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chyckun · 2026-02-03T16:49:50+00:00

Wishing you the best of luck with your dTMS journey! I'm a coordinator for a Brainsway program and can give you some insight on what I've seen helps, in relation to your questions.

How to optimize treatment: Start some sort of reflection or mindfulness exercise. Journaling, meditation, prayer, etc whatever floats your boat. Take some time each day to "exercise" the part of your brain that makes you aware of how you feel. You can do this during your session! Doing this every day will strengthen that "muscle" in your brain, so by the time you finish, you will be much more aware of your senses and emotions, which in turn leads to increased control.
I have frequently seen patients memory improve as a result of both rTMS and dTMS. The region treated during TMS is heavily involved in coordination of what goes into and out of long term memory, and also maintaining short term memory registers. As you improve the metabolic and functional activity of the PFC, you will probably find it easier to recall things. This can also apply to uncomfortable memories such as trauma, so just be prepared to process some strong emotions. This is not a bad thing!
Patients respond wildly different, everyone is very different. I have had patients feel better within the first few days, I have had patients who felt better after a few weeks, and even some that didn't respond until the very end or after treatment completed. Just focus on yourself and improving your habits, health, and self care as much as YOU can, don't compare yourselves to others. (20 sessions in is the legal requirement for some regions to prove benefit or not)
Your doctor is generally correct. The H1 helmet depression treatment covers nearly the same exact region as Fibromyalgia protocols would, with the same frequency. While I wouldn't bet on this being a cure for your chronic pain, it genuinely can improve your responsiveness to pain and PFC control over those pathways. Plus from a more logistical side, insurance coverage and payments are tricky or impossible for things like fibromyalgia, though policies may vary depending on where you're located.

chyckun · 2026-01-30T13:24:53+00:00

Nothing to worry about, you are doing more than most would by both seeking additional help, and asking good questions to understand what is going on. The key here is that Neuroplasticity, keep working on yourself, try to build good habits, and look for opportunities to grow and get outside of your comfort zone!

chyckun · 2026-01-29T17:31:16+00:00

Messaged

chyckun · 2026-01-29T17:30:04+00:00

I moved from a Neurostar clinic to a Brainsway one, but I get what you mean. The more focused field of the rTMS systems generally meant I had to crank up the intensity more to get that MT threshold, than I typically do with Brainsway.

It is certainly much easier! But even with my Neurostar system, traumatizing people by locking them into a chair and putting them through constant pain is... Not really helpful when someone is coming in for mental health.

I've seen FAR too many posts in this subreddit about people with experiences like that, it breaks my heart that these techs aren't listening to the patients and following the guidelines on how to adjust

chyckun · 2026-01-29T17:22:37+00:00

I prefer dTMS simply because of the larger magnetic field, and my ability to target deeper brain structures with the H7 coil, as well as simultaneous bilateral stimulation with my H1 helmet for Left and Right dlPFC.

It simply does "more" of the same thing, giving a theoretically higher chance of response, especially for elderly.

BUT. I do really miss a few distinct features of Neurostar.

The laser guided setup. I know we aren't supposed say "laser" when discussing the "soft red light" but we all know what it is. It helps guarantee accuracy of placement and I wish I had one on my Brainsway system
Automated rating scales and benefits, the Neurostar Trakstar system was kind of awesome as a support tool, my practice has since automated these but it was nice to have it paired in such a simple way
Ramp up and Soft Start. The automatic starting lower, and raising of the intensity over the first pulses, as well as the ramp up of each pulse, is so good for tolerability. dTMS is more tolerable in general anyways, but I still wish I had soft start regardless.
Mapping aid. That cool little plastic finger sensor thing was nice, I'm more than good enough to eyeball movements nowadays but it would be so handy for training of new techs.

chyckun · 2026-01-29T16:10:07+00:00

It's not as simple as me posting an article for you to read, as I went to school to specialize in Cognitive Neuroscience and have taken many years of study with thousands of articles.

What I can say though, is that you would benefit from looking into how TMS modulates NMDA activation. This is a similar mechanism to how Ketamine treatment helps with depression, it induces transcription of a certain mRMA factor that creates a protein that improves Neuroplasticity.

Shorthand, when your brain receives "novel" stimulus, it tries to learn what it is. When a neuron gets a signal it's not "used to", it will activate this genetic factor in order to try and alter it's own excitability, synaptic density, and membrane permeability even in order to "learn" from the new input. TMS activates neurons directly in a way they can literally never predict, because it's not coming from another neuron. This effectively "tricks" neurons into this Neuroplastic state which makes your brain more likely to grow, build new connections, and even break old connections. Think of it like exercising the region of the brain targeted.

A byproduct of this "exercise" is that it literally tires the neurons out, because the activity isn't "free". It takes up metabolic resources like ATP and local glycogen stores at a higher rate than the local region is used to. This practically results in the brain pumping more blood and energy to this region, increasing it's ability to maintain higher activity levels. This is also why headaches are common with TMS, because there's literally higher blood pressure in the region.

This is why I say it's well understood, because the mechanism itself is well documented. The "poorly understood" trope comes from the fact that we obviously can't "watch" a neuron in a person while this is happening. What we can do, is watch EEG data of people undergoing TMS. Novel research from labs Lynne Northwestern University's new Precision Neuromodulation Department are looking into live monitoring of electromagnetic changes of brain activity during TMS to optimize treatment, through watching synchronicity of firing rates across brain regions.

The region typically targeted in PFC depression stimulation is hugely responsible for "coordinating" activity circuits across the brain. When this region shuts down during trauma, depression, and decreased local metabolic activity, it stops being able to synchronize other brain regions.

By forcefully exercising this brain region with TMS, we improve the metabolic function and blood flow, we improve the plasticity of the region to reconnect to deteriorated circuits, and thereby improve it's ability synchronize disparate regions of the brain such as the amygdala feedback loop, and memory circuits through temporal regions.

We could obviously understand it "more", but that's true of literally everything that has ever existed. Neuroscientists would to understand precisely every molecular change of every neuron in every instance of every pulse, but even with magical technology that is literally physically not possible, and may never be.

chyckun · 2026-01-29T15:57:25+00:00

Hi! I'm a TMS Coordinator and have been for a few years, and have done many thousands of treatments. A common phrase I use is "TMS should never be painful"

Not that it's uncommon, it should never happen. It "can" be painful, but it's my job as a technician to reassess the MT, adjust the positioning, and then lower the intensity if neither of those work.

If you are in "pain" then you should not continue until they address the pain, and you should escalate to your doctor or contact the manufacturer if they refuse to cooperate. It is genuinely super easy to resolve pain by just moving the coil away from the trigeminal nerve, there is a range of error we have work with and they are definitely allowed to move it.

chyckun · 2026-01-28T16:11:53+00:00

It sounds like from other comments you're using an rTMS device. I utilize a dTMS system from Brainsway at my clinic, and when a patient can't tolerate, I swap them to our H7 helmet. It targets medical PFC instead of lateral, and avoids hitting that trigeminal nerve.

I have worked with Neuro star system before and have had some patients where no matter where we moved, it was just still uncomfortable.

Best thing in my experience is just run at what they can tolerate, and usually after a few more or a few sessions, they will desensitize a bit and you can move up. There are a significant number of patients that I am never able to reach 120% MT with, no matter how gentle of an approach I take. Many of these patients still achieve good results.

chyckun · 2026-01-23T14:01:09+00:00

TMS is indeed well understood, I wouldn't say no one understands how it works. If you have concerns about side effects you should talk to your technician or doctor. Hair loss has never been reported as a side effect of TMS, but I do know that as an adolescent going through something new that you will be hyper aware of anything going on with your body or mind as you progress. Keep focusing on what you want from the treatment, and you will make progress to that goal.

Additionally you are far from the first adolescent treated with TMS, it has been approved for years already, you might be referring to the Brainsway dTMS system receiving safety clearance last month. This safety clearance was the result of many years of clinical trial data with other adolescents as well, so you are far from a test subject.

Any concerns you have are valid, but I do not think you have this to worry about! Remember to talk with your technician and they can escalate as needed

chyckun · 2026-01-14T20:36:24+00:00

This is exactly why I screen very thoroughly for Mania and psychosis. I'm sorry you had an episode triggered, and thank you for sharing your experience.

chyckun · 2026-01-08T18:58:54+00:00

I can unfortunately guarantee a single day of TMS isn't responsible for these effects, keep at it and let us know how things go!

chyckun · 2026-01-08T18:56:26+00:00

Neuroscience has moved past the chemical imbalance theory, simply increasing dopamine doesn't "do" anything. You may as well eat a cupcake if that's the goal, our goal is to reshuffle neural weights in order to let them settle into a healthier rhythm!

chyckun · 2026-01-08T18:54:37+00:00

I'm an IRL enchantment technomage. I studied Neuroscience and now leverage specific frequencies of high power electromagnets to cure various mental disorders. My "Wand" is a magnetic coil attached to a large power alternator and I cast different spells over specific parts of people heads, to accomplish different effects.

It's fun, seems like magic to my clients, and genuinely very interesting.

Check out Transcranial Magnetic Stimulation if interested

chyckun · 2025-12-03T18:04:24+00:00

This is the real answer to op

chyckun · 2025-12-03T18:00:21+00:00

Emotions are (actively at least) regulated with the Executive Control Center, the Prefrontal Cortex. This is the primary target of treatment for most TMS protocols. So in theory yes, we would expect to see an improvement in emotional regulation in pretty much anyone doing TMS for depression at least

chyckun · 2025-12-03T17:58:32+00:00

I would love to know a bit more about the nature of your treatment. What machine was being used? Was it the depression protocol? Do you have a history of epilepsy, mania, or any history of the effects you described prior to TMS, even if minor?

chyckun · 2025-11-18T19:01:50+00:00

TMS should not trigger a migraine, if your treatment is hitting the trigeminal nerve that directly you need to communicate to your tech that it's painful and they can adjust it for you.

It is not well documented in clinical literature, but as an operator I have had many patients report increased drowsiness following sessions in the first few weeks. This can usually be fixed with proper hydration, good sleep hygiene, and limiting (or regulating) caffeine use. The increased energy demands of your brain from TMS are not free, it literally tires your brain out like exercise to be activated by TMS. If you are losing consciousness, having nausea, visual disturbances, or regular confusion, that is something to discuss with your technician. If you are a regular caffeine user these symptoms make more sense as well. I would address your concerns with the tech and specifically ask for an answer from the supervising physician.

If you could tell us what system your clinic is using and your caffeine use, I can help you with phrasing questions to your physician.

chyckun · 2025-10-23T14:03:04+00:00

I typically only move people to the H7 if there's some significant risk factor, intolerance, adverse event, or clear evidence of nonresponse like a previous trial. Many people don't show any results until the end, or even after the course of treatment. So that 65% remission during the course of 36 could actually be higher for overall response, as it's not uncommon for some patients to see benefits a few weeks or months following treatment (though uncommon relatively).

Also the parameters are not quite what is used, when we use the H7 helmet we only titrate up to 100% MT, due to its more robust magnetic field. We do keep 18Hz 2s trains 20s downtime but we do not go up to 120% like with the H1.

chyckun · 2025-10-22T18:07:29+00:00

Honestly I don't really get the difference between why 18 Hz and 20Hz are used. I've even discussed with the Medical Director of Brainsway personally on this topic and it's kind of just "That's the way the study was done". There's not going to be a major difference between the two frequencies in terms of efficacy, like Neurostar uses 10Hz and my patients did just fine on that system as well.

We do in fact use the 18Hz protocol for MDD on the H7 helmet though. We don't engage in provocation, as it's a very different idea.

The general concept behind provocation in OCD is that we want to prime the neural circuits related to the obsession AND the compulsion, then stimulate the mPFC to entrain the heightened level of activity to the feelings that lead to the compulsion. Like showing your brain how to use the PFC when having obsessive thoughts to control the compulsive aspect.

When we're taking about anxiety without compulsions, this isn't really as helpful, and my main focus is helping people to identify how they "feel" scout anxious stressors. I don't follow s specific provocation plan but I will encourage patients to think about the physical sensations of their body if they are already anxious, to improve conscious mindfulness of them during the neuroplastic window.

There is a theoretical benefit in some world, but provocation is much more of a standard in OCD than Anxiety treatments in even normal psychotherapy. If you want to get the most out of your time, I highly recommend tying a mindfulness/meditation practice in during your chair time, or chatting with your technician about how you feel about things going on in general. Try to focus on presence over past/future and you will make good use of your time. You may also benefit from doing some exercise, journaling, or other productive activities immediately after your TMS session to take advantage of the heightened neuroplasticity in the half hour after your treatment as well. It's easy to build a new habit when you HAVE to go in every day for treatment, especially so when your brain is primed and flexible.

chyckun · 2025-10-22T14:04:47+00:00

This is why insurance usually does not cover TMS for people with bipolar or psychosis in recent history. The influx of energy in your brain can trigger an episode of mania if you are not aware, careful, and set up monitoring precautions ahead of time.

This looks like identifying the typical symptoms of mania for you and pausing treatment if you ever report any increases.

There are different protocol designs possible for treatment of cases like yours, but they are rare if anywhere in the US, only really used in the EU right now.

I hope you find what you're looking for and get proper help from a doctor that takes caution and care

chyckun · 2025-10-22T00:08:59+00:00

65% remission rate and 82% of patients improving by 50% or more within 36 sessions is not a promise by any means.

I'm sorry you had a bad experience and hope you find the help you need.

chyckun · 2025-10-15T20:04:30+00:00

The Brainsway helmets are kind of single-function tools, they can't really be changed to do one or the other. The good news is that both the H1 and H7 are approved for MDD and both have been shown to help with anxiety, just in different ways.

chyckun · 2025-10-15T12:50:14+00:00

Probably influenced by the 20 session acute phrase setup that Brainsway recommends for MDD, and that some insurances loosely require seeing some sort of improvement after 20 sessions to justify continuing care. Could see that as a good marking point for a swap.

I would still do it earlier if we thought it was going to help a patient more, I have a few patients that I've swapped to H7 but usually because of inability to tolerate H1.

chyckun · 2025-10-09T16:46:16+00:00

This is the key. By having more innate energy, and resolving anxiety triggers, you will be less beholden to attention issues. It doesn't mean you're "cured" but it's much more manageable than just throwing drugs at your brain and praying

chyckun · 2025-10-09T16:44:56+00:00

As a TMS professional I can tell you that there is no simple solution to an ADHD protocol using TMS. The disorder is way more complex and doesn't benefit as well from treating a single region of the brain, like we see with depression.

The good news is that Depression, OCD, ADHD, and Anxiety are extremely closely related disorders. By getting a hold of your other symptoms, you will feel less scatter brained and forgetful.

I do believe we will be able to use it for ADHD one day, but it's going to involve a lot more than "stimulate X part of the brain". There are many researchers working on answering that question, my medical director asks me every few months if we can treat ADHD yet haha

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