What is the Typical Duration of a Mental Health Rehab Program?

Weighing telepsychiatry vs in-person care means holding two findings at once. Across many mental health conditions, video psychiatry performs about as well as sitting in the same room. For severe mental illness (SMI) such as schizophrenia and bipolar disorder, the trials simply have not been run, and parts of this care (injections, blood tests, physical checks, and crisis assessment) cannot travel through a screen at all. So the real question is rarely either-or. It is which parts of care can safely go virtual, which parts cannot, and who should be making that call as your stability changes over time. Here's what the research shows, and where the practical limits fall.

What Telepsychiatry Is and What In-Person Care Means

Telepsychiatry is psychiatric care delivered by video or phone: evaluations, medication visits, and therapy sessions held from wherever the patient is. In-person care means visits at a clinic, with the clinician and everything a clinic contains (labs, injections, vitals, a team down the hall) physically present. Between them sits hybrid care, a deliberate mix of both formats, which is how a great deal of psychiatric care in the United States now actually runs. The terms matter less than what each format can physically deliver, which is where the comparison gets concrete.

What the Research Shows

The broadest comparison to date is a 2023 meta-analysis in the British Journal of Psychiatry covering 32 randomized trials and 3,592 participants across 11 conditions (Hagi et al., 2023). Pooled together, there was no significant overall difference in symptom improvement between telepsychiatry and face-to-face treatment. By condition, telepsychiatry did better for depressive disorders, across 6 trials, and face-to-face did better for eating disorders, on the strength of a single trial. Dropout findings split the same way, each direction supported by one small study. Several of the condition-level results rest on a single trial, which makes them fragile rather than final, and the authors note as much.

That finding cuts in both directions. Video care is not a watered-down version of psychiatry; for depression in particular it holds up well, and dismissing it would misread the data. At the same time, a pooled average across 11 conditions says nothing about the conditions that never made it into the trials, and the trials skew toward the diagnoses that are easiest to study remotely.

What We Know, and Do Not Yet Know, About SMI

Schizophrenia and bipolar disorder are largely missing from this evidence. A 2022 systematic review in JMIR Mental Health went looking for randomized trials of telehealth psychotherapy and found 12 trials with 931 patients, none of which studied schizophrenia or bipolar disorder, leading the authors to call for high-quality research before treating telehealth as equivalent for these conditions (Greenwood et al., 2022). The Hagi meta-analysis likewise names neither condition among its findings. Narrative reviews describe telehealth with psychosis as feasible and acceptable, and feasibility is a different claim than tested equivalence.

The absence of strong trials is not proof that telepsychiatry harms people with severe mental illness, and it is not proof of equivalence either. For conditions this serious, that gap counsels care in what gets moved online, and it puts the burden on care models to show their format choices serve the patient rather than the schedule.

What Needs to Happen In Person

Some components of SMI treatment are physical, and no quality of webcam changes that:

• Long-acting injectable antipsychotics are administered by a clinician, on a schedule, in person. For many people they are the backbone of stability.
• Blood monitoring comes with several core SMI medications: lithium levels, the regular blood counts recommended with clozapine, and metabolic monitoring for people on antipsychotics, per each medication's prescribing requirements. These need a clinic or a lab, not a login.
• Physical exams and vitals catch the medical problems that psychiatric medications can cause and that psychiatric illness so often hides from everyone, including the patient.
• Interventional treatments such as TMS and Spravato are delivered in clinic under supervision, by design.
• Crisis assessment is a hands-on clinical skill. Judging safety through a screen, with a person who may not want to be seen clearly and can end the call at will, is a genuinely harder task than assessing someone in the room.

For severe mental illness, these are routine, recurring parts of treatment rather than rare events, which is why fully remote care for this population runs into walls that have nothing to do with anyone's opinion of telehealth. A care plan that includes an injectable every four weeks and quarterly labs has an in-person spine no matter how the conversations happen.

Where Telepsychiatry Fits Well

Video visits earn their place in several situations: stable follow-ups and medication check-ins once a plan is working, access for people who live far from psychiatric care or cannot travel easily, and flexibility for family members joining a session from different places. For a routine fifteen-minute medication review in a stable month, driving an hour each way serves nobody.

Those are real advantages, and they come with real conditions. A video visit requires privacy at home, which not every household offers, a reliable connection, and the ability to engage through a screen, each of which gets harder exactly when symptoms are most active. Paranoia can make a camera feel threatening; depression can make logging in feel impossible. The format works best for the stable stretches of an illness that does not always stay stable.

Hybrid Care and Level of Need

The workable frame is level of need rather than loyalty to a format. Someone newly stabilized after a hospitalization needs more in-person contact: labs, physical checks, possibly injections, a team reading them closely. Someone two stable years into treatment may handle routine visits by video and come in for bloodwork and periodic full evaluations. A rough month might mean temporarily moving visits back on site.

The mix should shift as stability shifts, in both directions, and the people best positioned to adjust it are a care team who knows the whole picture, the same logic that separates outpatient from inpatient levels of care.

Why a Coordinated, In-Person Team Matters for SMI

Severe mental illness is a whole-body, whole-life illness, and people living with it face higher rates of serious physical illness, so treating it takes more than a sequence of appointments in any format. At Amae Health, one team (psychiatrists, therapists, and primary care physicians, along with peer mentors, care coordinators, dietitians, and health coaches) works from a shared plan in one place, so the injection, the lab draw, the therapy session, and the medical follow-up belong to one plan rather than four calendars. That is the part of care a screen cannot substitute for: not the conversation, which video carries fine, but the coordination and the physical medicine around it. It is the model behind our psychosis care and bipolar disorder treatment, and our full care model shows how the pieces fit.

Talking to Our Care Team About the Right Format

The right format is a clinical question with a moving answer: it depends on your current symptoms, your medications and their monitoring, your stability, and your goals. A first conversation can settle where to start and how to adjust from there. Reach out to our care team about the right format for this stage, and our patient and family resources describe what coordinated care involves.

Frequently Asked Questions

Is telepsychiatry as effective as in-person psychiatry?

For many conditions, yes. A 2023 meta-analysis of 32 randomized trials found no significant overall difference in symptom improvement, and telepsychiatry did best for depressive disorders. Results vary by condition, and evidence for schizophrenia and bipolar disorder specifically is limited.

Is telepsychiatry effective for schizophrenia?

The research is thin. A 2022 systematic review found no eligible randomized trials of telehealth psychotherapy for schizophrenia, while narrative reviews describe telehealth with psychosis as feasible and acceptable. Limited research is the accurate summary, not evidence of failure.

Can long-acting injectable antipsychotics be given by telehealth?

No. Injections are administered in person by a clinician, so people on long-acting injectables need in-person visits on their injection schedule, whatever else happens by video.

Do I need blood tests or physical checks with serious mental illness?

Often, yes, depending on the medication. Lithium requires blood level checks, clozapine calls for regular blood monitoring, and antipsychotics call for metabolic monitoring under their prescribing requirements, all of which involve a clinic or lab visit.

Can telepsychiatry handle a mental health crisis?

No. Video visits are not built for emergencies. In a crisis, call or text 988 or go to the nearest emergency room; a care team can take over treatment planning once the person is safe.

What is hybrid psychiatric care?

A deliberate mix of in-person and video visits, adjusted over time as stability and needs change. In-person time covers the parts of care that require presence, such as injections and labs, while routine check-ins can happen by video.

What if I am having thoughts of suicide?

Help is available right now, at any hour: call or text 988 for free, confidential support.

Citations

1. Hagi K, et al. "Telepsychiatry versus face-to-face treatment: systematic review and meta-analysis of randomised controlled trials." British Journal of Psychiatry, 2023;223(3):407-414. doi.org/10.1192/bjp.2023.86. Tier 1 (peer-reviewed meta-analysis).
2. Greenwood H, et al. "Telehealth versus face-to-face psychotherapy for less common mental health conditions: systematic review and meta-analysis." JMIR Mental Health, 2022;9(3):e31780. PMC8956990. Tier 1 (peer-reviewed systematic review).
3. 988 Suicide and Crisis Lifeline. 988lifeline.org. Tier 2 (FAQ only).

People researching lithium vs Lamictal usually want a winner, and the evidence does not crown one. Lithium and Lamictal (lamotrigine) are both used to prevent mood episodes in bipolar disorder, and they differ in ways that matter: which pole of the illness each protects against best, how much monitoring each requires, and what risks each carries. Those differences, not a ranking, are what actually decide which one a psychiatrist reaches for. This comparison walks through how each medication works, what the research shows, their side effects and safety considerations, and the questions that shape the choice, including pregnancy planning and whether the two can be combined.

How Each Medication Works and What It Is Approved For

Lithium is the oldest mood stabilizer in psychiatry and still one of its most effective tools. It is used to treat acute manic episodes and as maintenance treatment, meaning ongoing medication that lowers the risk of future episodes.

Lamotrigine, sold as Lamictal, came to psychiatry from epilepsy treatment. It is an anticonvulsant, and its FDA approval in bipolar disorder covers maintenance treatment of bipolar I disorder, to delay the time to new mood episodes. It is not approved for treating acute mania, which means a person in the middle of a manic episode needs something else. In practice, lamotrigine's role is prevention, and clinicians most often think of it in connection with the depressive side of the illness.

Lithium vs Lamictal: Side-by-Side

What the Research Shows

The cleanest head-to-head data comes from an 18-month placebo-controlled trial in people with bipolar I disorder who had recently been depressed, with 463 patients randomized to lamotrigine, lithium, or placebo (Calabrese et al., Journal of Clinical Psychiatry, 2003). Lamotrigine beat placebo at delaying depressive episodes: at one year, 57% of people on lamotrigine had needed no intervention for depression, compared with 45% on placebo. Lithium beat placebo at delaying manic and hypomanic episodes, with 86% intervention-free for mania at one year versus 72% on placebo.

A 2021 Cochrane review pooling 11 trials and 2,314 participants filled in the comparison between the two drugs (summarized in American Family Physician, 2022). Lamotrigine and lithium had similar rates of depressive recurrence. Lamotrigine was less effective than lithium at reducing manic recurrence at one year. And fewer people on lamotrigine reported side effects than people on lithium over 6 to 12 months, a practical signal about tolerability.

You will often see this compressed into a slogan: Lamictal for depression, lithium for mania. The slogan is directionally useful and too simple. Lamotrigine's depressive-prevention results were similar to lithium's in the Cochrane data, and the absolute differences in the Calabrese trial were modest. Episode history, side effects, and monitoring preferences do more work in the real decision than the slogan suggests.

Monitoring and Safety

Lithium's prescribing information builds monitoring into the treatment: regular serum level checks, because the gap between a helpful and a harmful level is narrow, plus periodic kidney and thyroid testing, since the label identifies both as organs lithium can affect. For many people this becomes an unremarkable part of the routine, a few blood draws a year once stable. It is a real commitment, and a manageable one.

Lamotrigine does not require routine blood level monitoring, which is one of its practical appeals. Its defining safety issue is different: an FDA boxed warning for serious skin rashes, including Stevens-Johnson syndrome. Per the label, serious rash is rare, nearly all cases appear in the first 2 to 8 weeks of treatment, and the slow dose escalation the label requires exists to reduce that risk. This is why lamotrigine cannot be started quickly, and why any new rash during those early weeks should be reported to the prescriber right away. Neither safety profile is a reason for alarm. Both are reasons the medication belongs under a psychiatrist's supervision.

Side Effects Compared

The side effects most commonly reported with lithium in its labeling and the clinical literature are tremor, increased thirst and urination, weight gain, and thyroid effects, usually an underactive thyroid that is itself treatable. Lamotrigine is generally described as weight-neutral in the literature, with headache, dizziness, and nausea its commonly reported side effects, along with the rash risk described above. For someone whose previous medication caused significant weight gain, that difference alone can shape the conversation. For someone whose illness leans heavily manic, lithium's strength against that pole can outweigh its side-effect burden.

Suicide Risk and Lithium: What Is and Is Not Established

Lithium is frequently described as the mood stabilizer that prevents suicide, and the research record deserves more precision than that. A 2013 meta-analysis in The BMJ (Cipriani et al.) reported fewer suicides among people taking lithium than among controls. A 2022 reanalysis in Epidemiology and Psychiatric Sciences (Nabi et al.) reached a different conclusion: restricted to randomized trials, the evidence is inconclusive, because suicide is rare and a handful of events drive the estimates. Researchers are actively debating which analysis handles the data better. Lithium may protect against suicide, but the randomized evidence can't yet confirm it, so the question remains open.

Pregnancy and Planning Ahead

Lithium and lamotrigine carry different considerations in pregnancy, and this is a planning conversation rather than a verdict. For anyone who could become pregnant, the time to discuss medication is before conception, with a psychiatrist who can weigh episode history against the specific risks and benefits of each option, sometimes alongside an obstetrician. Untreated bipolar disorder in pregnancy carries its own serious risks, so the goal of that conversation is a plan that protects both the pregnancy and the person's stability, not a reflexive stop.

Can Lithium and Lamictal Be Used Together?

Yes, and the combination is common in clinical practice. The usual logic pairs lithium's protection against manic episodes with lamotrigine's role on the depressive side. Whether that combination fits any individual person is a psychiatrist's call, made from their episode pattern, their response history, and how they tolerate each medication.

Talking to a Psychiatrist About the Right Fit

The lithium vs lamotrigine decision runs through a short list of personal questions. Which pole of the illness has dominated your history, mania or depression? How do you feel about regular blood tests? Which side-effect profile is more livable for you? Are pregnancy plans on the horizon? A psychiatrist who knows your full history turns those answers into a plan, and adjusts it as your life and your illness change. Medication changes should never be self-directed, including stopping a drug that seems to have done its job.

Bipolar disorder treatment at Amae Health pairs that medication expertise with therapy and whole-person support in one coordinated care model, built for people whose illness has been hard to stabilize. If you are weighing these medications, or your current one is not working, talk with an Amae psychiatrist about what fits your history. Our guide to effective bipolar disorder treatment covers the bigger picture beyond medication.

Frequently Asked Questions

Is lithium or Lamictal better for bipolar depression?

Neither is simply better. Lamotrigine is often used to prevent depressive episodes, and in the 2021 Cochrane review its depressive-recurrence results were similar to lithium's. The right choice depends on a person's episode pattern, side-effect tolerance, and history, judged by their psychiatrist.

Is Lamictal effective for mania?

It is not approved for treating acute mania, and in the Cochrane review it was less effective than lithium at preventing manic recurrence at one year. People whose illness runs manic usually need a different or additional medication.

Do I need blood tests on Lamictal?

Routine blood level monitoring is not typically required for lamotrigine, unlike lithium. A clinician still tracks response and side effects, especially during the first weeks.

Why does Lamictal have to be started so slowly?

Slow dose escalation lowers the risk of serious skin rash, the subject of the medication's FDA boxed warning. Nearly all serious rashes occur in the first 2 to 8 weeks, so any rash in that window should be reported promptly.

Does lithium cause weight gain?

For some people, yes. Weight gain is a recognized lithium side effect, alongside tremor, thirst, and thyroid changes, while lamotrigine is generally considered weight-neutral. Individual experience varies widely.

Can you take lithium and Lamictal together?

Yes, the combination is common in clinical practice, often pairing lithium's anti-manic protection with lamotrigine's depressive-side coverage. It is a decision for you and your psychiatrist, never a self-directed change.

What if I am having thoughts of suicide?

The 988 Suicide and Crisis Lifeline offers free, confidential support by call or text, 24/7. If you are in immediate danger, call 911 or go to the nearest emergency room.

Citations

1. Calabrese JR, Bowden CL, Sachs G, et al. "A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently depressed patients with bipolar I disorder." Journal of Clinical Psychiatry, 2003;64(9):1013-1024. psychiatrist.com. Tier 1 (peer-reviewed RCT).
2. Hashimoto Y, et al. Cochrane review (2021) on lamotrigine for bipolar maintenance, summarized in American Family Physician, 2022. aafp.org. Tier 1 (Cochrane systematic review).
3. Cipriani A, Hawton K, Stockton S, Geddes JR. "Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis." BMJ, 2013;346:f3646. Tier 1 (peer-reviewed meta-analysis).
4. Nabi Z, Stansfeld J, Plöderl M, Wood L, Moncrieff J. "Effects of lithium on suicide and suicidal behaviour: a systematic review and meta-analysis of randomised trials." Epidemiology and Psychiatric Sciences, 2022;31:e65. Tier 1 (peer-reviewed meta-analysis).
5. 988 Suicide and Crisis Lifeline. 988lifeline.org. Tier 2 (FAQ only).

By the time most people start comparing TMS clinics, they've already been through a lot: two or three antidepressants, maybe more, often a stretch of therapy, and the slow realization that something still isn't working. Then the search results come back with a dozen Bay Area clinics, from San Francisco to San Jose, that all seem to say the same thing.

They aren't the same. Choosing the right TMS therapy clinic in the Bay Area comes down to a handful of checks: how carefully the clinic screens you, which protocol it uses, whether your insurance will pay, whether you can actually get there five days a week, and who looks after you once the last session ends. Below is each check, the questions to put to any clinic on a first call, and a plain account of what we do and don't offer at our Los Altos and San Mateo clinics.

How to choose a TMS clinic: 7 things to check

1. Confirm that a psychiatrist reviews your full history before treatment is scheduled.
2. Ask which TMS protocol the clinic uses and what it is FDA-cleared to treat.
3. Check that the clinic is in-network with your plan and files the prior authorization for you.
4. Test the commute at the hour you'd really travel, because a course means dozens of visits.
5. Find out who runs each session and how often your symptoms are measured.
6. Ask how TMS will fit with your current medication, therapy, and prescriber.
7. Ask what the plan is if symptoms come back after the course ends.

The rest of this guide takes those one at a time.

The three kinds of TMS providers in the Bay Area

The Bay Area has more TMS options than most regions, and they sort into three broad groups. Knowing which group a clinic belongs to tells you a lot before you ever call.

TMS-only clinics deliver the treatment and usually rely on your existing psychiatrist for everything else. Integrated practices put TMS inside a broader treatment plan with the same team managing medication, therapy, and follow-up. Neither model is wrong. They just put the work of coordination in different places, and on someone different. We offer both: standalone TMS if you already have a psychiatrist and therapist you want to keep, or TMS as part of full care with our team.

Make sure you're a candidate before you compare clinics

A clinic is only "right" if TMS is a clinically reasonable option for you in the first place. That question gets settled at a screening visit, and a good clinic won't skip it.

What insurers usually look for

Prior authorization is required by most major insurers, and the criteria tend to line up with what clinicians check anyway: a confirmed diagnosis of major depressive disorder (MDD), trials of several antidepressants from different classes without enough improvement, a trial of psychotherapy, and no medical reason to avoid TMS. Plans differ on the details, such as how many medication trials they want documented. At our clinics, getting to a first treatment takes three steps: a psychiatric evaluation, prior authorization, and a mapping visit. We handle the authorization, and its timing depends mostly on your insurer. Ask any clinic how long each step usually takes, since the total wait also depends on gathering past treatment records and booking the mapping visit.

What can rule TMS out

Most of the screening questions are about metal and electrical activity near the head. Metal in or near the head (surgical clips, fragments, some implants) and implanted devices such as cardiac pacemakers or medication pumps can rule TMS out. So can a history of seizures, stroke, brain injury, or neurosurgery, and the team will ask about epilepsy in the family too. Pregnancy calls for an individual assessment with both the psychiatric and obstetric teams. Regular dental fillings are fine.

If a clinic offers to book your first session before anyone has gone through these questions with you, treat that as a reason to keep looking.

Device and protocol: what the labels actually mean

Clinic websites throw around terms like rTMS, theta burst, deep TMS, and SAINT. They describe real differences in how treatment is delivered, and they change both your schedule and what the evidence says.

Standard rTMS, theta burst, and deep TMS

Repetitive TMS (rTMS) is the original form, first cleared by the FDA for depression in 2008. The National Institute of Mental Health describes a standard course as daily sessions five days a week for four to six weeks, and lists side effects that are usually mild: scalp discomfort, tingling of the face or jaw muscles during treatment, and brief headaches or lightheadedness.

Intermittent theta burst stimulation (iTBS) is a newer pattern of pulses that takes about 3 minutes per session instead of 37.5 for a standard 10 Hz session. In a randomized trial at three Canadian university hospitals (Blumberger et al., The Lancet, 2018), iTBS was non-inferior to standard rTMS for treatment-resistant depression. Shorter sessions, similar results. Deep TMS uses a different coil design to reach larger and deeper brain areas.

Ask any clinic which of these it offers and why it would pick one for you. A clear answer is a good sign.

About SAINT and "accelerated" TMS

The Bay Area has a particular connection to accelerated TMS. Stanford neuromodulation therapy (SNT, previously called SAINT) was developed at Stanford: it packs a full course into five days, with several sessions a day, and uses functional MRI to pick each patient's target. In a sham-controlled trial (Cole et al., American Journal of Psychiatry, 2022), the 29 participants analyzed at the interim stage saw a 52.5% average drop in symptoms with active treatment, against 11.1% with sham, four weeks after treatment. The study was small, and the protocol needs imaging and specialized equipment.

That matters when you shop. "Accelerated" on a clinic website can mean many things, from the imaging-guided Stanford protocol to simply more sessions per day. Ask whether the clinic uses MRI-guided targeting and exactly which protocol it delivers. For transparency: we don't offer accelerated TMS. Our Bay Area clinics use the standard daily course.

Run the commute test

This is the check people skip, and it's often the one that decides whether they finish. At our Los Altos and San Mateo clinics, a standard course runs about 36 sessions over six to nine weeks, with appointments Monday through Friday. After the first mapping visit, a typical session takes about 10 minutes, only 3 to 5 of which are the stimulation itself. The visit is short. The trip there is what you're really signing up for, roughly 36 times.

A clinic that looks close on a map can still be a 50-minute drive at the hour you'd need to go. Before you commit, do the drive once at your real appointment time, from wherever you'll actually be that day: home, the office, or school drop-off. Ask the clinic which time slots are open, how much flexibility there is if your week changes, and what happens if you miss a session. At our clinics, TMS sessions typically run between 10 a.m. and 3 p.m., so a midday break from work is usually the easiest fit. If you have to miss a day, call the team and the session is added at the end of the course rather than lost.

One thing works in your favor here. TMS needs no anesthesia or sedation, so you can drive home and head right back to work.

Who runs your sessions, and who talks to your psychiatrist

In most clinics, a trained TMS technician runs the day-to-day sessions, while a psychiatric prescriber sets the treatment plan and reviews how you're responding. Ask who will be in the room, which prescriber is responsible for your plan, and how often your symptoms will be rated on a standard scale. Without regular measurement, nobody can tell whether the course is working until it's over.

Here's how it works with us. Your psychiatric prescriber is there in person for the first mapping visit, where they find the right coil position and strength for you and set your treatment parameters. After that, a trained TMS technician from our care coordination team runs your daily sessions under that prescriber's supervision. You'll keep meeting with your prescriber throughout the course, and we track your symptoms with standard questionnaires such as the PHQ-9 for depression, from the first session to the last, so you both can see whether treatment is working.

Then there's everything else in your care. Most people keep taking their medication and seeing their therapist during TMS, so someone has to coordinate. At a TMS-only clinic, that someone is usually you and your outside prescriber. With us, you can choose. If you already have a psychiatrist or therapist, you can keep them and come to us for TMS alone: the evaluation, mapping, treatment, and psychiatric monitoring during the course. If you want more support, TMS can sit inside a coordinated plan with psychiatrists, therapists, primary care clinicians, health coaches, and peer support specialists on the same team.

Ask what happens after the last session

Results from TMS can last, but not always without help. In a 12-month follow-up of 257 patients from 42 clinical practices (Dunner et al., Journal of Clinical Psychiatry, 2014), 62.5% of those who had responded still met response criteria a year later, while staying on antidepressants with access to more TMS if needed. About 36% of the group had TMS reintroduced at some point during the year.

So ask each clinic what happens if symptoms start to return. Who notices? Who adjusts your medication? Can you come back for more sessions, and how fast? A clinic that only thinks in six-to-nine-week blocks may leave those questions with you.

While you're asking about results, notice how the clinic talks about them. "Response" usually means symptoms dropped by about half, and "remission" means they've largely gone. In one real-world study across 42 practices (Carpenter et al., Depression and Anxiety, 2012), 58% of patients met response criteria, and 37% reached remission, based on clinician ratings. A clinic that walks you through numbers like these, without promising where you'll land, is giving you a realistic picture.

Questions to ask on your first call

Keep this list open when you call:

• Who reviews my psychiatric and medical history, and which prescriber oversees my treatment?
• Which protocol and device do you use, and what is it FDA-cleared for?
• Are you in-network with my plan, and who files the prior authorization?
• What appointment times are open, and what is your missed-session policy?
• How do you measure progress, and what happens if I'm not improving halfway through?
• How will you coordinate with my current prescriber and therapist?
• What is the plan if my symptoms return after the course?

Be wary of any clinic that guarantees results, skips the screening questions, or suggests changing your medication without involving the psychiatrist who prescribes it.

TMS at our Los Altos and San Mateo clinics

At two Bay Area clinics, we offer TMS for adults with major depressive disorder that hasn't responded to medication: our Los Altos clinic on South San Antonio Road and our San Mateo clinic on O'Farrell Street. We don't have a clinic in San Francisco itself, so San Mateo is usually the closer option from the city and the northern Peninsula, and Los Altos from the South Bay.

Both clinics are in-network with Aetna, Anthem Blue Cross Blue Shield, Blue Shield of California, Optum, and Evernorth/Cigna. Sliding-scale pricing is available based on financial need. We don't currently accept Medi-Cal or the Health Plan of San Mateo. Same-day appointments are available for a first visit.

You can come to us for TMS alone and keep your current psychiatrist and therapist, or combine it with the integrated psychiatric care we provide for depression, bipolar disorder, and other complex conditions. If you're working out how to choose the right TMS therapy clinic in the Bay Area, start with a screening conversation: request an evaluation and our team will go through your history, your insurance, and whether TMS makes sense for you, or whether another approach fits better.

Frequently asked questions

What disqualifies you for TMS?

The main exclusions are metal in or near the head (other than dental fillings), implanted devices such as pacemakers or medication pumps, and a history of seizures. A history of stroke, brain injury, or neurosurgery can also rule it out. Pregnancy needs an individual assessment. For insurance purposes, you'll also usually need documented trials of several antidepressants and psychotherapy first.

Does insurance cover TMS therapy in California?

Many commercial plans cover TMS for major depressive disorder that hasn't improved with medication, almost always with prior authorization. Criteria vary by plan, so the clinic should run a benefits check before you start. Our Bay Area clinics are not contracted with Medi-Cal for TMS.

How much does TMS cost without insurance?

It depends on the clinic and the protocol, and a full course involves dozens of sessions, so ask for the total course price, not just the per-session rate. At our clinics, cash pay and sliding-scale pricing are available, and our team can walk you through the cost before you commit.

What are the downsides to TMS?

The biggest one is time: daily weekday visits for six to nine weeks at our clinics. Side effects are usually mild, mostly scalp discomfort and headaches that usually ease after the first week or so. Seizure is the most serious risk, and it's very rare. And TMS doesn't work for everyone, which is why measuring progress during the course matters.

Is there a TMS clinic in San Francisco?

Several providers offer TMS in San Francisco, including UCSF. Amae doesn't have a San Francisco clinic. Our nearest locations are San Mateo, a drive down the Peninsula, and Los Altos.