- 21297 Foothill Blvd, Ste 203 Hayward, CA 94541
- (415) 636-9700
- hello@exxceedwellness.com
TMS (transcranial magnetic stimulation) is an FDA-cleared, non-invasive brain stimulation treatment delivered in our Hayward, CA clinic. We offer the full protocol menu: Standard 10Hz rTMS, iTBS / Theta-burst (Express TMS), and Deep TMS (BrainsWay H-coil) — for treatment-resistant depression, OCD, and anxiety.
Transcranial magnetic stimulation uses focused magnetic pulses to stimulate or modulate specific regions of the brain. The pulses pass painlessly through the scalp into the cortex, where they induce small electrical currents that influence neural activity in targeted networks.
TMS is non-invasive, performed while you sit upright in a comfortable chair, and requires no anesthesia, sedation, or downtime. You can drive yourself home after every session and return to normal activities immediately.
The FDA first cleared TMS for treatment-resistant depression in 2008. In the years since, additional protocols and indications have been cleared, including OCD (Deep TMS, 2018), anxious depression, smoking cessation, and several others.
TMS candidacy is straightforward in many cases and clinically nuanced in others. Final candidacy is determined together at consultation, after a clinical review and a brief safety screen.
Most clinics offer one TMS protocol. We offer three, each with its own session length, indication scope, and clinical fit. Choosing the right protocol for you is part of the consultation.
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.
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.
Deep TMS uses a proprietary H-coil that reaches deeper cortical structures than figure-8 coils. The only FDA-cleared TMS protocol for OCD. Often the protocol of choice when OCD also needs treatment, or when prior standard rTMS hasn’t produced response.
Insurance coverage, prior authorization requirements, and clinical fit vary by protocol. We discuss the protocol decision with every patient before treatment begins.
The most established TMS indication. Used when oral antidepressants haven’t adequately worked. All three protocols we offer are FDA-cleared for TRD.
Deep TMS using the BrainsWay H-coil is FDA-cleared specifically for OCD when ERP and SSRIs haven’t produced adequate response. Standard rTMS is not cleared for OCD.
Deep TMS is FDA-cleared for depressive symptoms with comorbid anxiety. For primary generalized anxiety disorder without depression, evidence is emerging but use is off-label.
TMS has FDA clearance for smoking cessation (Deep TMS) and is used clinically off-label for ADHD, PTSD, and chronic pain. Off-label use is discussed case-by-case based on evidence and candidacy.
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 and Deep TMS, 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; OCD also needs treatment (Deep TMS) | 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. Coverage for Deep TMS for OCD and for anxiety indications can be more variable; 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 psychiatry, 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. Deep TMS runs about 20 minutes. 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. Coverage for Deep TMS for OCD typically requires the Deep TMS protocol specifically. 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.
Deep TMS uses a proprietary H-coil (BrainsWay) that reaches deeper cortical structures than the figure-8 coil used in standard rTMS. Deep TMS is FDA-cleared for additional indications including OCD specifically, which standard rTMS is not cleared for.
Yes. Deep TMS using the BrainsWay H-coil is FDA-cleared for OCD when ERP therapy and SSRIs haven’t produced adequate response. Standard rTMS is not FDA-cleared for OCD.
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.
