Mood and Anxiety Rating Scales

Please be sure to complete this online form as part of Medicare's TMS eligibility requirements

The following is the TMS consent form that your TMS psychiatrist will review with you. It is recommended that you read through it in advance and feel free to ask the psychiatrist any questions you may have. You will not be to sign anything at this point.

PLEASE NOTE: 

This is a copy of the consent form, not the official version that you will sign. The official consent form will be completed in the Mapping Room in the presence of your TMS psychiatrist. You will have the opportunity to ask any questions related to this before agreeing to undertake a TMS course.

Information about TMS

Background:

Individualised Transcranial Magnetic Stimulation (TMS) is a non-invasive therapy using electromagnetic stimulation of the brain. The magnetic field produced by the procedure induces trace amounts of electrical current in the brain. It is used after diagnosis for treatment and has shown great promise in the treatment of certain conditions or disorders that are not responsive to conventional treatments.

The procedure is administered by placing a special coil over the head while the patient remains seated in a chair. A powerful magnetic field is pulsed over regions of the brain based on a specific treatment protocol. It is often described as a tapping sensation. Patients are thoroughly screened and evaluated before the treatment and are monitored during TMS treatment session by a trained and TMS clinician or other certified clinician or practitioner to minimise any risk from the procedure, to monitor the patient’s response to treatment, and to monitor proper for continued treatment coil contact.

There is no guarantee that patients will respond positively to this therapy. TMS is Therapeutic Goods Agency (TGA)-approved for specific conditions, such as major depressive disorder in adult patients, and other conditions depending on the TMS system being used fo­­r treatment. In addition to Depression, TMS has been used to treat Generalised Anxiety Disorder (GAD), Post-Traumatic Stress Disorder (PTSD), Obsessive-Compulsive Disorder (OCD), Attention Deficit Hyperactivity Disorder (ADHD), Chronic Pain, Migraines, Fibromyalgia, Chronic Fatigue Syndrome, Insomnia, Post-Stroke Depression, Parkinson's Disease, Tinnitus, Alcohol Addiction, or Nicotine Addiction.

Our treatment protocols may involve the use of Theta Burst stimulation, a newer method that has been studied in research trials since 2005. The FDA approved Theta Burst for clinical use in 2018. According to the 2024 guidelines of the Royal Australian and New Zealand College of Psychiatrists (RANZCP), “commencing with left high frequency (LHF), right unilateral low frequency (RLF), left intermittent Theta Burst stimulation (iTBS), and sequential bilateral approaches are all supported by the available evidence.” A large non-inferiority trial found that iTBS applied to the left DLPFC produced effects equivalent to standard rTMS, and its use has become increasingly common in clinical practice (Blumberger et al., 2018). Additional clinical trials have confirmed the efficacy and safety of iTBS for treating depression (Clinical TMS Society, 2023)

You are free to stop therapy at any time

Risks and Side Effects

While rare, seizures have been known to occur in association with TMS treatment. The estimated average risk is approximately 1 seizure per 50,000–60,000 sessions in patients without seizure risk factors such as brain lesions or epilepsy (Rossi et al., 2009; Lerner et al., 2019). Although this risk is low, it is not entirely preventable, even in low-risk populations. To further minimise the risk, patients must inform staff of any changes in their alcohol or drug use, significant reductions in sleep (less than 4 hours per night), or excessive caffeine intake. These factors can increase the likelihood of a seizure and may require adjustments to the treatment protocol. Failure to disclose this information may increase the risk of complications

As per the RANZCP 2024 guidelines, "There are minimal risks with rTMS and any side effects are usually mild, transient and/or can be easily managed. The most commonly reported side effects with rTMS include local scalp pain or discomfort, headache, fatigue and facial muscle twitching during stimulation. The rate of clinical trial discontinuation due to adverse effects across 93 randomised controlled trials was 2.5% in patients receiving active, compared to 2.7% in patients receiving sham stimulation, supporting an excellent safety profile (Zis et al., 2020). "

About 1 in 3 patients undergoing this procedure may experience scalp or facial discomfort at the treatment site. If this occurs, please inform your TMS clinician, who may adjust the magnetic field dose or reposition the coil to help alleviate it. Some patients may experience temporary headaches, temporary fatigue, temporary insomnia or lightheadedness. Often a change in the position of the coil can alleviate this. Facial muscle twitching during treatment sessions (not afterwards) is common and normal given the proximity of the coil to your facial muscles. Rarely, patients may experience referred facial/tooth/jaw/ocular pain. If this occurs please notify your clinician and they will change the position of the coil.

Some patients experience an exacerbation or recurrence of previous symptoms during the early phase of treatment, presenting as "dips in mood" or mood changes (for example). There is also a small risk of inducing mania, particularly but not limited to those patients with a history of bipolar affective disorder. If either of these events occur, please notify your TMS clinician and they will assist you.

TMS should not be used by anyone who has magnet-sensitive metal in their head or within 30 cm of the TMS coil that cannot be removed. Failure to follow this restriction could result in injury. Please inform your psychiatrist if you have any metal objects or devices in your body that may be sensitive to magnets. These may include, but are not limited to, aneurysm clips, brain stents, implanted stimulators, electrodes, ferromagnetic implants in the ears or eyes, shrapnel in the head or neck area, or any other metal implants in the head.

There have been isolated case reports in the medical literature of exacerbated and persistent tinnitus, chronic headaches, prolonged photophobia, and retinal detachment following TMS. While these events are considered very uncommon, their exact frequency is not known, particularly with the newer theta burst or accelerated protocols, which have been less extensively studied compared to traditional TMS protocols. While no definitive causal relationship has been established, patients with pre-existing retinal conditions or a history of eye surgery are advised to discuss this risk with their treating psychiatrist prior to commencing treatment. If any visual disturbances occur during or after treatment, patients should notify their psychiatrist immediately.

It is important to notify your TMS psychiatrist if you are pregnant. The risk-benefit analysis for continuing TMS may change. TMS may be continued in certain circumstances, but how it is conducted may also change. Therefore, the TMS psychiatrist must be informed of any pregnancy as soon as possible, and treatments should be paused until a discussion with the psychiatrist takes place.

Effectiveness and Patient Experience

It is not possible to provide any guarantee that the TMS treatment will be successful. TMS treatment is not a cure, and future relapse remains possible. Treatment outcomes will also vary between individuals.

Clinical experience indicates that most patients who respond positively to a course of TMS are likely to respond similarly in the future. However, this is not guaranteed for all patients, and individual responses to repeat treatments may vary.

For most patients, the repeat course of TMS will be administered in a manner similar to the original treatment. As a result, the patient's experience, including potential side effects, is likely to resemble what they experienced during their initial TMS treatment.

The TMS team will apply their professional skill and judgment, but like many medical treatments, TMS comes with an inherent degree of risk that cannot be removed entirely.

Accelerated TMS protocols (aTMS)

In certain circumstances, we may conduct more than one TMS session per day. This is known as an Accelerated TMS protocol. While aTMS can provide similar clinical outcomes to standard TMS protocols in a shorter timeframe, it may increase the likelihood of experiencing certain TMS-related risks or side effects. According to the 2024 RANZCP guidelines:

• “Several studies have indicated that accelerated forms of rTMS and TBS can achieve similar clinical outcomes requiring fewer treatment sessions. Accelerated TMS (aTMS) studies had similar seizure and side effect incidence rates to those reported for once daily rTMS.”

•  “Accelerated TMS (aTMS) studies had similar seizure and side effect incidence rates to those reported for once daily rTMS. One seizure was reported from aTMS (0.0023% of aTMS sessions, compared with 0.0075% in once daily rTMS). The most common side effects were acute headache (28.4%), fatigue (8.6%), and scalp discomfort (8.3%), with all others under 5% (Caulfield et al., 2022).”

However, patients should be aware that aTMS involves a higher intensity of stimulation in a shorter period, which may lead to a greater accumulation of side effects, such as increased fatigue or headaches, compared to the standard protocol.

While the safety profile of aTMS is promising, less research overall has been conducted on aTMS compared to the standard protocol. As a result, its evidence base is less robust, and certain long-term risks remain less well understood. Further research is ongoing to determine the safest and most effective accelerated protocols.

Hearing  Protection

TMS machines emit a loud click with each magnetic pulse. Although quieter than models used in the past, there is still a risk to hearing that can be mitigated using hearing protection. As per Rossi 2021 et al , " When hearing protection was used, as in the majority of studies, no change in hearing sensitivity after TMS has been reported (Pascual-Leone et al., 1992; O’Reardon et al., 2007; Janicak et al., 2008).  When changes in hearing have occurred in the past, studies such as Kujawa and Liberman et all have suggest the effects on auditory systems were temporary."

Wearing ear protection, specifically earplugs, is therefore a required part of the TMS treatment protocol. Patients are strongly advised to use the earplugs provided during all TMS sessions. If you choose to decline the use of ear protection, you do so against medical advice. By declining ear protection, you acknowledge and accept full responsibility for any potential adverse outcomes, including but not limited to the worsening of tinnitus, hearing loss, or other auditory complications.

If you choose to decline ear protection, you will be required to sign a waiver confirming your decision and assumption of all associated risks. Please notify your TMS nurse or clinician immediately if you experience any auditory discomfort or changes during or after the treatment

If being treated with any Non Depression TMS protocols:

In Australia, "off-label use" refers to the use of a medicine, medical device, or treatment in a way that is not included in the approved indications, dosages, patient populations, or routes of administration specified in the product’s registration with the Therapeutic Goods Administration (TGA).

TGA Approval for TMS in Australia:
TMS treatments in Australia are regulated by the TGA, which grants approval for specific devices. For example, the Neurosoft machines used are TGA-approved for the treatment of Major Depressive Disorder in adult patients who have not achieved satisfactory improvement from antidepressant medications (https://neurosoft.com/files/documents/380/Australia_DV-2015-MC-06490-1.pdf)

What Constitutes Off-Label Use in TMS:
Any TMS treatment that deviates from the standard protocol for Major Depressive Disorder (one session per day, five times a week, over several weeks) is considered off-label in Australia. This includes:

• Accelerated TMS (aTMS): Providing TMS more than once daily or for durations shorter or longer than the standard protocol.

• Theta Burst Protocol (TBS): However, TBS was approved by the U.S. Food and Drug Administration (FDA) in 2018 following the THREE-D Trial (Blumberger et al., 2018).

• Certain Right DLFPC 1Hz, 100% Protocols:  However, longer and higher-intensity versions of the right-sided DLPFC 1 Hz protocol have been FDA-approved since 2013.

• Treatment of Non-Depression Conditions: This includes, but is not limited to Generalised Anxiety Disorder (GAD), Post-Traumatic Stress Disorder (PTSD), Obsessive-Compulsive Disorder (OCD), Attention Deficit Hyperactivity Disorder (ADHD), Chronic Pain, Migraines, Fibromyalgia, Chronic Fatigue Syndrome, Insomnia, Post-Stroke Depression, Parkinson's Disease, Tinnitus, Alcohol Addiction, or Nicotine Addiction.

While evidence supports the efficacy of TMS for some of these conditions, patients should understand that such treatments are not currently TGA-approved for these indications

This is despite the fact that in the USA, the FDA has approved TMS for conditions such as Major Depressive Disorder, OCD (via Deep TMS), Alcohol Addiction, and Nicotine Addiction, including the newer theta burst protocols. However, these approvals do not necessarily apply in Australia, where the TGA regulates medical device use.

To provide additional context, the following excerpts from the 2024 Royal Australian and New Zealand College of Psychiatrists (RANZCP) TMS Guidelines summarise the current evidence for off-label and advanced TMS protocols:

• PTSD:  "High- as well as low-frequency rTMS of the right DLPFC appears to significantly reduce core PTSD symptoms in patients with PTSD. rTMS may therefore be a promising alternative or add-on treatment for PTSD patients who show limited response to antidepressant medication and/or trauma-focused psychotherapy." (Kan et al., 2020)

• OCD:  "Given the considerable limitations of current treatment approaches for OCD, the use of deep TMS in patients failing to respond to standard treatment approaches is justifiable."

• Chronic Pain:  "Overall, findings support that HF-DLPFC stimulation is able to induce an analgesic effect in chronic pain and in response to provoked pain." (Che et al., 2021)

• Theta Burst Protocol:  "Additional clinical trials have verified the clinical efficacy and safety of iTBS for depression."

• Maintenance TMS:  "Maintenance rTMS is the provision of regular treatment sessions to patients who are in remission or who have minimal ongoing depressive symptoms, in order to prevent depressive relapse. There is emerging evidence that maintenance rTMS strategies can be used to prevent relapse but further research is required to define the most effective and efficient strategies." (d’Andrea et al., 2023; Fitzgerald, 2019)

• Retreatment TMS:  "Repeat courses are appropriate for patients who have had a demonstrated positive response to the initial course, and there is no clinical reason to restrict TMS to a maximum number over a person’s lifetime, given the excellent safety profile and as relapse can happen at any time."

• Accelerated TMS Protocol:  "Several studies have indicated that accelerated forms of rTMS and TBS can achieve similar clinical outcomes requiring fewer treatment sessions. Accelerated TMS (aTMS) studies had similar seizure and side effect incidence rates to those reported for once daily rTMS. Further research is continuing to define the optimal accelerated protocols."

To read the entire TMS 2024 RANZCP guidelines please see here:  https://www.ranzcp.org/getmedia/601ddc8c-cb96-4f4c-84e6-ca161e56ddc9/administration-of-rtms-2024.pdf

For a summary of the research into TMS' use in the treatment of non depression conditions, please see here:

The information on this webpage aims to summarise the efficacy of Transcranial Magnetic Stimulation (TMS) for different conditions. However, it’s important to recognise that the quality and findings of individual studies can vary, and not all results are universally conclusive. As such, there can be a risk of overgeneralisation or misrepresentation of findings. Meta-analyses, which combine data from multiple trials, offer a broader view but may still reflect differences in study design, patient groups, and treatment protocols. We recommend discussing any concerns with your psychiatrist to understand what TMS can offer in your specific case.

Depression: 

In the meta analysis by Vida et al in 2023 titled “Efficacy of repetitive transcranial magnetic stimulation (rTMS) adjunctive therapy for major depressive disorder (MDD) after two antidepressant treatment failures: meta-analysis of randomised sham-controlled trials” the response rate was almost two and a half times more with active rTMS treatment (RR: 2.25, NNT: 6.1) compared the sham group (those not getting TMS). This difference was even more pronounced when analysing remission rates. Based on the 9 analysed studies, nearly 36% of the TRD patients with rTMS treatment achieved remission (in the absence of Maintenance TMS).

GAD (Generalised Anxiety Disorder): 

GAD: As per Diefenbach et al 2016, this randomised controlled trial (RCT) investigating repetitive transcranial magnetic stimulation (rTMS) for generalised anxiety disorder (GAD) found that low-frequency right dorsolateral prefrontal cortex (DLPFC) stimulation significantly reduced anxiety, worry, and depressive symptoms compared to a sham treatment. At post-treatment, 77.8% of patients in the active rTMS group responded (≥50% reduction in anxiety scores) vs. 20.0% in the sham group (p = 0.012), with remission rates significantly higher at 3-month follow-up (67.7% vs. 0%, p = 0.003). fMRI scans showed increased right DLPFC activation post-treatment, which correlated with improvements in worry symptoms. rTMS was well tolerated, though facial twitching was more common in the active group. Despite a small sample size and high drop-out rate, findings support rTMS as a promising neuromodulation therapy for GAD. The R-DLPFC 1Hz protocol used at Neuralia TMS is derived off research by Diefenbach et al. 2016.

If applicable, I understand that TMS treatments for conditions other than Major Depressive Disorder or treatments that deviate from the standard protocol (e.g Accelerated TMS) are considered off-label in Australia, and the evidence base supporting its use may be less robust. 

If applicable, I acknowledge that off-label TMS use is not currently approved by the Therapeutic Goods Administration (TGA) and may involve greater uncertainty regarding safety, efficacy, and long-term outcomes.

PTSD (Post Traumatic Stress Disorder):

A recent meta-analysis by Harris et al in 2021 included 19 studies (376 participants) and revealed a large positive effect of TMS on PTSD symptoms: d = 1.17, 95% confidence interval (CI) = [0.89–1.45], p  0.001. This result comes from a review of 19 studies involving 376 people, showing that TMS treatment has a strong positive impact on reducing PTSD symptoms. The number "d = 1.17" is a way to measure how big the effect is, and anything above 0.8 is considered a large effect. 

So, 1.17 indicates a strong improvement in PTSD symptoms after TMS. The "95% confidence interval (CI) = [0.89–1.45]" means that researchers are 95% confident that the real effect of TMS falls between 0.89 and 1.45, which still represents a large positive impact. Finally, "p 0.001" shows that the result is statistically significant, meaning there’s a very small chance (less than 0.1%) that these findings happened by random chance. In simple terms, this data strongly supports the idea that TMS is signficantly effective in reducing PTSD symptoms. The R-DLPFC 1Hz protocol used at Neuralia TMS is derived off research by Nam et al. (2013). If applicable, I understand that TMS treatments for conditions other than Major Depressive Disorder or treatments that deviate from the standard protocol (e.g., Accelerated TMS) are considered off-label in Australia, and the evidence base supporting its use may be less robust.   If applicable, I acknowledge that off-label TMS use is not currently approved by the Therapeutic Goods Administration (TGA) and may involve greater uncertainty regarding safety, efficacy, and long-term outcomes.

If applicable, I understand that TMS treatments for conditions other than Major Depressive Disorder or treatments that deviate from the standard protocol (e.g Accelerated TMS) are considered off-label in Australia, and the evidence base supporting its use may be less robust. 

If applicable, I acknowledge that off-label TMS use is not currently approved by the Therapeutic Goods Administration (TGA) and may involve greater uncertainty regarding safety, efficacy, and long-term outcomes.

OCD (Obsessive Compulsive Disorder): 

A meta-analysis by Rehn et al published in the Journal of Psychiatric Research in 2018 examined 18 randomised controlled trials involving TMS for OCD. The analysis found that active TMS was significantly superior to sham TMS in reducing OCD symptoms, with a moderate effect size. Notably, the study also reported that higher frequencies of stimulation and longer treatment durations were associated with better outcomes. Note that his TMS course use deep coil. [3] 

Another significant study by Carmi et al, published in the American Journal of Psychiatry in 2019, evaluated the efficacy of dTMS for OCD. This multicenter, double-blind, randomized trial involved 99 patients and found that after 6 weeks of treatment, 38.1% of patients in the active dTMS group achieved a response (defined as a ≥30% reduction in Y-BOCS score), compared to just 11.1% in the sham group. [4]

PLEASE NOTE: For OCD we often use a specialised TMS coil called the double cone coil for our protocols. As per Rossi et al 2021, "Double-cone (or angled butterfly/double) coils are a larger version of figure-8 coils where the two circular windings are angled toward the subject’s head to increase the magnetic field strength in depth as well as the electrical efficiency. Consequently, the double-cone coil E-field penetrates deeper and is less focal than conventional figure-8 coils (Deng et al., 2014, 2013). Double-cone coils have been used to target various brain regions that may be difficult to reach with standard figure-8 coils, such as the leg motor area or medial prefrontal cortex, and were claimed to reach effectively the cingulate, insula, and cerebellum. In studies reviewed, no serious AEs such as seizures were reported (Ciampi de Andrade et al, 2012; Blumberger et al., 2018; Dunlop et al., 2015; Fernandez et al., 2018; Gerschlager et al., 2002; Grossheinrich et al., 2009; Huang et al., 2018; Kreuzer et al., 2015a; Kreuzer et al., 2015b; Modirrousta et al., 2015; Nauczyciel et al., 2014; Popa et al., 2010; Riehl, 2008; Ruohonen and Ilmoniemi, 2005; Sutter et al., 2015)." The R-DLPFC 1Hz protocol used at Neuralia TMS is based on research by Seo et al. (2016) If applicable, I understand that TMS treatments for conditions other than Major Depressive Disorder or treatments that deviate from the standard protocol (e.g., Accelerated TMS) are considered off-label in Australia, and the evidence base supporting its use may be less robust.  If applicable, I acknowledge that off-label TMS use is not currently approved by the Therapeutic Goods Administration (TGA) and may involve greater uncertainty regarding safety, efficacy, and long-term outcomes.

If applicable, I understand that TMS treatments for conditions other than Major Depressive Disorder or treatments that deviate from the standard protocol (e.g Accelerated TMS) are considered off-label in Australia, and the evidence base supporting its use may be less robust. 

If applicable, I acknowledge that off-label TMS use is not currently approved by the Therapeutic Goods Administration (TGA) and may involve greater uncertainty regarding safety, efficacy, and long-term outcomes.

Tinnitus:

The systematic review and meta-analysis of 29 randomised studies with 1,228 patients found that repetitive transcranial magnetic stimulation (rTMS) was effective in reducing symptoms of chronic tinnitus. The response rate showed significant improvements in Tinnitus Handicap Inventory (THI) scores compared to sham-rTMS at several intervals: [9] 

 • 1 week post-intervention: Mean difference (MD) of -7.92 (95% CI: -14.18, -1.66) 

 • 1 month post-intervention: MD of -8.52 (95% CI: -12.49, -4.55) 

 • 6 months post-intervention: MD of -6.53 (95% CI: -11.40, -1.66) . [9] 

This indicates that about 40-60% of patients experienced meaningful symptom relief, with effects lasting up to six months after treatment. However, it should be noted that the response rates can vary, and the efficacy of rTMS needs further validation in larger trials to confirm safety and long-term benefits. 

As per Rossi 2021 et al, "there is a risk of worsening hyperacusis by performing stimulations applied over the auditory cortex, near the ear, in patients with rTMS indicated for the treatment of tinnitus, especially when hyperacusis was already present before rTMS (Lefaucheur et al., 2012). More generally, pre-existing auditory symptoms were found to be possibly aggravated by rTMS applied over the auditory cortex in 1–2.2% of patients treated for tinnitus or auditory hallucinations. This risk can be reduced with hearing protection.

If applicable, I understand that TMS treatments for conditions other than Major Depressive Disorder or treatments that deviate from the standard protocol (e.g Accelerated TMS) are considered off-label in Australia, and the evidence base supporting its use may be less robust. 

If applicable, I acknowledge that off-label TMS use is not currently approved by the Therapeutic Goods Administration (TGA) and may involve greater uncertainty regarding safety, efficacy, and long-term outcomes.

Parkinson's Disease (Motor Symptoms): 

To measure improvements in motor symptoms, the study by Zanjani et al 2015 used scores from the Unified Parkinson’s Disease Rating Scale (UPDRS), particularly sections II (which focuses on daily activities) and III (which focuses on motor function). [10] Lower scores on these sections indicate improvement. 

Key Findings: 

• Short-term Effects: When looking at the short-term effects (up to 1 day after treatment), active rTMS (real stimulation) significantly improved motor symptoms, as shown by a 3.8-point improvement in UPDRS III scores compared to the sham group (fake treatment). The effect size (Cohen's d of 0.27) indicates that the improvement was modest but noticeable. [10]

• Long-term Effects: One month after treatment, the difference in motor improvement between the active and sham groups was not statistically significant, but there was still a 6.3-point improvement in motor symptoms from baseline in the active rTMS group. [10]

  • The placebo effect (improvement due to belief in treatment, not the treatment itself) was not seen, as those in the sham group did not show significant improvement in motor symptoms (UPDRS III scores). [10]

Conclusion: While rTMS targeting the M1 showed some positive effects on motor symptoms in the short term, especially right after treatment, the long-term benefits were less clear. The researchers recommend more studies to confirm these findings and better understand the effects of rTMS in PD treatment. In summary, rTMS may help improve movement problems in Parkinson’s patients, but the improvements are more noticeable in the short term, and further research is needed to draw stronger conclusions.

If applicable, I understand that TMS treatments for conditions other than Major Depressive Disorder or treatments that deviate from the standard protocol (e.g Accelerated TMS) are considered off-label in Australia, and the evidence base supporting its use may be less robust. 

If applicable, I acknowledge that off-label TMS use is not currently approved by the Therapeutic Goods Administration (TGA) and may involve greater uncertainty regarding safety, efficacy, and long-term outcomes.

Nicotine Addiction:

Li et al in 2013, produced a tudy investigated whether high-frequency repetitive transcranial magnetic stimulation (rTMS) could reduce cigarette cravings in people who are dependent on nicotine. [12] 

The results were as follows. Stimulation of the left DLFPC with real, but not sham, rTMS reduced craving significantly from baseline (64.1± 5.9 vs. 45.7±6.4, t = 2.69, p = 0.018). When compared to neutral cue craving, the effect of real TMS on cue craving was significantly greater than the effect of sham TMS (12.5 ±10.4 vs. −9.1±10.4; t = 2.07, p = 0.049). More decreases in subjective craving induced by TMS correlated positively with higher Fagerström Test for Nicotine Dependence (FTND) score (r = 0.58, p = 0.031) and more cigarettes smoked per day (r = 0.57, p = 0.035). [12] 

Here's a breakdown of the findings:

• Participants: Sixteen people who were nicotine-dependent but not actively seeking treatment participated in the study.

• Study Design: The participants were randomly assigned to receive either:

• Real rTMS: High-frequency (10 Hz) stimulation applied to the left dorsolateral prefrontal cortex (DLPFC).

• Sham rTMS: A fake version of the treatment (like a placebo), where it looks and feels like rTMS but doesn't actually stimulate the brain.

• Procedure: The participants were exposed to smoking cues (things that might make them want to smoke) before and after rTMS treatment and asked to rate how much they craved a cigarette after each exposure. [12]

Results 

• Reduced Cravings: For those who received real rTMS, cravings significantly decreased after the treatment, from a baseline craving score of 64.1 to 45.7 (on a scale out of 100). This reduction was statistically significant (p = 0.018), meaning it is unlikely to have happened by chance. [12] In contrast, the sham rTMS group did not show a significant reduction in craving.

• Comparison to Neutral Cues: When comparing the real rTMS effect with neutral (non-smoking) cues, the reduction in cravings was much greater in the real rTMS group compared to the sham group.

• Correlation with Nicotine Dependence: The more dependent a participant was on nicotine (measured by the Fagerström Test for Nicotine Dependence) and the more cigarettes they smoked per day, the larger the reduction in craving after real rTMS. This suggests that people with higher nicotine dependence experienced a greater benefit from the rTMS.

Conclusions 

• rTMS Reduced Cravings: A single session of high-frequency rTMS to the left DLPFC significantly reduced the urge to smoke when exposed to smoking cues.

• Potential Smoking Cessation Aid: This suggests that rTMS could be helpful as part of a smoking cessation treatment plan, though more research is needed to confirm its effectiveness over the long term. In summary, this study shows that rTMS may help reduce cravings in nicotine-dependent people, especially those with higher nicotine dependence. More research is needed to explore how it could be used to help people quit smoking.

If applicable, I understand that TMS treatments for conditions other than Major Depressive Disorder or treatments that deviate from the standard protocol (e.g Accelerated TMS) are considered off-label in Australia, and the evidence base supporting its use may be less robust. 

If applicable, I acknowledge that off-label TMS use is not currently approved by the Therapeutic Goods Administration (TGA) and may involve greater uncertainty regarding safety, efficacy, and long-term outcomes.

ADHD (Attention Deficit Hyperactivity Disorder):

In a study by Chen at al in 2023, a meta-analysis of five RCTs with 189 participants (mean age of 32.78 and 8.53 years in adult and child/adolescent populations, respectively) demonstrated that rTMS was more effective for improving sustained attention in patients with ADHD compared with the control groups (SMD = 0.54, p = 0.001). A secondary analysis also showed that rTMS was more effective for improving processing speed than the control groups (SMD = 0.59, p = 0.002) but not for enhancing memory or executive function. [5] 

1.  Sustained Attention: The analysis showed that rTMS (repetitive transcranial magnetic stimulation) was more effective than control treatments (such as sham or placebo) at improving sustained attention in people with ADHD. The effect size (SMD = 0.54) suggests a moderate improvement, and the result was statistically significant (p = 0.001), meaning it's unlikely to be due to chance. [5]

2. Processing Speed: In a secondary analysis, the study found that rTMS also improved processing speed (how quickly participants could complete tasks) more than the control groups. This improvement was slightly larger (SMD = 0.59) and also statistically significant (p = 0.002).

3. Memory : However, rTMS did not significantly improve memory compared to control treatments.

In summary, rTMS appears to be helpful for improving sustained attention and processing speed in people with ADHD, but it doesn't seem to have much effect on memory.

If applicable, I understand that TMS treatments for conditions other than Major Depressive Disorder or treatments that deviate from the standard protocol (e.g Accelerated TMS) are considered off-label in Australia, and the evidence base supporting its use may be less robust. 

If applicable, I acknowledge that off-label TMS use is not currently approved by the Therapeutic Goods Administration (TGA) and may involve greater uncertainty regarding safety, efficacy, and long-term outcomes.

Chronic Pain:

As per the RANZCP (Royal Australian and New Zealand College of Psychiatry) 2024 TMS guidelines, "A large number of studies have explored the use of TMS in the treatment of chronic pain although these have varied substantially in the pain syndrome targeted and the type of TMS used. Benefits have been seen in studies applying stimulation to the primary motor cortex (M1), to the DLPFC and using deep TMS. The most consistent promising effects seen in clinical trials have been present when stimulation has been applied to the left M1 although it has been pro- posed that optimal treatment should involve a systematic evaluation of multiple treatment targets in an individual patient (Lefaucheur and Nguyen, 2019). 

A meta-analysis conducted to characterise the potential analgesic effects of high-frequency rTMS over the DLPFC on chronic pain identified no overall effect of TMS across chronic pain conditions, although there was a significant short-term analgesia in neuropathic pain conditions only (Che et al., 2021). Furthermore, significant analgesic effects in chronic pain were demonstrated with stimulation of the M1 site although optimal protocols have not yet been confirmed (Lefaucheur and Nguyen, 2019). "

Based on the MDPI article titled Transcranial Magnetic Stimulation to Treat Neuropathic Pain: A Bibliometric Analysis, the response rate for TMS in treating chronic neuropathic pain ranges between 30% and 40%. This means that approximately 30-40% of patients treated with TMS experience significant pain relief compared to placebo. [6] This response rate is considered moderate and suggests that while TMS can provide substantial pain relief for some patients, it is not universally effective. 

The efficacy of TMS tends to vary depending on individual factors, the type of neuropathic pain being treated, and the stimulation protocol. This was similar to results found by the Walton Centre’s trial, which is the only NHS (National Health Service) in the UK conducting TMS specifically for chronic pain.

If applicable, I understand that TMS treatments for conditions other than Major Depressive Disorder or treatments that deviate from the standard protocol (e.g Accelerated TMS) are considered off-label in Australia, and the evidence base supporting its use may be less robust. 

If applicable, I acknowledge that off-label TMS use is not currently approved by the Therapeutic Goods Administration (TGA) and may involve greater uncertainty regarding safety, efficacy, and long-term outcomes.

Migraines/Headaches: 

In a 2022 study by Zhong et al, a meta-analysis combined results from 8 studies and found that rTMS, particularly when applied to the left dorsolateral prefrontal cortex (LDLPFC), significantly reduced how often people experienced migraine attacks. Random effects analysis showed an effect size of −1.13 [95% confidence interval (CI): −1.69 to −0.58] on the frequency of migraine attacks, indicating that rTMS was more effective for decreasing migraine attacks than the sham rTMS. 

The effect size being -1.13, meant that migraine frequency dropped signficantly in those treated with rTMS compared to those who got a fake (sham) treatment. The confidence interval (CI: -1.69 to -0.58) shows that researchers are confident the true effect is somewhere within that range. In simpler terms, the confidence interval shows that rTMS reduces migraines, and researchers are 95% sure that the true amount of reduction is somewhere between a moderate and a large effect. [8] The L-DLPFC 10Hz protocol used at Neuralia TMS is derived off research by Brighina et al.

If applicable, I understand that TMS treatments for conditions other than Major Depressive Disorder or treatments that deviate from the standard protocol (e.g Accelerated TMS) are considered off-label in Australia, and the evidence base supporting its use may be less robust. 

If applicable, I acknowledge that off-label TMS use is not currently approved by the Therapeutic Goods Administration (TGA) and may involve greater uncertainty regarding safety, efficacy, and long-term outcomes.

Fibromyalgia: 

In a meta analysis by Su et al in 2021, Pain 16 randomised controlled trials were compared in terms of reduction of pain intensity. All comparisons underwent meta-analysis, which revealed significantly less pain in the rTMS group after treatment (SMD, −0.751, 95% CI, −0.991 to −0.511, I2 = 35.9%). [7] Here's a breakdown of the numbers: 

1.  Pain Reduction After Treatment: The meta-analysis looked at 16 studies and found that people in the rTMS treatment group experienced significantly less pain compared to others. The standardized mean difference (SMD) was -0.751, meaning there was a moderate reduction in pain. A negative number here shows that pain decreased. The 95% confidence interval (CI) of -0.991 to -0.511 means the researchers are confident that the true reduction in pain falls within this range. The "I² = 35.9%" refers to how consistent the studies were with each other, with a lower percentage indicating less variability between studies. [7]

2. No Publication Bias: The funnel plot and Egger test are ways to check if the results might be skewed because only certain studies were published (called publication bias). A "p = 0.88" means there's no evidence of publication bias, which supports the reliability of the findings. [7]

3. Pain Reduction Over Time:  2 Weeks to One Month Follow-Up: The studies showed that the reduction in pain was still significant after two weeks to one month, with an SMD of -0.516 (again, a moderate decrease in pain). [7] 1.5 to 3 Months Follow-Up: Even after one and a half to three months, the reduction in pain remained significant, with an SMD of -0.588. [7] The "I²" values indicate how similar the results were across the studies. At two weeks to one month, I² was 0.0%, meaning there was almost no variation between the studies. For the longer follow-up, I² was 52.6%, indicating more variability between the studies. [7]

Overall, these findings suggest that rTMS treatment significantly reduces pain, and the effect lasts for several months after the treatment ends. There was no sign of bias in the studies, meaning the results are likely reliable.  The L-DLPFC 10Hz protocol used at Neuralia TMS is derived off research by Fitzgibbon et al. (2013).

If applicable, I understand that TMS treatments for conditions other than Major Depressive Disorder or treatments that deviate from the standard protocol (e.g Accelerated TMS) are considered off-label in Australia, and the evidence base supporting its use may be less robust. 

If applicable, I acknowledge that off-label TMS use is not currently approved by the Therapeutic Goods Administration (TGA) and may involve greater uncertainty regarding safety, efficacy, and long-term outcomes.

Post Stroke Depression:

In a systematic review by Gao et al , a total of 8 trials was included and 336 participants provided data for meta-analyses. Large effects were found for rTMS + cognitive training on global cognition (g = 0.780, 95 % CI = 0.477-1.083), executive function (g = 0.769, 95 % CI = 0.291-1.247), working memory (g = 0.609, 95 % CI = 0.158-1.061) and medium improvement on ADL (g = 0.418, 95 % CI = 0.058-0.778) were seen. [11]. While, no effects were found on memory or attention. Subgroup analyses showed that combinations of phase of stroke onset, rTMS frequency, stimulation site and stimulation sessions were potent factors that modulate the effects of rTMS + cognitive training for cognitive function. 

 Here’s a breakdown of the key findings in simpler terms: 

1. Participants and Scope: The study analysed data from 336 participants across 8 trials, all aimed at evaluating how well rTMS combined with cognitive training works to improve brain function. [11]

2. Large Effects: The combination of rTMS and cognitive training showed significant improvements in: Global cognition (overall mental abilities), with a large effect size (g = 0.780), meaning it had a strong positive impact.  Executive function (skills like planning, problem-solving, and organizing), with another large effect size (g = 0.769).  Working memory (the ability to hold and use information in the short term), with a noticeable improvement (g = 0.609). [11]

3. Medium Improvement in Daily Living: There was a moderate improvement in activities of daily living (ADL), which means that rTMS helped participants perform everyday tasks better (g = 0.418). [11]

4. No Improvement in Memory or Attention: The treatment combination did not show significant improvements in memory or attention.

5. Subgroup Analysis: The study also found that certain factors, like the phase of stroke recovery, rTMS frequency, the part of the brain being stimulated, and the number of treatment sessions, influenced how effective the rTMS and cognitive training were for improving cognitive functions.

In summary, combining rTMS with cognitive training significantly improved general cognition, executive function, working memory, and daily activities, but had no effect on memory or attention. Additionally, certain treatment variables could influence the effectiveness of the therapy.

If applicable, I understand that TMS treatments for conditions other than Major Depressive Disorder or treatments that deviate from the standard protocol (e.g Accelerated TMS) are considered off-label in Australia, and the evidence base supporting its use may be less robust. 

If applicable, I acknowledge that off-label TMS use is not currently approved by the Therapeutic Goods Administration (TGA) and may involve greater uncertainty regarding safety, efficacy, and long-term outcomes.

Alcohol Addiction:

A systematic review and meta analysis by Mehta et al 2024 reports on the use of repetitive transcranial magnetic stimulation (rTMS) to treat alcohol use disorder (AUD) and other substance use disorders (SUDs). [13] Here is a breakdown of the findings. 

Overview of Alcohol Studies: 

Number of Studies: 16 studies examined the effects of rTMS on AUD, focusing on reducing alcohol cravings and alcohol consumption. Participants: 2406 participants were involved in rTMS studies across all SUDs, including AUD. rTMS Treatment: Most of the AUD studies used multiple rTMS sessions (10–20 sessions) with high-frequency (HF) stimulation targeting different parts of the brain, including the dorsolateral prefrontal cortex (DLPFC) and the medial prefrontal cortex (mPFC). These brain areas are involved in self-control, decision-making, and cravings. [13] 

Key Findings on Alcohol Addiction: 

1. Positive Effects on Craving and Consumption: 7 of 16 studies showed that rTMS significantly reduced alcohol cravings and/or alcohol consumption compared to a sham (placebo) treatment. Specifically, deep TMS (using specialized H-coils that can penetrate deeper into the brain) was highlighted as potentially more effective than traditional rTMS. For instance, studies using H-coils targeting the mPFC and anterior cingulate cortex (ACC) reported significant reductions in alcohol cravings. One study used a special protocol called continuous theta burst stimulation (cTBS) and found a significant reduction in alcohol cravings after 10 sessions targeting the mPFC.

2. Meta-Analysis Results: A meta-analysis combining results from 10 studies (447 participants) found that repeated rTMS sessions significantly reduced alcohol cravings compared to sham treatments, with a moderate-to-large effect (SMD = -1.25). This means participants felt noticeably fewer cravings after rTMS. Another meta-analysis of 5 studies (184 participants) found that repeated rTMS significantly reduced alcohol consumption, meaning participants drank less alcohol after the treatment (SMD = -1.39). [13]

3. Single-Session rTMS: In contrast to the multi-session studies, 5 studies that tested the effects of a single session of rTMS on alcohol cravings and consumption showed no significant improvements. This suggests that a single rTMS session is not enough to reduce cravings or drinking. [13]

Conclusion for Alcohol Addiction: 

Multiple sessions of rTMS, especially when using deep TMS targeting the DLPFC, mPFC, or ACC, appear to effectively reduce alcohol cravings and alcohol consumption in people with alcohol use disorder. 

Single sessions of rTMS do not seem to have any significant effect on cravings or consumption. 

The findings suggest that rTMS, particularly when delivered over multiple sessions and targeting key brain regions, could be a promising tool to help people with alcohol addiction reduce their cravings and alcohol intake, but further research is necessary to confirm these results and explore long-term effectiveness. 

In summary, rTMS shows potential as a treatment for alcohol addiction, particularly when delivered in multiple sessions, but single-session treatments are not effective.

If applicable, I understand that TMS treatments for conditions other than Major Depressive Disorder or treatments that deviate from the standard protocol (e.g Accelerated TMS) are considered off-label in Australia, and the evidence base supporting its use may be less robust. 

If applicable, I acknowledge that off-label TMS use is not currently approved by the Therapeutic Goods Administration (TGA) and may involve greater uncertainty regarding safety, efficacy, and long-term outcomes.

Patient Acknowledgements and Consent

PLEASE NOTE: 

The following acknowledgements and consent are to be signed in the presence of your TMS psychiatrist, only AFTER you have spoken to the TMS psychiatrist and read this form. You should not proceed unless you have raised and received answers to all questions and queries that you may have.

General Consent and Treatment Understanding

• I have been informed of the nature of TMS, its effects, anticipated length of time of treatment, frequency and duration of treatment, side effects, possible alternative treatment methods (eg. medication, therapy), benefits and risks of the planned TMS course and have given my consent voluntarily to participate in TMS treatment.

• I acknowledge there has been a discussion of risk benefit analysis in relation to my medical condition with respect to the aforementioned risks.

• I acknowledge that I have read and understood the TMS information sheets provided to me. I confirm that I have had the opportunity to discuss this material with my TMS psychiatrist and operator, ask any questions, and receive answers that address my concerns to my satisfaction. 

• I understand that I can change my mind at any stage, even after a course of treatment has begun.

• I have not been guaranteed the TMS treatment will be successful as treatment outcomes may vary between individuals. I understand the TMS treatment is not a cure for the condition, so I may still relapse in the future.

• I acknowledge that whilst we  will administer TMS treatment, the responsibility for the overall management of my mental health, including but not limited to changes in medication, significant deteriorations in mental health or potential suicidal thoughts, remains with my referring and primary treating doctor (General Practitioner or Psychiatrist, if applicable). Should there be any significant deterioration in my mental health, I agree to inform both my primary treating doctor and my TMS clinician.

• We do not provide emergency mental health care. If you experience a crisis or an emergency, including suicidal thoughts or worsening mental health, you must contact your primary treating doctor, call emergency services (000), or present to your nearest hospital emergency department immediately.

• If I have tinnitus or migraines, I acknowledge that TMS stimulation could potentially worsen either condition, usually temporarily. Depending on the results of a risk-benefit analysis, protocols will be specifically chosen to try to reduce (but not fully eliminate) the risk of this occurring. I will inform the doctor immediately if I observe any such changes. Should this occur, the doctor may adjust the protocols, change the location of the treatment, pause treatment until symptoms subside, or terminate the treatment altogether. For individuals with pre-existing tinnitus, ear protection (ear plugs) is expressly required to mitigate associated risks

• I acknowledge and understand that TMS treatment carries the potential risk of inducing or tinnitus, migraines, or headaches. I recognise that the selection of treatment protocols is based on a careful assessment of the associated risks and benefits. While reasonable measures may be implemented to mitigate these risks, the complete prevention or elimination of such adverse effects cannot be guaranteed. I will notify the TMS team immediately, and adjustments to my treatment protocol will be made as necessary. Should this occur, the doctor may adjust the protocols, change the location of the treatment, pause treatment until symptoms subside, or terminate the treatment altogether.

• I acknowledge that TMS carries a rare risk of ophthalmic side effects, including but not limited to retinal detachment, photosensitivity, and visual disturbances. While these rare side effects are predominantly observed in individuals with pre-existing ocular pathology, such as a history of retinal detachment, they may, in rare instances, occur in individuals without such a history. I accept these risks and confirm that I have been given the opportunity to ask questions and discuss them with my TMS psychiatrist. I agree to disclose any history of eye conditions, eye surgeries, or other visual health concerns to my TMS psychiatrist before starting treatment. I will promptly report any visual symptoms experience during or after TMS to the TMS team.

• If I have Bipolar Disorder, I acknowledge that I am at an increased risk of switching to a manic episode. This risk is usually reduced by taking a mood-stabilising medication. I acknowledge that if I have bipolar disorder, I am required to take all prescribed medications, including any mood-stabilising medications, as directed by my primary psychiatrist or GP to help reduce the risk of adverse effects during TMS treatment.

Patient Responsibilities

• I acknowledge that TMS, like many medical treatments, comes with an inherent degree of risk that cannot be removed entirely. But I agree to help the TMS team manage and mitigate the risks, by meeting my responsibilities as a patient (as outlined in this form and as specified by the TMS team from time to time).

• I will provide accurate information about my medical history and current medications, including any supplements or recreational substances.

• Any changes in my health, medications, sleep patterns, alcohol use, or substance use, may affect my treatment. I will therefore promptly inform the Neuralia TMS team and my primary treating doctor if, during a course of TMS:

  • I regularly drink more than four standard drinks of alcohol per day;

  • I abruptly stop using alcohol or benzodiazepines after frequent excessive use, or if I intend to change the dosage, quantity, or frequency of my usage;

  • I change my medications (in particular, antidepressants, benzodiazepines, mood stabilisers, antipsychotics, or bupropion);

  • I experience any medical issues;

  • I am pregnant or suspect I may be pregnant; or

  • I experience any significant changes in my medical or mental health status, including shifts in mood, new symptoms, or any deterioration in mental health.

• I understand that TMS requires accurate, up to date information from me to ensure coordinated and comprehensive care throughout my treatment. I understand that failure to disclose relevant information and changes may result in treatment complications, and expose me to increased risk – such as the risk of seizure.

Off-Label and Accelerated Protocols (if applicable)

• If applicable, I understand that TMS treatments for conditions other than Major Depressive Disorder or treatments that deviate from the standard protocol (e.g., Accelerated TMS) are considered off-label in Australia, and the evidence base supporting its use may be less robust than for TGA-approved TMS treatments.

• If applicable, I acknowledge that off-label TMS use is not currently approved by the Therapeutic Goods Administration (TGA) and may involve greater uncertainty regarding safety, efficacy, and long-term outcomes.

Treatment Monitoring and Protocol Adjustments

• I am aware that if I am started on the left side of the brain (prefrontal cortex) and there have not been any improvements by around session 20, I may be switched to the right side of the head. If I am started on the right side of the brain (prefrontal cortex), and there have not been any improvements by around session 20 then I will have a discussion with one of our TMS clinicians prior to any changes in protocol.

• I understand that most patients who benefit from TMS experience results by the fourth week of treatment. Some patients may experience results in less time while others may take longer.

Equipment and Facility Use

• I acknowledge that there is a camera in the room so TMS clinicians can monitor the positioning of the TMS coil on your head. This will be used if a TMS clinician has left the room. There will be no recording.

• I understand that the TMS treatment involves the use of a coil held in place by a mechanical boom arm. While every precaution is taken to ensure proper handling and maintenance of the equipment, I acknowledge that there is a very small risk of mechanical injury resulting from unexpected equipment failure or user error. This includes, but is not limited to, the possibility of the boom arm or coil shifting or falling, which could result in minor physical injury. I understand that all staff are trained to minimise this risk, and I consent to proceed with treatment acknowledging this potential, albeit rare, risk.

Medicare Rebated TMS

• If received Medicare rebated TMS, I declare that I am over 18 years old, have been diagnosed with a Major Depressive Episode, have not previously received TMS, have received psychological therapy, and have failed to receive satisfactory improvement for Major depressive episode despite the adequate trial of at least 2 different classes of antidepressant medication for at least 3 weeks.

Ear Protection

• I acknowledge that ear protection, specifically earplugs, is required as an integral part of the TMS treatment protocol. Ear protection (ear plugs) is especially important for patients with pre-existing tinnitus.

• I understand that declining ear protection is against medical advice, and I assume full responsibility for any potential adverse outcomes, including but not limited to, exacerbation of tinnitus or other hearing-related complications.

• I acknowledge that if I choose to decline ear protection, I do so against medical advice and accept any associated risks, including the possibility of worsening tinnitus or hearing issues.

ADHD, TINNITUS, PAIN, FIBROMYALGIA or MIGRAINE PROTOCOLS: 

I acknowledge that the use of TMS for the treatment of ADHD, fibromyalgia, chronic pain, migraines, or tinnitus is considered off-label in Australia. While this practice is commonly undertaken worldwide, it is not approved by the Therapeutic Goods Administration (TGA) for these conditions. I understand that off-label use may involve an increased risk of side effects and potentially reduced efficacy compared to its use for TGA-approved indications. By proceeding with treatment, I accept these risks and agree that Neuralia TMS will not be held liable for any adverse outcomes related to the off-label nature of this treatment.

SEIZURE RISK FACTORS: 

I acknowledge that I have been informed of the potential risk of seizures associated with TMS treatment. I understand that certain factors, such as a personal or family history of seizures, brain injury, sleep deprivation, excessive alcohol or substance use, or changes in medications, may increase this risk. I agree to disclose any history of seizure-related conditions, brain injuries, or other seizure risk factors to the TMS team before starting treatment. I will also notify the team promptly of any changes in my health, medications, sleep patterns, or substance use during the course of treatment, as these changes may further increase the risk of seizures.

PAST SEIZURE: 

I acknowledge that, due to my history of seizures, I am at an increased risk of experiencing a seizure during TMS treatment. This risk has been estimated at 2–3%, and I understand that while all reasonable precautions will be taken to minimise this risk, it cannot be entirely eliminated. By consenting to TMS treatment, I accept these risks and agree that the clinic will not be held liable for seizure-related complications.

FERROMAGNETIC MATERIAL RISK: 

I acknowledge that, in my specific case, there is a small risk associated with the potential presence of ferromagnetic material in the head or neck region. All reasonable efforts have been made to determine whether this material is ferrous or non-ferrous. Where 100% confirmation could not be achieved, I accept the small risk that the material may be ferrous and could cause adverse effects, including warming or movement during treatment. I understand that if such an event occurs, TMS treatment will be ceased immediately. By consenting to TMS treatment, I accept these risks and agree that the clinic will not be held liable for any adverse outcomes associated with the presence of ferromagnetic material

TMS DURING PREGNANCY RISK: 

I understand that while larger, standardised studies on the use of TMS during pregnancy are encouraged, current research (e.g., Rossi et al., 2021) has reported no adverse effects on the fetus or newborn child. Therefore, TMS is considered to pose minimal risk to the pregnant woman and child. I accept that the risks may not be fully understood and consent to proceed with treatment with this understanding.

PRE-EXISTING MIGRAINES or HEADACHES: 

I acknowledge that there is a potential risk of TMS treatment worsening pre-existing migraines or headaches. I understand that the treatment protocol has been specifically chosen to minimise this risk; however, it cannot be fully eliminated. I agree to inform the TMS team immediately if my symptoms worsen during/ after treatment. Should this occur, the doctor may adjust the protocols, change the location of the treatment, pause until symptoms subside, or terminate the treatment.

PRE-EXISTING TINNITUS: 

I acknowledge that undergoing TMS treatment, with pre-existing tinnitus carries a greater risk of inducing or exacerbating tinnitus. I recognise that the selection of treatment protocols is based on a careful assessment of the associated risks and benefits. While reasonable measures will be implemented to mitigate these risks, the complete prevention or elimination of possible adverse effects cannot be guaranteed. I will notify the TMS team immediately, and adjustments to my treatment protocol will be made as necessary. Should this occur, the doctor may adjust the protocols, change the location of the treatment, pause treatment until symptoms subside, or terminate the treatment altogether.

PRE-EXISTING BIPOLAR DISORDER: 

I acknowledge that I have been informed of the potential risk of a manic switch as a rare side effect of TMS, particularly for individuals with bipolar disorder, and understand that this risk may be reduced by staying on mood-stabilising medication as prescribed. I agree to disclose any history of bipolar disorder to my TMS team and to inform them promptly of any changes in my mental health or medication compliance during treatment. I acknowledge that if I have bipolar disorder, I am required to take all prescribed medications, including any mood-stabilising medications, as directed by my primary psychiatrist or GP to help reduce the risk of adverse effects during TMS treatment.

ACCELERATED TMS: 

Before initiating aTMS, the clinical team will carefully assess the risks and benefits in your specific case. By consenting to aTMS, you acknowledge and accept that: 1. The intensity and frequency of treatment sessions may increase the likelihood of certain side effects. 2. The evidence base for aTMS is less extensive than for standard TMS protocols. 3. Additional side effects may arise due to the accelerated nature of the treatment.

Please read each statement and select which indicates how much the statement applied to you over the past week.  There are no right or wrong answers.  Do not spend too much time on any statement.

The rating scale is as follows:

0   Rarely or None of the Time (Less than 1 Day)

1   Some or a Little of the Time (1-2 Days)

2  Occasionally  (3-4 Days)

3   Most of the Time or All the Time (5-7 Days)

Please read each statement and select which indicates how much the statement applied to you over the past week. There are no right or wrong answers. Do not spend too much time on any statement.

The rating scale is as follows:

0 Did not apply to me at all (Never)

1 Applied to me to some degree, or some of the time (Sometimes)

2 Applied to me to a considerable degree, or a good part of time (Often)

3 Applied to me very much, or most of the time (Almost Always)

Obsessions are unwanted ideas, images or impulses that intrude on thinking against your wishes and efforts to resist them. They usually involve themes of harm, risk and danger. Common obsessions are excessive fears of contamination; recurring doubts about danger, extreme concern with order, symmetry, or exactness; fear of losing important things.

Compulsions are urges that people have to do something to lessen feelings of anxiety or other discomfort. Oftenthey do repetitive, purposeful, intentional behaviors called rituals. The behavior itself may seem appropriate but itbecomes a ritual when done to excess. Washing, checking, repeating, straightening, hoarding and many otherbehaviors can be rituals. Some rituals are mental. For example, thinking or saying things over and over under yourbreath.

After pressing submit you should see the following:

If you don't, please check over your answers.  

You have likely missed one of the questions and the form will not have been submitted.