NeuroStar TMS Therapy for Depression | Mercer Island & Seattle

Board-certified psychiatrist and TMS Program Director Dr. Cara Erkut offers NeuroStar TMS therapy for treatment-resistant depression on Mercer Island, serving Seattle, Bellevue, and the greater Eastside.

When Antidepressants Aren’t Enough

You’ve tried the medications. Maybe two. Maybe five. Maybe you’ve lost count.

Each time your doctor suggested something new, you felt that flicker of hope. And each time, either the side effects became unbearable or the depression just… stayed. Weight gain from one pill. Feeling emotionally flat from another. Sexual dysfunction that made you question whether treating depression was worth losing other parts of yourself.

Sound familiar?

I’m Dr. Cara Erkut, and I hear this story almost every week in my Mercer Island practice. Patients who’ve been cycling through antidepressants for years, wondering if they’re somehow “doing depression wrong” because nothing seems to stick.

That’s where TMS comes in.

What Is TMS Therapy, Exactly?

TMS stands for Transcranial Magnetic Stimulation. I know that sounds like something from a science fiction movie, but the concept is actually pretty straightforward.

Depression isn’t just “feeling sad.” Brain imaging studies show that people with depression have reduced activity in specific regions, particularly the left dorsolateral prefrontal cortex. Think of it as a section of your brain that’s running on low power.

During TMS, we place a magnetic coil against your scalp, and it delivers focused pulses to that underactive area. These pulses generate small electrical currents that gradually “wake up” those sluggish neurons. Over the course of treatment, your brain starts functioning more normally again.

The FDA cleared TMS for depression back in 2008, and since then we’ve accumulated massive amounts of real-world data. My practice uses the NeuroStar Advanced Therapy System, which has been used in over 7.6 million treatment sessions across more than 182,000 patients. Those aren’t laboratory numbers. That’s actual clinical experience.

Why I Became a TMS Program Director

When I finished my psychiatry residency at the University of Washington, where I served as Chief Resident, I’d already seen hundreds of patients struggle with treatment-resistant depression. The standard approach felt like throwing darts at a board and hoping something would land.

I got involved with TMS because it offered something different. Instead of flooding your entire system with medication and waiting to see what happens, TMS targets the specific brain region involved in depression. The precision appealed to me.

Now, as TMS Program Director, I’ve guided dozens of patients through treatment. Some had tried eight or nine medications before walking through my door. Watching their symptoms lift, often for the first time in years, reminds me why I got into psychiatry in the first place.

I’m also a member of the Clinical TMS Society and maintain active involvement in the psychiatric education community through my role as Clinical Instructor at UW Harborview Medical Center. This isn’t a treatment I prescribe casually. It’s become central to how I practice.

What the Research Actually Shows

I believe in being direct about outcomes. TMS isn’t magic, and it doesn’t work for everyone. But the numbers are genuinely impressive.

According to NeuroStar’s clinical data from real-world practices, approximately 83% of patients experience significant improvement in their depression symptoms. That’s not “they felt a little better.” That’s clinically meaningful change measured by standardized assessments.

Even more striking: 62% achieve what we call remission. Their depression symptoms essentially disappear.

For adolescents ages 15 and older (TMS was recently FDA-cleared for this group), the response rate hits 78%, with 48% reaching remission. If you’re a parent watching your teenager struggle with depression that medications can’t touch, those numbers matter.

What Does TMS Feel Like?

This is probably the question I get asked most, so let me walk you through it.

Your first appointment is the longest because we need to do “mapping.” I’m not literally making a map of your brain, but I am calibrating the treatment to your specific anatomy. I’ll place the magnetic coil against your scalp and deliver single pulses until I find the spot that makes your thumb twitch. That tells me I’ve located your motor cortex, which helps me precisely target the prefrontal region.

Some people find mapping mildly uncomfortable. You might feel a light tapping sensation. If you’ve ever been near an MRI machine, the clicking sound is similar.

Once we’ve got your settings dialed in, regular treatment sessions are pretty routine. You’ll sit in a comfortable chair, fully awake and alert. Many patients read, scroll through their phones, or just chat with our staff during the 19-minute session. The magnetic pulses create a rhythmic tapping feeling on your scalp. Weird at first, but most people get used to it within a few sessions.

After each session, you can drive yourself home and go about your normal day. No anesthesia, no sedation, no recovery time. That’s a big deal for people who need to keep working or taking care of their families while undergoing treatment.

The most common side effect is headache or scalp discomfort right after treatment, especially in the first week. We can adjust the settings if it’s bothering you, and most patients find it fades quickly. Over-the-counter pain relievers usually help.

Serious side effects are rare. The biggest concern is seizure, but we’re talking about less than 0.1% of patients. I screen carefully for seizure risk before recommending TMS.

The “TMS Dip” Nobody Warns You About

Here’s something I want to mention because you’ll probably read about it online and get worried.

Some patients experience what’s called a “TMS dip” during treatment. Usually around weeks two or three, they suddenly feel worse instead of better. More tired, more sad, more frustrated. If you’re paying attention to online forums, you’ll see people posting things like “TMS ruined my life” or “I felt terrible in week two.”

I’m telling you this upfront because I don’t want you to panic and quit if it happens. In my experience, patients who push through the dip usually end up with excellent outcomes. The ones who stop treatment during that tough period often wish they’d continued.

If you’re in the middle of treatment and struggling, call my office. We can talk through what you’re experiencing and adjust if needed. What I don’t want is for you to suffer in silence and give up.

Is TMS Right for You?

TMS works best for adults with major depressive disorder who haven’t responded adequately to antidepressant medications. That’s actually the FDA indication. If you’ve tried at least one antidepressant without satisfactory improvement, you may be a candidate.

I also treat adolescents ages 15 and older, though TMS is used as an add-on to their existing treatment in this age group.

TMS may not be appropriate if you have:

• Metal implants in or near your head (dental fillings are fine)
• A history of seizures or epilepsy
• Certain other neurological conditions

During your evaluation, we’ll go through your complete medical history. I’m thorough about screening because I want you to be safe, and I want the treatment to work.

Insurance Plans Accepted

We accept most major insurance plans to make quality psychiatric care accessible. If you don’t see your plan listed, call us anyway. Coverage for TMS has expanded significantly, and we can verify your specific benefits.

Not sure about your coverage? We’ll verify your benefits before your first appointment so there are no surprises.

What Happens After Treatment Ends?

Most patients maintain their improvement for months after completing TMS. A significant study followed patients for 12 months and found that NeuroStar’s benefits held up over time.

Some patients do need “maintenance” sessions down the road. Depression is a chronic condition for many people, and just like you might need occasional physical therapy tune-ups for a back injury, some patients benefit from periodic TMS sessions to keep their mood stable.

Better sleep is frequently the first thing patients notice. Energy improves. Concentration sharpens. And somewhere in the middle of treatment, often around week three or four, patients tell me they realized they’d laughed at something for the first time in months. That “lifting of something heavy,” as one patient described it.

I can’t promise you’ll feel like a completely different person. But I can tell you that most patients who complete treatment wish they’d done it sooner.

Serving the Greater Seattle Area

My practice is located on Mercer Island, which puts me right in the middle of the Seattle metro area. Patients come from Seattle, Bellevue, Kirkland, Redmond, Renton, Issaquah, Sammamish, and beyond.

If you’re on the Eastside, you’re probably looking at a 10-15 minute drive. Coming from Seattle proper, the I-90 floating bridge puts you on my doorstep in about the same time. I know the daily commitment feels daunting, but patients consistently tell me the location made it manageable.

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