If you are considering rTMS treatment for depression, one of the most common questions is what the process looks like once treatment begins. Repetitive transcranial magnetic stimulation, often called rTMS or TMS, uses magnetic pulses to stimulate targeted areas of the brain involved in mood regulation. The Royal Australian and New Zealand College of Psychiatrists notes that rTMS for major depression should be delivered in suitable clinical settings, using appropriate protocols, trained staff and TGA-approved equipment.
Most people want to know how many sessions are involved, whether they can keep working, when they might notice changes, and what happens after the course finishes. The exact plan varies from person to person, but the week-by-week outline below gives a clear guide for general readers.
Key Takeaway: What is the usual rTMS treatment timeline?
A typical rTMS course for depression is planned over several weeks. An initial course will consist of 30 sessions when provided by, or on behalf of, a psychiatrist trained in rTMS.
A treatment timeline may include:
- Referral from GP or psychiatrist
- A suitability assessment
- Brain mapping
- Regular sessions across several weeks
- Progress review during the course
- An end-of-treatment review
- Follow-up or retreatment if symptoms return
Some are generally around 30 minutes, depending on the type of TMS being used.
If you are wondering what to expect during TMS therapy, note this timeline:
Before week 1: Assessment and planning
Before treatment begins, the clinical team will require a referral from your GP or psychiatrist. The TMS staff will then organize an assessment and provide checks to determine if rTMS is suitable. This usually includes a review of symptoms, diagnosis, previous treatments, medical history and safety factors. People with certain implanted metal or electronic devices may need extra consideration and consultation before TMS treatment is recommended.
This stage also gives patients time to ask questions. How often are appointments? Can sessions fit around work? What should happen if mood changes during the course? A good assessment should make the plan clear before treatment starts.
For eligible Australian patients, referral pathways and Medicare rules may also be discussed.
Week 1: Getting used to the treatment process
The first week is usually about setup, comfort and routine. During one of the the first appointments, the TMS psychiatrist will carry out a mapping session to identify the treatment area and set the custom treatment program. Patients often describe the mapping session as a tapping sensation or pulsing on the scalp. The machine may make a clicking sound during stimulation.
Common early effects can include:
- Mild scalp discomfort or irritation
- Headache
- Temporary facial muscle twitching during stimulation
- Tiredness after a session
- Feeling uncertain because the process is new
These effects are usually discussed before treatment starts. Many people can return to daily activities after a session, although individual advice should always come from the treating clinician.
Patients will also be asked to complete some scales to provide an insight into how they are feeling at the start of the treatment.
Week 1 is less about dramatic change and more about becoming familiar with the setting, the staff and the rhythm of appointments.
Weeks 2 to 3: Building a routine
By the second and third weeks, sessions often feel more predictable. Patients will quickly realise the routine of the treatment and a better sense of how treatment fits into their day. Some people notice small changes in mood, sleep, energy or motivation. Others feel little difference at this stage.
That does not always mean treatment is failing. Clinicians usually monitor symptoms across the full course rather than judging progress from one session or one difficult day. Depression can shift unevenly.
During this period, it helps to keep notes on:
- Mood changes
- Sleep quality
- Energy levels
- Appetite
- Concentration
- Side effects
- Missed sessions or schedule changes
This information gives the treating team a clearer picture than memory alone.
Weeks 4 to 6: Reviewing progress
The later weeks are often when progress reviews become more focused. During the midway point of the treatment course the patient will complete another round of scales. The TMS psychiatrist will provide a review and discuss progress with the patient. The clinician may compare current symptoms with the starting point and ask about daily function, not just mood scores. Are mornings easier? Is work less overwhelming? Has social withdrawal eased? These details can matter.
After treatment: Follow-up and maintenance
After the main course ends, patients will have a review. This may cover symptom improvement, side effects, relapse risk and ongoing care. Some people do not need further sessions for some time. Others may be considered for retreatment or maintenance care if symptoms return.
Follow-up matters because depression care rarely ends on the final appointment. A practical plan may include monitoring symptoms, staying connected with treating clinicians, and acting early if warning signs come back.
Can you work, drive and keep your routine?
TMS therapy in Sydney does not usually require general anaesthesia, and many patients attend appointments as outpatients. That can make it easier to plan sessions around normal routines.
Still, scheduling takes commitment. A course will involve frequent weekday visits, so patients should think about travel time, parking, work flexibility and support at home.
How to know if rTMS is right for you
rTMS is not suitable for everyone, and it should not be chosen based only on a timeline. Suitability depends on diagnosis, treatment history, safety screening and clinical judgement. For people with depression that has not improved enough with other treatments, rTMS may be worth discussing with a qualified clinician.
A clear assessment can help answer the most personal question: not only “How long does TMS take?” but “Does this treatment make sense for me?”
Frequently Asked Questions
How long does rTMS treatment take?
A course often runs over several weeks, with regular sessions scheduled during that period. A course typically has 30 sessions for eligible patients. Each session taking on average 30 minutes.
When does rTMS start working?
Response varies. Some people notice shifts in sleep, energy or mood midway through the treatment. Others need almost a full course to notice a difference. Clinicians usually assess progress across the whole course rather than after one or two sessions.
What happens during the first TMS session?
The first session may include mapping, setting the custom treatment program and explaining what the treatment will feel like. Patients may feel tapping on the scalp and hear clicking sounds from the machine.
Can I drive after TMS therapy?
Many people return to normal activities after a session, but personal advice should come from the treating clinician. If you feel tired or unwell after a session, let the clinic team know and ask them for advice before driving home.
Do I need maintenance TMS?
Some people may need follow-up or retreatment if symptoms return. Others may not. The decision depends on your response, relapse risk and clinician’s advice.
Considering rTMS treatment and want to know whether it may be suitable for you? Contact Sydney TMS to book an assessment and learn what to expect before starting TMS therapy.
