How TMS works
Transcranial magnetic stimulation (TMS) is a non-invasive treatment for depression and several other conditions. TMS involves using small electromagnetic fields to stimulate different parts of the brain. The TMS coil is placed on the scalp to specifically target a part of the brain for treatment of a specific condition.
The electromagnetic energy directed at the brain has been shown to improve ‘plasticity’ (connections between brain cells) and increase levels of neurotransmitter molecules which are deficient in depression, anxiety, pain and other conditions.
TMS doesn’t involve any drugs or sedation. Nothing is placed inside the body. TMS avoids the side-effects associated with antidepressants.
TMS involves stimulation of nerve cells by using focal magnetic impulses. During a single session, a patient receives thousands of stimulations directed at specific targets in the brain depending on which condition is being treated. When this occurs, brain cells change their activity. This results in safe, non-invasive, long-lasting change.
TMS has been studied for over fifteen years, involving research centres worldwide. Evidence has shown TMS to be a safe and effective treatment for drug-resistant depression. This has led to Medicare funding TMS treatment for this condition.
TMS has also shown to be effective in other mental health conditions such as anxiety, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).
TMS is also used to treat pain conditions including fibromyalgia, and peripheral pain syndromes, post-stroke recovery, and neurological conditions such as chronic migraine, and tinnitus.
There is ongoing research into how TMS can be applied to several other conditions. These findings will broaden the application of TMS in the future.
TMS is completely drug-free and non-invasive. This removes the risks associated with traditional therapies like anti-depressant medications and electroconvulsive therapy. TMS does not have any withdrawal side-effects.
TMS may cause scalp discomfort or headache during treatment. Usually, these symptoms resolve quickly without any medication. Scalp discomfort can be decreased by adjusting the TMS coil and is usually only present for the first treatment session. If needed, over-the-counter painkillers are usually effective to resolve lingering headache.
Very rarely, TMS can cause seizures in people who are already pre-disposed. Seizures due to TMS tend to be short-lived and resolve spontaneously. All patients are carefully assessed for risk of seizure prior to being offered TMS treatment.
For depression, TMS has approximately 60% efficacy in patients who have failed multiple antidepressants. Of these patients, 71% remain in remission after 1 year. In patients who are not treatment-resistant but are highly sensitive to medication, the efficacy is approximately 80%.
Reference: Camila Cosmo, Amin Zandvakili, Nicholas J Petrosino, Yosef A Berlow, Noah S Philip. Repetitive Transcranial Magnetic Stimulation: Recent Critical Advances in Patient Care. Current Treatment Options in Psychiatry. 2021 Mar; 8:47-63.
Our website contains a lot of information about TMS. We also have an information brochure specifically for GPs and other doctors. You can find it by clicking here.
ECT (Electroconvulsive therapy) and TMS (Transcranial Magnetic Stimulation) are not the same. While both come under the overall category of “Neurostimulation,” they are actually quite different.
ECT uses an electric current to specifically cause a seizure. When a person experiences a seizure it is thought that there is a large dump of neurotransmitters (seritonin, noradrenhaline and dopamine) resulting in the “hitting of a reset button.”
TMS on the otherhand uses a focal magnetic field to penetrate the skull and stimulate the nerves of the brain. This stimulates both growth and healing. Unlike ECT, we do NOT want to cause a seizure.
ECT is usually done as an inpatient in hospital. It requires sedation that this overseen by an anaesthetist. ECT if often saved by patient with severe catatonic depression or psychosis. TMS, unlike ECT is not associated with cognitive side effects such as memory loss.
Our Other Services
Dr Wick sees limited patients for adult ADHD management, and provides a comprehensive diagnostic process and management plan. Wait times for ADHD assessments may be longer than for TMS and general psychiatry in order to see those patients requiring urgent attention in a timely manner.
Adult ADHD assessment and management is billed separately from general psychiatry and TMS services. Please contact us for a comprehensive fee schedule.
Yes, we are able to offer Telehealth appointments if required. As per our COVID safety policy, if you are experiencing any symptoms of COVID or feeling unwell, we ask that you do not attend the clinic in person. We are happy to reschedule your appointment or offer a Telehealth appointment instead. We use Zoom, FaceTime or our own videoconferencing software to connect to you.
Here are some great resources to help support your mental health (please remember, if you are concerned about an urgent threat to life, call 000 immediately):
National organisation raising awareness about depression, anxiety and suicide prevention
Phone: 1300 224 636
Black Dog Institute
NSW-based mental health research institute with a wide range of online resources about depression, anxiety and suicide prevention.
Brother to Brother
A 24-hr crisis hotline to assist Aboriginal and Torres Strait Islander men of all ages in crisis. This service was started by Dardi Munwurro and is staffed by Aboriginal people including Elders.
Ph: 1800 435 799
A not-for-profit organisation for law enforcement, national security and first-responders dedicated to improving mental health.
Head to Health
A website by the Australian Government that helps people find digital mental health resources which can cater to their individual needs.
A counselling service available to young people from 0-25 years old, confidential and available 24/7.
Ph: 1800 551 800
A 24/7 crisis support and suicide prevention service.
Ph: 13 11 14
Neuralia TMS specialises in transcranial magnetic stimulation, with a vision of expanding our services to offer further innovative treatments for mental health in the future.
Dr Wick also sees patients for general psychiatry management and adult ADHD at our Palmyra and West Leederville (Pax Centre) locations. Referrals for general psychiatry and adult ADHD management can be done using our secure online referral form.
My TMS treatment
The duration of each TMS session is 30 minutes. This includes 19 minutes of treatment time, plus time to conduct safety checks and ensure any concerns are dealt with by our staff.
A standard treatment course is usually 35 sessions delivered up to 5 days a week.
Duration of treatment is individual based on how quickly patients respond to therapy, and their availability around work and other commitments. However, it is important to have TMS sessions frequently in order to gain the full effect of treatment. Having less frequent treatments increases the possibility of the treatment not working.
No, you do not require an MRI prior to your initial review with the TMS psychiatrist. If further tests are required, the psychiatrist will discuss them with you during your appointment.
Please see your GP or other medical practitioner for a referral to our service. In order to be eligible for a Medicare rebate for treatment-resistant depression, we need a referral from a GP or psychiatrist.
If you are a medical practitioner who wishes to refer a patient, please see our ‘Referrals‘ page for options on how to refer to us.
If you would like to discuss the suitability of a referral or any details of the treatment please call 6230 3996 or email email@example.com
The wait-time for our initial assessment with our TMS Psychiatrist is 1-2 weeks from receival of the referral. Our team at Neuralia TMS will aim to get you seen as soon as possible. If you need to be seen urgently, please ask your referring doctor to contact us directly.
As aTMS course requires very frequent treatment sessions, we can offer you an initial review and mapping session in advance of commencing treatment. This is to allow for arrangements to be made with work or other commitments so that you may attend your daily treatment sessions.
Your GP/psychiatrist will refer you to us for TMS therapy. A team member will contact you to book your first appointment.
2. INITIAL REVIEW & TMS PRESCRIPTION
Our TMS Psychiatrist will have an in-depth review with you to ensure you are safe to proceed, obtain informed consent and prescribe the appropriate TMS therapy protocol.
3. MAPPING & RESTING MOTOR THRESHOLD
Our TMS Psychiatrist and TMS Technician will perform mapping and determine the RMT prior to the first treatment session. This can be done in advance or on the same day as the first treatment session.
4. ACUTE TREATMENT PHASE
You will receive TMS up to 5 times per week for 20-30 sessions, delivered by our TMS Technicians. During this time, we will regularly check to see if you’re responding well to treatment.
5. ONGOING TREATMENT PHASE
Our TMS Psychiatrist will review you and assess the need for further TMS sessions (up to 35 total if under Medicare).
Our TMS Psychiatrist will write a detailed treatment summary on discharge. If required, you may have maintenance therapy at a reduced frequency.
TMS will not be provided if a patient has more than 2 standard drinks 24 hours before a treatment session. This is because alcohol can influence the effectiveness, tolerability and safety of the TMS treatment. Please notify your doctor or TMS nurse if you believe this will be an issue.
Yes, you can drive, work, study or do anything that you would do normally. There are no limitations or restrictions on what you can do. There is also no need for any fasting before treatment.
Most of our patients remain on their antidepressants while having TMS. Even if your antidepressant has not been sufficiently effective, TMS can work synergistically and improve the overall outcome of the medication therapy. However, many of our patients elect to be drug-free and thus commence TMS without antidepressants.
TMS is not painful or invasive.
TMS is felt as a rapid tapping sensation over the scalp. This sensation lasts for 4 seconds, after which there is a 11 second gap. This cycle continue for a total of 20 minutes. During this time feel to watch Netflix in our treatment room, listen to music, sit quietly or chat with our TMS nurse.
If the tapping sensation feels too strong, we simply reduce the intensity. The sensation tends to be variable and depending on an individual’s scalp sensitivity and the stimulus dose.
Our TMS rooms have televisions and music within the treatment room. As such you are free to watch TV (Netflix), listen to music, sit quietly, relax or chat with your friendly Neuralia nurse. If you happen to fall asleep, our nurse will monitor whether your head has moved to ensure coil positioning is optimal.
No, you do not. Rather, we recommend not making any changes to your mediction prior to commencing TMS. This allows us to more clearly ascertain the cause of any of your improvements. Often patients who respond well to TMS do end up coming off their medication.
Please note: this is general advice and your TMS psychiatrist may provide different advice depending on your personal circumstances.
If you are being seen at Neuralia TMS only for TMS treatment, then it is unlikely that the doctor will prescribe any medications for you. Your GP/psychiatrist will continue to manage your medications.
If you are being seen as a general psychiatry patient, then medication may be a part of your treatment. If you would like to be referred for psychiatry review by Dr Wick, please look at our General Psychiatry Services page. Your GP can use our online referral form for general psychiatry referrals in addition to TMS referrals.
Some, but not all patients will be offered maintenance TMS. Maintenance sessions occur on a less frequent basis eg. weekly for 4 weeks, fortnightly for 8 weeks, then monthly.
Maintenance TMS aims to maintain the results achieved from the treatment course.
The decision to continue with maintenance TMS will depend on your response to the acute TMS course and your preferences. You can discuss ongoing TMS sessions with the psychiatrist during your reviews.
Clinic Policies and Costs
A complete TMS treatment course involves 3 reviews with a psychiatrist, an initial mapping session and 35 treatment sessions.
Reviews with TMS psychiatrists at our partner clinics are billed according to the policies of our partners.
All reviews with the TMS psychiatrist at Neuralia TMS Palmyra are bulk-billed, so there is no out-of-pocket cost.
TMS mapping sessions are a once-off cost of $220. For Medicare eligible patients, the maximum out-of-pocket cost of a mapping session is $61.55.
TMS treatment sessions cost $180. For Medicare eligible patients, the maximum out-of-pocket cost of a treatment session is $44.
These costs will drop further if you exceed the Extended Medicare Safety Net (ESMN) threshold. You can check if you will exceed your EMSN threshold by logging into your Medicare account on myGov.
TMS for treatment-resistant depression will be offered under Medicare from 1st November 2021. This means that for eligible patients, Medicare will pay back a portion of the cost of treatment.
In comparison to long term treatment with a private psychologist and psychiatrist, TMS is a cost-effective therapy for mental health conditions.
TMS is covered by DVA for White and Gold Card members. DVA White Card members will require coverage for mental health conditions under their agreement.
TMS can be covered under WorkCover WA. If you would like to receive TMS under WorkCover or DVA White Card, we are happy to assist you with making enquiries and providing documentation to support your claim.
Please contact us via email at firstname.lastname@example.org if you have any questions regarding TMS treatment with DVA or WorkCover.
Studies have shown that the best results occur when patient have treatments 5 times a week (for a 19 minute session). If the occasional session needs to be skipped, this is unlikely to greatly impact treatment effect. If patients simply cannot attend 5 times a week, we can discuss a reduced frequency of 3-4 days a week.
The number of total treatments required is variable and individual. Most people require approximately 20 sessions. Some people require up to 35 sessions or more. Medicare currently cover up to 35 sessions for treatment resistant depression.
That is ok. Missing the occasional session will not be deterimental. However, missing many treatment sessions in a row is less than ideal and will result in decreased effectiveness of the treatment. If you are sick, it is important that you contact us on 6230 3996 or via email at email@example.com
In order to protect our staff and patients, we will screen everyone daily for COVID-19 symptoms. We ask that you do not come for your treatment sessions if you have any respiratory symptoms, fever or loss of sense of smell. We will also be complying with mask-wearing and sanitising procedures as per the WA Government guidelines.
- We understand that sometimes your schedule changes unexpectedly.We ask for 1 or more business days’ notice prior to a cancellation or rescheduling.If an appointment with the psychiatrist is cancelled with less than 2 business days’ notice, we charge a cancellation fee of $120.For TMS appointments cancelled with less than 24 hours notice on a business day (prior to the weekend for Monday appointments), we charge a cancellation fee of $50.We cannot rebook your appointment until the cancellation fee is paid.Our staff are happy to work with you to arrange your appointments to suit your schedule as much as possible.Please note: our cancellation policy does NOT apply if you cannot attend because you have tested positive for COVID-19, are awaiting a COVID-19 test result or have been told to self-isolate. Please contact us immediately and we will assist you in rescheduling your appointments.
Neuralia TMS is a private billing service. We bulk-bill TMS reviews with the doctor only.
Reviews for General Psychiatry, ADHD, report writing or other assessments are privately billed. Patients who are eligible for Medicare/DVA will receive a rebate towards the cost of their appointments.
We aim to provide a high quality service, which involves a lot of work ‘behind the scenes’ by our doctors, nurses and admin staff after our patients have left. In order to do this, we need to bill appropriately. Public mental health services are completely bulk-billed but may have extended wait times.
If you are an existing patient experiencing financial difficulty, please contact us so we can work with you to offer support and options.
If you would like a detailed breakdown of our fees, please contact us by email or phone. Your fees may vary depending on your circumstances and previous medical history.