Is It Okay to Miss One Day of TMS?

Is It Okay to Miss One Day of TMS?
If you’re undergoing transcranial magnetic stimulation (TMS) for major depression or another mental health condition, you might find yourself in a situation where you need to miss an appointment. Whether it’s due to an unexpected illness, a family emergency, or a scheduling conflict, skipping a session can cause anxiety and concern about your treatment’s effectiveness. It’s a common worry among TMS patients, and you are not alone in wondering about the impact of a missed procedure. Let’s explore what happens when you skip a day of TMS therapy and what you can do to ensure your treatment stays on track for the best possible outcomes.
Dr. Nicholle Peralta, M.D.

Date:01/28/2025

So, Is Missing One Day of TMS Therapy
Acceptable?

Generally speaking, missing a single day of TMS therapy is acceptable and won’t significantly impact your overall treatment outcome. While consistency is ideal for optimal results, one or two skipped sessions won’t derail your progress or diminish the therapy’s effectiveness. The brain’s response to TMS treatment is cumulative, building over multiple procedures rather than depending on a perfect day-to-day schedule.
However, it’s essential to communicate with your healthcare provider about any skipped appointments. They may recommend adjusting your schedule to compensate for the missed session or extending your therapy course by one day. The key is to avoid making skipped treatments a habit and to return to your regular schedule as soon as possible. As a general rule, avoid missing multiple TMS sessions in a row.

Why Consistency Matters?

Consistency in TMS therapy matters because it gradually modifies neural pathways and promotes lasting changes in brain activity. Each treatment session builds upon the progress of previous ones, creating a cumulative effect that strengthens neural connections and helps regulate mood-related circuits. Think of it as physical therapy for your brain — like regular exercise that leads to stronger muscles, consistent TMS sessions produce more robust and lasting therapeutic benefits.

Patients who follow a regular treatment schedule typically experience better outcomes and more sustainable symptom improvements. This is why TMS clinical practices are carefully designed with specific timing and frequency requirements, usually involving daily sessions over several weeks to achieve optimal results. Every mental health condition, such as major depressive disorder (MDD), obsessive-compulsive disorder (OCD), bipolar depression, and anxiety, have their own TMS protocols. Therefore, following the schedule is the best way to achieve final treatment outcomes.

Effects of Missing One TMS Treatment

Immediate Impact

The immediate impact of missing a single TMS session is typically minimal. Most patients won’t notice significant changes in their symptoms or mood after skipping one treatment. Unlike some antidepressant medications that have a daily therapeutic effect, TMS works by creating gradual changes in brain function over time. Therefore, missing one day doesn’t usually lead to an immediate reversal of progress or a sudden return of symptoms.

Think of it like missing one day at the gym during a long-term fitness program – while it’s not ideal, it won’t undo all your previous achievements. However, some particularly sensitive patients with treatment-resistant depression or bipolar disorder might report feeling slightly more anxious or experiencing mild fluctuations in their mood, often due to the break in their routine rather than a direct physiological effect of skipping the treatment.

Long-Term Considerations

From a long-term perspective, an occasional missed session is unlikely to impact your overall treatment success. However, multiple skipped appointments or developing a pattern of inconsistent attendance could potentially affect the final depression outcomes. Effective TMS treatment relies on a cumulative effect, where each session contributes to lasting changes in brain activity.

While your brain won’t “lose” the progress it has made from previous sessions, frequent interruptions might extend the time needed to achieve optimal results or slightly reduce the therapy’s effectiveness. This is why Mindset TMS recommends completing the entire treatment course as prescribed. If you miss a session, your provider might recommend adding it to the end of your schedule to ensure you receive the full therapeutic benefit.

Can a Missed Session Cause Problems With Insurance?

While many insurance companies cover TMS therapy, they often have specific requirements to ensure treatment adherence and proper scheduling. Insurance providers typically approve a predetermined number of sessions based on clinical protocols, and frequent missed appointments could potentially create complications with coverage. Some insurance plans require documentation of consistent attendance and might scrutinize cases with multiple gaps in treatment. A missed session usually won’t trigger insurance issues, but a pattern of skipped appointments could lead to questions about therapy compliance or, in rare cases, affect coverage authorization.

Mindset TMS helps patients verify how their insurance covers TMS therapy and their attendance requirements at the beginning of their treatment to avoid any unexpected issues.

Standard TMS Schedules

Repetitive TMS

Repetitive TMS is the most commonly used form of TMS therapy. The standard treatment schedule typically involves 20-40 sessions over 4-8 weeks. Each procedure lasts about 20 to 40 minutes, depending on the specific protocol and targeted area. Repetitive TMS is highly effective for conditions like MDD and OCD. It is personalized to the patient’s response over time.

Deep TMS

This technique penetrates deeper brain structures than traditional repetitive TMS. The standard schedule is similar, with sessions administered 5 days a week over 4-8 weeks. Each procedure typically lasts 20 to 40 minutes. Deep TMS is particularly beneficial for treatment-resistant depression and OCD. The wider coil configuration allows for broader stimulation, making it a versatile option for diverse patient needs.

Theta Burst Stimulation (TBS)

TBS is an advanced, shorter-duration form of TMS that delivers rapid bursts of magnetic pulses. A standard TBS session lasts about 3 to 9 minutes, and the overall schedule may vary depending on patient needs. For example, the SAINT protocol includes 5-10 daily TBS sessions over 5 days of intense therapy. Its efficiency and shorter procedure duration make it an attractive option. Our patients report similar results without a lower time commitment.

What to Do If You Missed a Session?

Communicate With Your Provider

After missing a TMS session, the first and most crucial step is to contact your healthcare provider as soon as possible. Your treatment team needs to know about any interruptions in your schedule to monitor your progress and adjust your plan if necessary. Be honest about why you missed the session and any concerns you might have. Most providers understand that life circumstances sometimes interfere with treatment schedules and will work with you to find solutions. This open communication also helps maintain the therapeutic relationship and ensures you receive the best possible care.

Reschedule

Once you contact your provider, their office will reschedule your missed appointment as soon as possible. Many TMS clinics, like Mindset TMS, have flexible schedules to accommodate occasional missed sessions. We recommend getting back on track with your regular treatment plan as quickly as possible. If your usual appointment time doesn’t work well with your schedule, this might be a good opportunity to discuss alternative time slots that might be more suitable. Remember, the sooner you reschedule, the better your chances of maintaining treatment momentum.

Make Up the Missed Sessions

Your provider might recommend adding the missed session to the end of your treatment course to ensure you complete the entire protocol. This approach helps maintain the total dosage of TMS therapy needed for optimal results. In some cases, if you’ve missed multiple sessions, your provider might suggest slightly adjusting the treatment protocol or extending the overall duration of your therapy course. Completing the entire journey is crucial for achieving the best possible outcomes.

Best Practices for Treatment Adherence

Planning Ahead

Successful TMS treatment requires careful planning and organization. Start by mapping out your entire schedule in advance, considering work commitments, family obligations, and other regular activities. Block out consistent times for your TMS sessions and treat them as non-negotiable appointments. It’s helpful to identify potential scheduling conflicts early and address them proactively. Consider discussing your treatment schedule with your employer or family members to ensure they understand the importance of these sessions and can support your commitment to TMS therapy.

Setting Reminders

In our busy lives, even necessary appointments may slip our minds. We recommend establishing a reliable system of reminders to help you stay on track with your TMS sessions. This might include setting multiple alarms on your phone, using a calendar app with notification features, or maintaining a physical calendar where you mark off completed procedures. Some patients also find it helpful to create reminders for preparation activities like leaving home or wrapping up work. Consider establishing a backup reminder system, such as asking a family member to help you remember or using multiple digital platforms.

Transportation Arrangements

Reliable transportation is crucial for maintaining consistent TMS treatment attendance. It is best to plan your travel method for each session, whether driving yourself, arranging rides with family members, or using public transportation or ride-sharing services. Have a backup plan for unexpected situations, such as car troubles or lousy weather. If you rely on others for rides, communicate clearly about schedules and ensure they understand the importance of arriving on time.

Conclusion

Missing one day of TMS therapy is generally not a cause for significant concern. While consistency is key to achieving the best results, an occasional skipped session won’t derail your progress. The cumulative nature of TMS means that each procedure builds upon the last, and your provider will work with you to adjust your schedule if necessary. By maintaining open communication, rescheduling promptly, and planning, you can stay on track with your treatment and maximize its benefits. Mindset TMS is here to support you throughout your journey toward improved mental health!