Day Seven
The power of the train/pulse has to be at 120% by the 2nd week to make the treatment as effective as possible; if you don't make it that's okay. Your goal will continue to be to raise power until you reach 120%. If its not at 120% [in two weeks] that isn't automatically bad it just means TMS is not as effective as fast as if you were at full power. My appointment went very smooth, we started at a lower power [110] than I finished at yesterday, then transitioned to 115% a little later. We tried full power [120] but it was slightly too strong for me so I decided to stay at 115 for today. I had no issues with hand movements. Me and the TMS tech chatted during the treatment and finished a show I was watching. After 20 minutes we transitioned to low frequency cycle and I recorded it. After that I answered the daily questions because we forgot in the beginning. The only things that impact treatment are: sleep quality and amount, meds/medication changes, drinking alcohol recently, using more weed than normal, not eating, and drinking more coffee than usual- they impact your motor threshold [MT] which is checked at the 1st and ~15th appointment. The first time I did TMS, I noticed a lot of mild changes around Day 7 so I am very excited to write down any benefits I have noticed. Since starting TMS, I have had less anxiety attacks and have slept better and have had a slightly better mood generally. My self harming urges have also calmed down. I have also been a lot more social and had more energy/less fatigue. 
Today I wanted to discuss and dispel some misconceptions about TMS, what it is, and what it does.
"TMS is a brain treatment, will it change your personality?" No, TMS is not like brain surgery, and wil not change any aspect of your personality. It specifically targets the part of your brain that leads to depression or anxiety [depending on what you are having treated] not the entire brain, and its not invasive.
"Is there a change you could loose your memories?" No, TMS is safe and does not have life changing side effects like this. The most serious side effect for the brainsway machine is a seizure, and that occurs in 0.1% of patients. There are also steps the TMS technician takes to reduce the risk of seizures. The neurostar machine had no recorded cases of seizures.
"Does the relief from TMS last forever?" ait certainly can! Many patients [over half] get full remission from TMS and don't need a second round or further treatment. However, if you don't get full remission the average length of relief is one year [but it could be longer/shorter] and if you do TMS therapy again, or try a maintenance dose, your chance of remission increases!
"Is TMS the same as electro-shock therapy/ECT?" No, TMS therapy uses MRI- strength magnets, not electricity, to stimulate or subdue areas of the brain.
"Can I stop my SSRIs when/after I do TMS therapy?" This is on a case by case basis and you should consult your psychiatrist/prescriber and therapist before stopping your medication. Many people take fewer SSRIs or lower their dose after completing TMS therapy. I was able to completely go off of antidepressants after my first full treatment! Personally, I decreased my meds half way through my first full treatment and fully stopped them after my first round of treatment had finished.
Here are some good articles to read! 6 myths of TMS debunked and 8 myths about TMS addresses also this commonly asked questions TMS
Today went well, I did most of my treatment on full power and hardly noticed it changed. We watched more unsolved mysteries of Netflix [which I highly recommend] and low frequency went well. A normal treatment consists of 3,000 pulses from the coil. Even though TMS therapy uses magnets that are MRI strength, you can use your phone during treatment [unlike an MRI!] The day after this session, my mood and energy were really good [even though a lot is going on personally] so I feel like that's a good sign that it is working!
Day Nine:
Today I woke up and felt the intended changes of TMS, and continued to benefit from elevated mood & easier emotional regulation throughout the day. Today we did a Motor Threshold check, which is a fairly simple process where the tech will tell [with a different coil placement than during treatment] to make sure that the power is as effective as it can be. Here is how it was explained to me: the motor threshold is your ability to withstand the theraputic impacts of TMS, and its almost like a multiplier. If your MT is low, having a higher power is what makes the total output 120% and if your MT is higher [relatively] the power can be lower and it will have the same impact! It works kind of the opposite of a drug/substance tolerance, where the higher the tolerance the more substance [in this case amount would be power output] you need to get the same overall effect as somebody with a low tolerance taking a smaller amount. When I do TMS I respond fairly fast- the same day and the next day- but when I was talking to my tech I learned that its normal to feel the impacts of TMS the week of treatment or even the week after! So if you are doing TMS and don't feel changes right away, don't worry!
Day Ten:
Today went very well! We did a quick check to make sure the power was at the right setting and ended up lowering it slightly, and then continued on like normal. Motor threshold checks, like I did yesterday, happen about once a week and you will also do cortical mapping on your first day and re-mapping half way through treatment. We discussed how my re-mapping is coming up, because I've been struggling to sit up as tall as I need to be aligned. We ended up using a seat cushion they had to make me taller! Also I will explain the physical alignment of the neurostar. In my photos you may see some metal pieces that align either parallel or perpendicular to my head, and these help the TMS technician get my head aligned so the coil can be in just the right place. A laser which shines from the top of the machine, and the paper thing thats always on the X and Y axis of my head, also help. The other component is a physical blue dot in front of me that I'm supposed to look at while we align. Once I'm physically aligned the tech will change the position of the guiding arm things and it will show them where to place the coil. With the brainsway the physical reference is on your head, in the form of a blue cap with a flexible tape measure attached to it, which the tech can adjust to align with the 0,0 coordinate of the machine on the coil.
Day Eleven
Today I slept less than 5 hours, so I called Greenbrook TMS & asked what I should do. I could either push back my appointment or cancel it. I decide to cancel it, since I doubted I'd sleep enough before we had to leave. If you sleep less than 5 hours it decreases your motor threshold and that makes TMS less effective and increases the risk of serious side effects. For this reason, TMS technicians will ask about your sleep in the daily questions.
As always, I hope I've helped shed light on this very important treatment! I've had ups and downs this week and while I've had thoughts of s.h. they are much less intense as before I stared TMS and I haven't done anything. My emotion regulation is much better, my mood and energy are better. I socialize more, I have more goals and dreams. Over the weekend, since the impacts of TMS can develop even days or a week after treatment, my mental health continued to improve. When things bring down my mood its easier to work through and execute coping skills. When my thoughts spiral, it's much easier to pull myself out. Please leave a comment if you have questions, suggestions, or feedback!
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