By Madison Avenue TMS & Psychiatry - Published on June 30, 2025

Last updated on June 30, 2025

Whether you’ve heard about Transcranial Magnetic Stimulation (TMS) therapy, have done your own research on it, or already have your first session scheduled, you might be wondering, “What can I expect on my first TMS appointment?”  

In this article, Olivia Tween, TMS coordinator at Madison Avenue TMS & Psychiatry, guides you through the steps from before your arrival to after your first TMS treatment session, helping you feel more prepared and at ease. 

But first, let’s understand exactly what TMS is. 

Transcranial Magnetic Stimulation (TMS): A Noninvasive Alternative to Depression Treatment 

TMS is an FDA-approved, noninvasive treatment overseen by a medical practitioner. It uses painless magnetic fields to stimulate nerve cells in the brain. Studies show that TMS is particularly effective for treatment-resistant depression, but also works in treating other mental health conditions like anxiety, Obsessive-Compulsive Disorder (OCD), and postpartum depression.

For those who have not responded to traditional treatments for depression, like oral antidepressants, suffer from medication side effects, or are looking for less invasive therapies, TMS is a promising alternative. 

What to know before you arrive at your first TMS appointment

The night before your treatment

TMS is an outpatient treatment, with the first appointment typically lasting for about half an hour to an hour, so there’s no need to make special plans ahead of time. The night before treatment, Olivia shares that patients should go about their evening as usual. 

“Before your first appointment, it is recommended that you stick to your typical routine,” she says. “Get a good night’s sleep, take all your medications as usual, eat normally, and stay hydrated.” 

The day of your treatment

Patients can drive after TMS treatment, so they don’t have to arrange transportation for the day. 

On the day of your appointment, try to avoid wearing any metal jewelry or accessories on your head or in your hair. Some patients may want to bring earplugs depending on their sound sensitivity. Make sure to complete any paperwork required for the appointment and bring your ID, insurance card, or any other documents requested by your provider.

During your appointment 

Mapping Session

“Your first TMS appointment will likely begin with a mapping session,” says Olivia. “During this procedure, your provider will find the exact location on your scalp where the TMS coil should be positioned, as well as the appropriate level of stimulation for your brain.”

You’ll be seated in a comfortable chair and fitted with a positioning cap (similar to a swim cap), which will allow your provider to keep the magnetic coil properly aligned. The provider will then deliver short, single pulses of stimulation to different areas of your brain’s motor cortex to trigger small twitches in your thumb and fingers. “These subtle, involuntary movements help to determine your motor threshold, which is the minimum amount of stimulation required to consistently trigger a finger twitch,” says Olivia. The motor threshold determines the strength or intensity of the stimulation during treatment.

Once your treatment location and motor threshold are identified, that information is saved and used for future treatment sessions. Throughout your treatment course, your provider may occasionally perform a “re-map” to ensure that your motor threshold is still accurate.

Beginning the Treatment Session

After the mapping session, your provider will move the magnetic coil into the newly determined treatment location to begin your first TMS treatment session. Your provider should start the stimulation at a low intensity and increase gradually towards the target dose as you adjust to the sensation.

TMS treatment involves alternating between brief periods of rapid pulsing (2-4 seconds) and longer rest intervals (10-20 seconds), typically lasting around 15-20 minutes total. TMS does not require anesthesia or sedation, so you are awake and alert throughout the treatment.

“During stimulation, you will hear a clicking sound or tapping sound and feel a tapping sensation on your scalp,” says Olivia. “You may experience some initial discomfort during or immediately after the session, but this should decrease as you acclimate to the stimulation. Make sure you communicate with your provider about any intolerable sensations or side effects, such as scalp tenderness or headache,” says Olivia. 

After the Treatment Session

Immediately after treatment, you will be free to go about your normal daily activities, drive, exercise, go to school/work, etc. “You might have a mild headache, for which you can take over-the-counter pain relievers such as Tylenol or Advil,” says Olivia.

After your first TMS appointment, you’ll likely start daily treatment sessions (5 days a week) for 4-6 weeks. 

TMS therapy can be a turning point in your depression, especially if other treatments haven’t helped. Your first appointment is just the beginning, and although it may feel strange or unfamiliar at first, many patients report that it becomes routine very quickly. 

“Try to stick with it,” says Olivia. “It may take time to see improvements, but by committing to TMS treatment, you are taking a powerful step towards improving your mental health.”

Olivia stresses the importance of open communication with your TMS care team and encourages patients to feel comfortable asking questions at every stage of treatment. “A good TMS provider will always welcome your curiosity and work with you to address any concerns you may have about the treatment.”

To learn more or schedule a consultation with our team at Madison Avenue TMS & Psychiatry, call us at (212) 731-2033 or visit madisonavetms.com.

Madison Avenue TMS & Psychiatry