Antidepressant medications and psychotherapy are the first line treatments for major depression. These treatments, however, do not work for all patients. In these instances, TMS might be used as an alternative treatment, or to augment antidepressant medications or psychotherapy. Patients who have failed to achieve an adequate response from antidepressants, or who are unable to tolerate medications, might consider and respond well to TMS therapy.

Because TMS uses magnetic pulses, before beginning a treatment, patients are asked to remove any magnetic-sensitive objects (such as jewellery, credit cards). Patients are required to wear earplugs during treatment for their comfort and hearing protection, as TMS produces a loud clicking sound with each pulse, much like an MRI machine. Patients are seated comfortably during each session of TMS.

During the first TMS session, several measurements are made to ensure that the TMS coil will be properly positioned over the patient’s head. Once this is done, the TMS coil is suspended over the patient’s scalp. The TMS technician then measures the patient’s motor threshold, by administering several brief pulses. The motor threshold is the minimum amount of power necessary to make the patient’s thumb twitch, and varies from individual to individual. Measuring the motor threshold helps the TMS Technician to personalise the treatment settings and determine the amount of energy required to stimulate brain cells.

Once the motor threshold is determined, the coil is then brought forward so that it rests above the front region of the patient’s brain. Treatment is then commenced. During the treatment, patients will hear a series of clicking sounds and will feel a tapping sensation under the treatment coil.

Motor threshold is not checked at every treatment but may be reassessed if there is concern it may have changed, for example, because of a change in medication.

At TMS Erina TMS is always prescribed by our psychiatrist Dr Mason or Dr Montanari. At TMS Erina, all TMS physicians and technicians have received training and are specifically credentialed in TMS. The initial motor threshold is always determined by a psychiatrist. The treatment itself is administered by an experienced TMS technician under the supervision of the TMS psychiatrist.

The TMS technician will monitor the patient during the treatment. The patient can stop a treatment at any time by asking the staff member present.

Each session lasts approximately 19 minutes using our standard protocol. There is a new treatment protocol available using Theta Burst which lasts 3 minutes, and may be suitable for certain patients if they are interested.

Patients receive TMS 5 days a week. A typical course of TMS is 4 to 6 weeks. However, this can vary depending on an individual’s response to treatment.

By treatment number 10 patients start noticing an improvement in mood. Most patients should have a good response after 20 treatments.  A more severe depression may require 30 treatments.

If you know you have a holiday or time away coming in the two to three months from starting treatment, just let your TMS technician know as the treatment has a gradual kindling effect so it is important not to miss more than a few days in the middle of your course. Your technician  can discuss with you what your best options are. We can do tapering towards the end of the treatment course if travel is essential.

Unlike ECT, TMS does not require any sedation or general anaesthesia, so patients are fully awake and aware during the treatment. There is no “recovery time”, so patients can drive home afterwards and return to their usual activities.

People undergoing TMS describe the ‘magnetic taps’ as irritating, but not painful. After a few sessions, patients often become used to this feeling.

TMS is well-tolerated and associated with few side-effects and only a small percentage of patients discontinue treatment because of these. The most common side-effect, which is reported in about a fifth of patients treated with TMS, is headaches. These are mild and usually settle over the course of the treatment. Over-the-counter pain medication can be used to treat these headaches.

You may experience tingling of the forehead muscles. These too tend to diminish over the course of treatment although adjustments can be made immediately in coil positioning and stimulation settings to reduce discomfort.

The TMS machine produces a repetitive noise and because of this earplugs are given to the patient to use during the treatment. Patients with tinnitus may be more sensitive to the noise of the repetitive pulse and may require headphones in addition to earplugs. No evidence suggests these effects are permanent if earplugs are worn during the treatment.

TMS is not associated with many of the side-effects caused by antidepressant medications, such as gastrointestinal upset, dry mouth, sexual dysfunction, weight gain, or sedation.

The most serious risk of TMS is seizures. However, the risk of a seizure is exceedingly low. At TMS Erina, we follow up-to-date safety guidelines that are designed to minimise the risk of seizures. While TMS is a safe procedure, it is important to point out that because it is a new treatment, there may be unforeseeable risks that are not currently recognised. These are discussed in detail with your TMS psychiatrist prior to treatment.

TMS is non-sedating.  Patients can drive after their treatments.

TMS and ECT are both forms of brain stimulation. They use different techniques to modulate nerve functioning. Both are more effective than medication but have very different side effect profiles. ECT uses electricity. TMS is a milder treatment using magnets. TMS does not involve the use of anaesthetic or chemical treatment and the patient is awake throughout the procedure. 

Unlike ECT, TMS is not associated with memory loss.

Neurofeedback is a method that has been extensively studied in the treatment of ADHD, sleep and epilepsy. However, there is very little controlled research done on the effects of neurofeedback on depression. For this reason, Neurofeedback cannot be seen as an evidence-based approach to treat depression. TMS is extensively studied in the treatment of depression and therefore has a greater chance of treatment success.

Contraindications are: 

• Epilepsy
• Cochlear Implant
• Stroke in the past 6 months
• Retinal Detachment
• Brain Shunt
• Pacemaker (relative contraindication) 

Patients can have metal fillings or metal bridges in the mouth and still have TMS.

Download Patient Screening Form

It is hard to predict who will respond to TMS and who will not. By treatment number 10 there is a clear differentiation into 2 groups-responders and non responders. Responders show a sustained reduction in depression scores. Non responders do not show decreased depression rating scores. Approximately 50-60% of patients receiving TMS  will be responders.

There is evidence for using TMS for anxiety using right sided low frequency treatment. Medicare funded TMS is only available for depression and has a bigger evidence base. For this treatment we use the standard left sided protocol.

There is a relapse risk on stopping medication. Combining TMS with medication is likely to give better results. Once a person has been well for 6-12 months then medication could be reduced and stopped. If a person is not tolerating medication and it needs to stop, then that should be done either slowly or with a cross taper to another antidepressant to minimise withdrawal symptoms.

For Medicare subsidised TMS, the following criteria must be met: 

• A person has depression that has not responded to 2 different antidepressants or to therapy.
• If a person has tried and cannot tolerate medication this is taken into account also.  

Before TMS treatment is commenced a thorough suitability assessment is conducted by the psychiatrists at TMS Erina.

TMS is offered at TMS Erina. Before scheduling you for treatment, you must first be evaluated by one of our TMS psychiatrists to determine if TMS would be safe and appropriate for you.

You will need a GP referral or psychiatrist referral to receive TMS treatment at our clinic. 

Should your GP wish to discuss the treatment with our Psychiatrist please use our contact number 02 4314 7000 or email us at admin@tmserina.com.au

Download GP Referral Form

Referrals can be faxed to 02 4314 7007 or emailed to admin@tmserina.com.au

Many people can continue their usual exercise routine during a course of TMS. Your treating clinician can provide individual advice if you have a medical condition, experience symptoms during treatment or plan strenuous activity.

Follow any instructions provided by the clinic and have your referral, relevant medical history and current medication details available. Contact the clinic beforehand if there have been recent changes to your health, medications or treatment plan.

Bring your Medicare card, referral information if applicable, a list of current medications and any relevant medical records requested by the clinic. The TMS Erina team can confirm what is required when your appointment is booked.

TMS does not usually require fasting. Unless your treating clinician has provided different instructions, you can generally eat and drink before attending. Ask the clinic if you have specific dietary or medical concerns.

Caffeine can affect people differently. Tell your treating team about your usual caffeine intake and follow any individual advice provided, particularly if your intake changes significantly during the treatment course.

Contact the clinic as soon as possible if you cannot attend. The team can discuss rescheduling and whether the interruption may affect the timing of the remainder of your treatment course.

A support person may be able to accompany you to the clinic, depending on clinic procedures and privacy considerations. Contact TMS Erina before the appointment so the team can explain what is possible.

Wear comfortable clothing and avoid bringing unnecessary magnetic-sensitive items. You may be asked to remove items such as jewellery, hair clips or other objects near the treatment area before the session begins.

Phone use may not be practical during treatment because you need to remain seated with the treatment coil correctly positioned. The TMS technician will explain what you can do safely during the session.

Allow time for check-in, preparation, treatment and any required discussion with the team. Appointment length can vary depending on the treatment protocol and whether measurements or reviews are needed.

Pregnancy or plans to become pregnant should be discussed with the treating psychiatrist before treatment. The clinician can consider the available evidence, your health and other treatment options when advising you.

Many dental fillings and dental restorations do not prevent TMS treatment. However, all implanted or metallic devices should be disclosed during screening so the psychiatrist can determine whether treatment is appropriate.

TMS produces a repetitive clicking sound and hearing protection is used during treatment. Tell the clinic about tinnitus, hearing loss or hearing devices before treatment so appropriate precautions can be discussed.

TMS does not involve general anaesthesia. Questions about memory, concentration or other cognitive symptoms should be discussed with the treating psychiatrist, particularly because depression itself can affect these areas.

Sleep may change for many reasons during treatment, including the underlying mental health condition, medication changes and daily routines. Tell the treating team about significant sleep changes so they can be reviewed in context.

TMS may require additional clinical consideration for people with bipolar disorder because treatment suitability and risks differ between individuals. A psychiatrist must assess the diagnosis, current mood state and treatment history.

Alcohol use should be discussed openly with the treating psychiatrist. Alcohol can affect sleep, mood, medications and seizure risk, so individual advice may be needed during a course of TMS.

Some medication changes can affect symptoms, treatment planning or safety considerations. Tell the TMS team about any prescription, over-the-counter or supplement changes before or during treatment.

Motor threshold testing helps the clinical team determine an individual stimulation level. Brief magnetic pulses are used to identify the minimum intensity that produces a small movement, which helps guide treatment settings.

Motor threshold may be reassessed if the treating team believes it could have changed, such as after a significant medication change or for another clinical reason. The team will explain when reassessment is appropriate.

Theta burst stimulation is a form of TMS that delivers magnetic pulses in a particular pattern. It may be suitable for some patients following psychiatric assessment and selection of an appropriate treatment protocol.

The treating team may use clinical reviews, discussion of symptoms and standardised rating measures to monitor progress. The way progress is assessed will depend on the treatment plan and individual circumstances.

Responses to treatment vary. If symptoms are not changing, the treating psychiatrist can review progress, confirm the treatment approach and discuss appropriate next steps based on the individual clinical picture.

At the end of a treatment course, progress is reviewed and the psychiatrist may discuss follow-up care, ongoing treatment and relapse-prevention planning as part of the broader mental health management plan.

Maintenance TMS refers to additional treatment sessions that may be considered after an initial course for some patients. Whether it is appropriate, and when it may be offered, depends on clinical assessment and applicable funding criteria.

Depression can be recurrent, and individual outcomes after any treatment vary. Ongoing review, medication or psychological care, lifestyle support and maintenance treatment may be discussed as part of relapse-prevention planning.

A further course may be considered for some people depending on their previous treatment, clinical circumstances and current Medicare or self-funding arrangements. A psychiatrist must assess suitability.

TMS is one treatment option within a broader mental health care plan. It may be used alongside other care depending on clinical advice. Do not stop or change medication or therapy without speaking with the treating healthcare professional.

A Central Coast GP can provide a referral for psychiatric assessment when clinically appropriate. The psychiatrist will then assess whether TMS is a suitable treatment option.

Contact TMS Erina or speak with your GP or psychiatrist about a referral. The clinic team can explain the referral, assessment and appointment process.

TMS Erina is located in Erina and is accessible to people living in Gosford, Terrigal and other Central Coast suburbs. Contact the clinic for directions, parking information and appointment availability.

Patients should contact TMS Erina for the latest parking and building-access information before their first appointment. This can make arrival easier and allow enough time for check-in.

Contact the clinic before booking if you have mobility or accessibility requirements. The team can provide current information about building access and discuss any assistance that may be needed.

A referral may be provided by an eligible GP or psychiatrist outside the Central Coast. Contact TMS Erina to confirm referral requirements and how supporting clinical information should be supplied.

With appropriate consent, relevant members of your treating team may communicate to support coordinated care. Ask TMS Erina how information sharing and consent are managed.

Availability of telehealth depends on the type of appointment, clinical requirements and current clinic arrangements. Contact TMS Erina to ask whether telehealth is suitable for your initial enquiry or assessment.

Personal and health information is handled in accordance with applicable privacy obligations and clinic policies. Ask the clinic how information is collected, stored and shared as part of your care.