🧠 Episode Outline – Magnetic Waves Podcast: The Supervised Mind
Title: When Is It Time to Use TMS?
Host: Dr. Faisal Rafiq 🎯 Learning Objectives * Understand what TMS is and how it works neurologically * Learn FDA-approved vs. off-label uses * Identify when to introduce TMS in a treatment plan * Recognize TMS’s role alongside or instead of medication * Explore documentation, supervision prompts, and real-world patient dialogue 🧠 Segment 1: What Is TMS? * Transcranial Magnetic Stimulation = non-invasive neuromodulation * Targets left dorsolateral prefrontal cortex * Outpatient procedure, no anesthesia * Sessions last ~20 mins, done 5x/week for 4–6 weeks ✅ Segment 2: FDA-Approved Indications * MDD (Major Depressive Disorder) * OCD (with deep TMS coils) * Smoking cessation 🧾 Covered by insurance after 2–4 failed med trials 🧪 Segment 2B: Off-Label Uses * Bipolar depression (with mood stabilizer) * PTSD (right-sided or bilateral protocols) * Generalized anxiety * Chronic pain / fibromyalgia * Tinnitus, stroke recovery, cognitive enhancement ✅ Often successful in patients with medical fragility or high med intolerance 🌈 Segment 2C: TMS in Autism Spectrum Disorder * Not a cure for autism, but can help with: * Repetitive behaviors * Emotional reactivity * Irritability * Comorbid depression/anxiety * Targets: medial or dorsolateral prefrontal cortex * Still experimental—seen in adolescents and young adults with mood symptoms 🧠 Supervision Tip: “What’s the functional goal—mood, rigidity, or attention?” 🔄 Segment 3: When to Consider TMS * Failure of 2+ antidepressants * Intolerance to meds * Patient preference for non-pharmacologic option * Depression severe but not ECT-appropriate 💊 Segment 4: Comparing to Medication * No weight gain, sedation, or GI upset * Can be used alongside meds or when simplifying regimens * Great option for: * Pregnancy (Not Approved but Tested) * Medical comorbidities * Low adherence to meds 🧘 Segment 5: What It’s Like for Patients * Mild discomfort (scalp tapping, headache) * No cognitive side effects * Common explanation:
“Like physical therapy for your mood circuits”
 📊 Segment 6: Coverage and Protocol Variants * Covered by most insurances with documentation * Newer options: * Theta Burst Stimulation (3–5 min sessions) * Accelerated TMS protocols * Self-pay or research-based access expanding 📋 Segment 7: Documentation Essentials * Prior med trials, dose, duration * Clinical severity scales (PHQ-9, QIDS-SR) * Note: "TMS discussed as evidence-based option" * Functional impairment and treatment resistance 💭 Segment 8: Supervision Questions * “Are we maxing out meds when a better modality exists?” * “Is this depression—or circuit dysfunction?” * “What prevents me from bringing this up sooner?” 🧭 Final Takeaway TMS is safe, effective, and underutilized.
It’s not just for psychiatry’s toughest cases—it’s a legitimate next step in care.