Service · Coming soon
TMS
Transcranial magnetic stimulation: a non-medication treatment for depression that hasn't responded to antidepressants.
Not available yet. Dr. Nguyen expects to add TMS at Voyager within the next year. This page explains what it is and who it tends to help, so you know whether it's worth waiting for. Until then, we can start with the care that's available today.
What it is
Transcranial Magnetic Stimulation
TMS uses focused magnetic pulses, the same kind used in an MRI, to stimulate a region of the brain involved in mood regulation. A small coil rests against the scalp and delivers those pulses in short bursts. Over a course of treatment, the aim is to shift the activity of a circuit that tends to be underactive in depression.
It is non-invasive, and it does not involve anesthesia or sedation. You stay awake and alert throughout, sitting in a chair, and you can drive yourself home and go back to your day afterward.
Because the pulses are applied to one area rather than travelling through the whole body, TMS avoids the systemic side effects that lead many people to stop taking antidepressants, such as weight change, sexual side effects, or stomach upset.
TMS is FDA-cleared for major depressive disorder in adults who have not responded adequately to antidepressant medication. It is one option among several, not a replacement for therapy or medication, and it tends to work best as part of a plan that still includes them.
Who it's for
Is this worth waiting for?
TMS is usually considered when:
- Depression hasn't lifted after one or more adequate antidepressant trials
- Medication helps somewhat, but not enough, and the next step isn't obvious
- Side effects have made it hard to stay on a medication long enough to know whether it works
- You'd rather try a non-medication option before adding another prescription
- You're looking for something to pair with therapy rather than replace it
Whether TMS is a good fit is a clinical decision, not a checklist. It starts with a full psychiatric evaluation, which is something we can do now.
Another option, for when the usual ones haven't been enough.
What to Expect
What a course looks like
TMS is a course of treatment rather than a single appointment. In general:
- Sessions are done in person. Unlike the rest of our care, TMS can't be delivered by telehealth
- A standard course runs five days a week for roughly four to six weeks, followed by a short taper
- Individual sessions are short, and you sit in a chair, awake, the whole time
- The first session includes mapping, so it takes longer than the ones that follow
- You can drive yourself home and return to work, school, or your usual routine right after
- We track your symptoms through the course, so progress is measured rather than guessed at
The daily schedule is the part most people underestimate. It's worth thinking through before committing, and we'll talk it through honestly with you.
Safety
Side effects and safety
The most common side effects are discomfort at the treatment site, often described as a tapping or knocking sensation, and headache. Both are usually mild, and they tend to settle within the first week as you get used to the sessions.
Seizure is a known but rare risk, and the screening beforehand is designed to identify anyone for whom that risk is higher. TMS also isn't appropriate for people with certain non-removable metal implants in or near the head, which is another thing that screening covers.
None of this is a decision you make alone or on the day. We go through the risks, the alternatives, and the reasons for and against, and you decide.
FAQ
Frequently asked questions
Dr. Nguyen expects to offer TMS within the next year. We'd rather not put a firm date on it until everything is in place. If it's something you're interested in, mention it at your consult and we'll keep you posted as it gets closer.
You sit in a chair, awake, with a coil resting against your head. Most people describe a tapping or knocking sensation on the scalp during the pulses. There's no sedation and no anesthesia, and you can drive yourself home afterward.
No. TMS needs the device and a trained operator, so the sessions have to be in person. Everything around it, including the evaluation, the decision, and the follow-up care, can still happen by telehealth.
Not automatically. TMS is often done alongside medication and therapy rather than instead of them. If it turns out a medication is no longer earning its place, that's a separate, deliberate conversation, and we'd handle it as a planned taper.
Many plans cover TMS for depression once specific criteria are met, which usually means documented antidepressant trials that didn't work well enough. Coverage and prior-authorization rules vary by plan, so we'll confirm what yours requires before anything starts. See Insurance & Fees.
Keep Exploring
Available now at Voyager
Ready when you are.
Start with a free, no-pressure phone consult, and we'll figure out the right next step together, whether that's TMS later or something we can begin now.
In a crisis? Call or text 988, call 911, or go to your nearest ER. Voyager does not provide emergency services. Crisis resources.