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Medical assessment: There are some contraindications for TMS treatment, including having metal implants and a history of seizures. Patients must be cleared for these before beginning treatment safely.

Understanding symptom profile: Different sites of stimulation are used depending on the symptoms being treated. For depressive symptoms, the left dorsolateral prefrontal cortex is targeted. For OCD, we stimulate the medial prefrontal cortex and the anterior cingulate cortex. 

Brain mapping: Once the site of stimulation has been decided, we will conduct a “mapping” exercise that allows us to find the site of stimulation on your head which is slightly different between people due to the natural uniqueness of the brain.

Determining stimulation intensity: We will perform an exercise to assess your optimal intensity for pulses. This intensity will be used throughout your treatment.

20 minutes of stimulation: A helmet will be placed over your head for the period of the session—20 minutes. Expect clicking noises from the electromagnetic pulses emitted from the TMS machine. 

Face twitches: the electromagnetic pulses can also activate tissue in muscles in your face, leading to muscle twitches around the head. For some people, this can manifest as jaw pain.

Entertainment: Your alertness or awareness is not altered, so you are free to watch shows on your device, listen to music, read a book, etc. However, you are unable to use wireless or wired earphones/headphones during sessions.

Technician: A TMS technician will stay in the treatment room with you to ensure your safety and comfort throughout the session.

Discomfort: You may experience scalp discomfort or headaches immediately after sessions. After several sessions, this often stops occurring.

Traveling home: You will be able to drive yourself home and return to your daily plans as your state of consciousness is not impacted by the electromagnetic pulses.

Maintenance sessions: After your full course of treatment, you may be eligible for maintenance sessions, with a personalized treatment plan adjusted to your symptom profile. This may begin months or years after your initial TMS treatment; it is very flexible.

Medical assessment: Like TMS, there are contraindications associated with Spravato. Before beginning treatment, you must be cleared to ensure you are eligible for Spravato.

Medication Adjustments: You may be asked to adjust your medication schedule around your Spravato appointment. However, this is not always necessary and will be discussed further in-depth with your practitioner.

Supervised self-administration: In the treatment room at our clinic, you are able to administer the nasal spray independently. Your medical professional will be present to ensure the correct technique and dosage to ensure your safety.

Post-administration monitoring: You will be monitored for 2 hours for adverse reactions before you are cleared to leave. We want to ensure your body is receptive to Spravato and you return home in a safe, healthy state.

Driving home: You will be unable to drive until the next after, after a restful sleep, due to the effects esketamine has on the body. You may like to bring a support person who can take you home following your session.

Returning to work: It is also recommended you do not return to work until after a restful sleep.

Diagnosis: Obtaining a diagnosis or understanding your symptoms is crucial to selecting the appropriate medication.

Medical assessment: We will evaluate the most appropriate medication based on other medications you may be using and possible adverse chemical interactions. We will also need to know any medication you have previously trialed to rule out possible options.

Medication management: A plan to adjust dosage will be developed to maintain a record of trailed medication.

Monitor effects: Symptoms may be expected as the body adjusts to the chemical changes occurring in the brain. After a couple of weeks, symptoms often subside. If symptoms remain or their consequences exceed the benefits of the medication, a new medication can be trialed after 2 to 5 days of no medication.

Continuation: A schedule of medication may be continued for months or years. They may wean off the medication if the patient or psychiatrist believes it is no longer needed.

Changing approaches: If multiple medications are ineffective and symptoms are deemed treatment-resistant, alternative options may be considered, such as TMS, which has been supported by empirical evidence as a treatment that is effective for treatment-resistant depression.

Clinical interview: You will undergo a clinical interview where the therapist and patient may explore their therapy goals, symptoms, personal background, and current situation and stressors.

Determine a psychotherapy approach: Based on your needs and personal preferences, you may decide whether CBT or DBT is your preferred psychotherapy, with your therapist’s guidance.

Treatment plan: You and your therapist will develop a flexible treatment plan that achieves your therapy goals and provides structure and individual aims for each session.

Opening up:  A key part of psychotherapy is exploring your mental state, thought patterns, emotional responses, original or triggers of mental health symptoms, and past experiences with your therapist. These may be sensitive topics, so it is important to be prepared and feel safe with your therapist.

Practice coping skills: Identifying coping mechanisms that may work best for you can be a difficult process. Getting this right is crucial to the outcome of your treatment. It is okay for it to take some time for you to feel confident in performing your coping skills. Part of this process may involve practicing small exercises at home to perfect your skills.

Moving on: If you or your therapist believes your therapy goals have been accomplished, you may choose to discontinue your sessions, reduce the frequency of your appointments, or move on to new therapy goals. Alternatively, you may cease therapy if you feel it is not a suitable treatment style, in which case you may like to try any of the previously mentioned approaches.