to get TMS during their lunch break in the middle of their workday,” says Dr. Brechtel.
“A lot of patients come in saying, ‘I’ve tried everything else, so why not this?’” says Dr. Adebogun. “But there’s often a lot of hesitation. They ask if it’s going to change their personality or if it will be painful. The answer is no. TMS is safe, and most describe the sensation as a tapping or pulsing on the scalp. One patient told me, ‘I’m scared this is going to be just another thing that doesn’t work, but I’m also scared to hope it might.’ “That kind of vulnerability is common,” he explains. “It’s part of why I find it so meaningful that adults have responded so well to this treatment. Because of that safety and success, TMS is now approved for adolescents as young as 15.”
The focus of the first session is determining the optimal motor threshold: the precise dose of magnetic stimulation each person requires. After that, daily treatment begins.
“With adolescents especially, we talk about how this isn’t a quick fix,” explains Dr. Brechtel. “They might feel frustrated when nothing changes right away, and we normalize that. The early phase is really about showing up consistently.” She adds, “An 18-year-old patient once said to me, ‘It doesn’t hurt, but there is a tapping sensation. Is it weird that I kind of like having something to do every day?”
Weeks 2–3: Routine Sets In—and So Do the Doubts
By the second or third week, most patients have fallen into a rhythm. Treatments last about 17 minutes. Some people listen to music or chat with our TMS technician, who is always present during treatment. Other patients choose to watch their favorite TV show or sit quietly.
However, emotionally, this is often the most challenging period.
Dr. Brechtel shared one patient’s sentiments at this stage of TMS treatment: “I’ve changed meds six times. I didn’t make this decision lightly. But I am here now, and I told myself if this doesn’t help, at least I’ll know I tried everything.”
“In my experience, about 50 % of my patients have mild improvement in anhedonia, which is the inability to experience joy or pleasure, a common symptom of depression,” explains Dr. Brechtel. “Patients start noticing that when they engage in an activity they used to enjoy, it seems tolerable and even mildly enjoyable. For most, at this point in treatment, they are not yet enjoying these things at the level they did before they were depressed, but there is a difference.”
Dr. Adebogun also weighs in, saying, “For some patients, this may be a point where patients start to feel frustrated. They ask, ‘Shouldn’t I be feeling better by now?’ We remind them that TMS is cumulative and that it’s more like physical therapy for the brain than a light switch you flip on.”
At this phase, some individuals report mild side effects, including scalp discomfort, headache, fatigue, or emotional flatness.
Week 4: Subtle Shifts and Quiet Progress
Then, often around Week 4, something shifts. Not dramatic. Not life-changing. But noticeable.
“We’ll hear things like, ‘I didn’t cry today,’ or ‘I got out of bed without a struggle,’” says Dr. Adebogun. “Patients are often surprised. The change isn’t always obvious until they look back and realize, ‘Oh, I’m functioning again.’”
Others describe moments of unexpected clarity, such as enjoying a song, laughing at a joke, or making plans for the first time in weeks.
“With adolescents and young adults, we hear things like, ‘I texted my friends again,’ or ‘I finished my homework early,’” says Dr. Brechtel. “Parents might say, ‘They’re smiling more.’ These are the small wins that indicate the treatment is working. One parent told me, ‘For the first time in months, I saw her laugh. Not a polite smile—an actual laugh.’ That moment stuck with me.”
It is important to remind patients that they may experience a mild to moderate improvement in motivation levels.
“I encourage them to take advantage of this TMS jump start and be mindful of any habits they may have fallen into during or before their depression, such as limiting screen time for entertainment to less than 1 to 2 hours per day,” shared Dr. Brechtel. “If possible, slowly start engaging in some form of physical activity and ideally increase to doing this 2 to 5 days a week. This is important because excessive screen time and a sedentary lifestyle correlate with worsening depression.
Weeks 5–6: Emotional Reconnection
By the final stretch of treatment, many patients begin to experience deeper emotional reconnection. Their mood may not be perfect, but it’s lighter. The fog lifts.
Dr. Brechtel recalls another patient experience. “A 47-year-old mother of three adolescents shared with me last month, after completing her sixth week of TMS, that TMS had changed her life. She was able to enjoy playing with her children and had enrolled in a pottery class. This was something she had thought of doing for years but could not find the energy.”
Dr. Adebogun relates with similar feedback. “A patient told me, ‘I actually care about my life again.’ That’s the kind of thing we hear. There’s more motivation, more participation in daily life.”
Some patients report deeper sleep, better focus, and a return of emotional range. For many, the black-and-white world of depression starts to show color again.
“One of my younger patients said, ‘I feel like I woke up,’” recalls Dr. Brechtel. “And that’s exactly what we want to hear. It means they’re reconnecting with themselves and their environment.”
Dr. Adebogun adds, “One of my adult patients put it this way: ‘I didn’t realize how long I had been surviving instead of living. Now I want to do things again. Not because I have to, but because I want to.’”
“A lot of our patients come in worn down, not just by depression, but by the process of trying to get better,” says Dr. Brechtel. “TMS offers a non-drug, non-invasive option after all that trial and error. When it starts to work, it’s incredibly validating.”
What Happens After TMS Ends?
TMS is not the end of the journey; it’s often the beginning of a new phase in the recovery process. Many patients continue with therapy or medication. Others come back for maintenance treatments later.
“We talk with each patient about what long-term support will look like,” says Dr. Adebogun. “TMS can reset the brain, but habits, relationships, and self-care still matter.”
“For adults as well as adolescents, this can be a launching point for healthy coping skills,” adds Dr. Brechtel. “We want to build on the momentum. A 38-year-old schoolteacher shared with me, ‘It didn’t fix everything, but it gave me enough energy to start fixing things.’ That’s success to me.”
Final Thoughts: You’re Not Alone in This
Depression that doesn’t respond to typical treatments can be incredibly isolating. It can make people feel like nothing will work for them. But treatment-resistant doesn’t mean untreatable, and TMS is one of the most promising options available for those who’ve already walked the hard road of medications and therapy.
If you’re considering TMS or supporting someone who is, know this: the path is real, the progress is possible, and the experience is shared—even if it looks a little different for everyone.
Interested in learning if TMS is right for you or someone you love?
Learn more about TMS at Geode Health
