- 21297 Foothill Blvd, Ste 203 Hayward, CA 94541
- (415) 636-9700
- hello@exxceedwellness.com
TMS Therapy
Nefretiri Abat, J.D., PMHNP-BC · California-licensed Psychiatric-Mental Health Nurse Practitioner
Non-invasive, FDA-cleared treatment for depression, including treatment-resistant depression. Standard rTMS and three-minutes theta-burst (ITBS/Expres) protocols available in hayward
The TMS protocols we offer
Most clinics offer one TMS protocol. We offer two, each with its own session length, indication scope, and clinical fit. Choosing the right protocol for you is part of the consultation.
Original Protocol
Session length: 19–37 min
FDA-cleared for: Major depressive disorder, treatment-resistant depression
The original FDA-cleared TMS protocol. Magnetic pulses are delivered to the left dorsolateral prefrontal cortex via a figure-8 coil. Strong evidence base, well-tolerated, suitable as a first-line TMS option for most depression patients.
Express Option
Session length: ~3 min
FDA-cleared for: Treatment-resistant depression
Intermittent theta-burst stimulation, also called Express TMS. Clinically equivalent to standard 10Hz rTMS for depression but delivered in a fraction of the time. Strong fit for working professionals who can’t spare 30+ minutes per daily session.
Both protocols are FDA-cleared for TRD.
The most established TMS indication. Used when oral antidepressants haven’t adequately worked. Both protocols we offer are FDA-cleared for TRD.
Our Magstim Horizon 3.0 is FDA-cleared as an adjunct for adults with OCD. We offer focal TMS for OCD that hasn’t responded adequately to SSRIs and ERP — an in-house interventional option, and a different, focal technology than BrainsWay’s Deep TMS (which we don’t use).
In March 2025 the FDA cleared TMS for adolescents ages 15 through 21 with major depressive disorder, as an add-on to antidepressant medication — not as a replacement for it. Our Magstim Horizon 3.0 carries this clearance.
This clearance applies to major depressive disorder only. It does not cover anxiety or OCD in this age group, and we do not treat below age 15. A parent or guardian is part of every candidacy decision and consent conversation.
Your first appointment is a brief mapping session to identify your motor threshold (the magnetic pulse intensity needed to stimulate your motor cortex) and locate the precise treatment target. This is painless and typically takes 30 to 60 minutes.
For Standard 10Hz rTMS, treatment is daily, five days per week, for approximately six weeks — about 30 sessions in total. iTBS / Express TMS uses the same daily schedule but each session takes only about 3 minutes. We monitor response throughout.
After the initial course, some patients benefit from a tapered maintenance schedule. Long-term follow-up is individualized based on response, prior history, and your treatment plan with your psychiatric provider.
TMS has a favorable side-effect profile compared to oral antidepressants. Most side effects are mild and short-lived.
The most serious risk associated with TMS is seizure, with an estimated risk of approximately 1 in 30,000 sessions in patients without seizure-predisposing factors. We screen carefully for risk factors before treatment begins.
For treatment-resistant depression, three categories of treatment are commonly considered: continued or augmented oral medication, Spravato (esketamine), and TMS. Each has different mechanisms, time commitments, and side-effect profiles.
| TMS | Spravato | Oral medication | |
|---|---|---|---|
| Mechanism | Focused magnetic stimulation of specific cortical regions | NMDA glutamate receptor modulation (esketamine) | Monoamine system (serotonin/norepinephrine/dopamine) |
| Session length | 3 to 37 minutes per session, depending on protocol | About 2 hours (dose plus monitoring) | Daily oral dose at home |
| Course | Daily 5x per week for ~6 weeks | Twice-weekly induction, then taper | Ongoing daily, indefinite |
| Driving day-of | Permitted | Not allowed; designated driver required | Permitted |
| Side effect profile | Scalp discomfort, mild headache | Dissociation, dizziness, transient BP changes | Variable by drug class; weight, sexual, sleep effects common |
| Best fit when | Want to avoid sedation | Faster onset preferred; active suicidal ideation | First-line for new-onset depression |
Many patients use these in combination — for example, continuing an oral antidepressant during a TMS course. The right combination is determined together at consultation.
TMS for treatment-resistant depression is commonly covered by major California insurance plans, with prior authorization required. Coverage criteria typically include documented inadequate response to two or more antidepressants. California’s mental health parity law generally requires plans to cover TMS for TRD on the same terms as medical-surgical care.
Our team handles the prior authorization process with your plan once you’re scheduled for a TMS consultation. We verify benefits before treatment begins.
TMS at Exxceed Wellness is overseen by Nefretiri Abat, J.D., PMHNP-BC, a board-certified Psychiatric-Mental Health Nurse Practitioner with twenty years of clinical training and a Juris Doctor in addition to her psychiatric credentials. Her training spans interventional psychiatric care, including the protocol selection, candidacy assessment, and ongoing clinical oversight that distinguish a careful TMS practice from a one-size-fits-all clinic.
All TMS sessions are delivered in-office at our Hayward, CA clinic. Telehealth medication management is available statewide for ongoing care between or after a TMS course.
It depends on the protocol. Standard 10Hz rTMS runs 19 to 37 minutes per session. iTBS / Express TMS runs about 3 minutes. We choose the protocol with you based on diagnosis, schedule, and clinical fit.
A typical course is 5 sessions per week for approximately 6 weeks — about 30 sessions in total. Some patients also receive a tapered maintenance schedule afterward, individualized to response.
Often yes for treatment-resistant depression with documented antidepressant failures, under California’s mental health parity law. We handle prior authorization.
Most patients describe it as a tapping or knocking sensation, not painful. Mild scalp discomfort at the treatment site is the most common side effect and usually resolves within the first week.
Many patients notice changes by week three or four of the treatment course. Full benefit typically emerges by the end of the six-week course. Response is monitored at every session.
If TMS doesn’t produce adequate response, Spravato, combination strategies, ECT referral, and other interventional options remain available. We don’t end the conversation when one treatment falls short.
Schedule a TMS consultation at our Hayward, CA clinic. We’ll review your full medication history, talk through which protocol fits your diagnosis, and start the prior-authorization process if you’re a good fit.
Schedule a TMS consultation
or call (415) 636-9700
Standard 10Hz rTMS · iTBS / Express TMS · Nefretiri Abat, J.D., PMHNP-BC · Last updated: 2026-05-07
Exxceed Wellness · 21297 Foothill Blvd #203, Hayward, CA 94541 · Serving Hayward, Castro Valley, San Lorenzo, San Leandro, Union City, Newark & Fremont.
Medically reviewed by Nefretiri Abat, J.D., PMHNP-BC — board-certified Psychiatric-Mental Health Nurse Practitioner.
