Frequently Asked Questions

Understanding TMS

1. What is Transcranial Magnetic Stimulation (TMS)? Transcranial Magnetic Stimulation (TMS) is a non-invasive, evidence-based treatment that uses gentle magnetic pulses to stimulate areas of the brain involved in mood regulation. It is FDA-approved for conditions such as Major Depressive Disorder (MDD) and Obsessive–Compulsive Disorder (OCD).
TMS is an out-patient procedure – there is no anaesthetic, no surgery, and virtually no systemic side effects. You remain awake and comfortable throughout each session and can return to normal activities immediately afterwards.

2. How does TMS work?
A small magnetic coil is placed against your scalp, usually over the left frontal region of the brain. The coil emits short, controlled magnetic pulses similar in strength to those used in MRI scanners. These pulses activate nerve cells that are underactive in depression, helping to restore healthy brain-circuit activity and, over time, reduce symptoms such as low mood and loss of motivation.

3. Is TMS the same as electroconvulsive therapy (ECT)?
No. TMS does not involve electrical currents, seizures, or anaesthesia. It is a modern neuromodulation technique that is precise, and well-tolerated, with no memory loss or cognitive impairment.

Suitability & Effectiveness

4. Who is a good candidate for TMS?
TMS may be appropriate for people who:

• Have not achieved adequate relief from antidepressant medication or psychotherapy

• Experience unwanted medication side effects, or

• Prefer a non-drug, non-invasive alternative.

It is particularly effective for treatment-resistant depression. Your initial consultation will include a full psychiatric assessment to ensure TMS is suitable and safe for you.

5. How effective is TMS?
International studies show that around 60–70 % of patients with treatment-resistant depression experience a significant improvement in symptoms, and many achieve full remission. Results can be long-lasting, especially when supported by maintenance sessions and continuing psychological or pharmacological care.

6. How soon will I see results?
Depending on the scheduling, people may notice early mood or energy improvements within 1–2 weeks. Improvement often continues even after the full course has finished.

7. How long do the benefits last?
For many, improvement lasts six months to a year or longer. If symptoms return, booster sessions can be arranged to help maintain stability.

8. What if TMS does not work for me?
If adequate benefit is not achieved, options may include a second course of TMS, medication adjustment, psychotherapy, or other advanced treatments such as tDCS (transcranial Direct Current Stimulation). We can discuss the next best evidence-based step.

Safety & Comfort

9. Is TMS safe?
Yes. TMS has been approved for clinical use for almost two decades and is supported by extensive research, NICE (National Institute for Health and Care Excellence) guidance, and international safety standards. The most common side effects are mild headache or scalp tenderness, which usually resolve as treatment progresses.
Serious adverse events are extremely rare (the risk of seizure is approximately 0.01-0.1% in people without a seizure disorder).

10. Does TMS hurt?
Treatment is generally not painful and the intensity can be adjusted to keep you comfortable. Typical sensations include:

• A rhythmic tapping or tingling on the scalp,

• Mild pressure beneath the coil,

• Occasional facial muscle twitches

• A clicking sound from the device (earplugs are provided although most patients do not feel they are necessary).

These sensations stop immediately when the stimulation ends.

12. What do patients usually feel after treatment?
Most people feel normal and resume their day straight away. Occasionally, there may be brief scalp sensitivity or a mild headache, easily managed with simple pain relief (e.g. paracetamol) if required.

13. Are there any medical conditions that make TMS unsuitable?
TMS is not recommended for individuals with certain metal implants or devices in or near the head (for example, aneurysm clips, cochlear implants, or deep-brain stimulators). Dental fillings and braces are fine. Uncontrolled epilepsy is another contraindication. Your full medical and surgical history will be reviewed beforehand.

Treatment Process

14. What happens during a TMS session?
You will sit comfortably while a trained clinician positions the magnetic coil. Treatment involves short bursts of magnetic pulses delivered over several minutes. You can relax, listen to music, or rest during the session.

15. How long does each session take?
The length of treatment sessions varies. Traditionally a session took around 20–30 minutes per day over 4-6 weeks but modern (accelerated) TMS can be delivered over a much shorter period of time, meaning that multiple treatments are possible each visit. This means that the course of treatment can be as little as 2 weeks. A full discussion of the treatment schedule will be part of the treatment planning.

16. Can I drive or return to work after treatment?
Yes. TMS does not cause drowsiness or affect alertness, so you can safely drive, work, or continue normal activities immediately afterwards.

17. Do I need to bring anything or prepare in advance?
No special preparation is required. You can eat, drink, and take your usual medication as normal before and after sessions.

Medication & Combined Care

18. Do I need to stop medication or therapy while having TMS?
No. Most patients continue their existing medication and psychotherapy during treatment. TMS can complement other treatments and often enhances overall wellbeing.

19. I would like to come off medication – can TMS help?
TMS may allow some people to reduce or discontinue antidepressants once they are stable, but this varies by individual. Any change to medication should be gradual and made only in consultation with your treating psychiatrist.

Types of TMS

20. What type of TMS does Dr Simon Mitchell offer?
Dr Mitchell provides repetitive Transcranial Magnetic Stimulation (rTMS), the most widely used and researched form of TMS. It targets the outer layers of the brain involved in mood regulation, with strong evidence supporting its safety and effectiveness for depression and other mood disorders.

Practical Details

21. How much does TMS cost? Is it covered by insurance?
Fees depend on the number of sessions and protocol used. A typical course of TMS involves 30 treatments, with each treatment costing 200 euro, for a total of 6000 euro.   TMS is not yet covered by the public health system in Ireland, but some private insurers may offer partial reimbursement. We can provide detailed quotes and supporting documentation for insurance claims. Up to 20% of the cost of TMS can be claimed against tax.

22. Why choose Dr Simon Mitchell for my TMS treatment?
Dr Mitchell is a Consultant Psychiatrist with specialist expertise in TMS and mood-disorder management. He is a former Medical Lead for Mood Disorders in Cambridge, a Member of the International Clinical TMS Society and an adjunct Clinical Associate Professor in University College Dublin. His clinic provides personalised, evidence-based care in a calm, professional environment, ensuring that every patient receives a tailored treatment plan and ongoing support.

23. Do I need a referral to begin TMS?
A referral from your GP or psychiatrist is the best pathway to ensure a coordinated approach to your care as well as providing important background on your physical health and medications.

24. Where is the clinic located and how can I book?
Appointments can be made by phone or email. The clinic is located in Dr Mitchell’s rooms in St John of God Hospital, Stillorgan, Co. Dublin. There is on-site parking and it is well served by public transport.

Key Takeaways

• Non-invasive, drug-free, and office-based treatment

• No anaesthetic or downtime

• High success rate for treatment-resistant depression

• Well-tolerated with minimal side effects

• Return to normal activities immediately after each session