How to choose: finding the right fit, together
When it comes to neuromodulation, there usually isn't one "best" treatment. There's a best fit for your specific situation — and finding it is something we work out together.
Finding the right fit.
If you've spent any time researching treatments for depression or other psychiatric conditions, you've probably run into a lot of different claims on which treatment to choose.
The truth is that "most effective on average" and "right for you" may not always be the same. A treatment that works well for most patients may not be the right fit for your specific situation or life circumstances.
That doesn't mean the decision is all yours to figure out alone. You shouldn't have to make a medical decision about a procedure without someone bringing the medical expertise. But it also shouldn't be a decision that gets made for you.
Shared decision-making, in practice.
Shared decision-making is one of those phrases that gets used in healthcare a lot without much meaning behind it. Here's what it actually means in this clinic.
Two people bring expertise to any medical decision. I bring the medical expertise — what these treatments do, who they tend to work for, what the risks are, what the evidence actually says, etc. I also tell you the limitations of what we know and what we can't know. You bring expertise on your own life — what matters to you, what you can tolerate, what your days look like, what you've already tried, what you're afraid of, what you're hoping for. Neither kind of expertise replaces the other, and neither of us should be making the decision alone.
What that looks like in practice: I lay out the realistic options. I tell you what I'd be thinking about if this were my own family member. I answer questions as many times as you want to ask them. And when we land on a plan, it's a plan we both actually agree with — not one I handed you and you nodded through.
Informed consent is a conversation, not a form.
Signing a consent form isn't the same thing as informed consent. A form is paperwork. Real informed consent is a conversation where four things have happened before you sign:
If any of those four pieces is missing at the time you're asked to sign, the consent isn't really informed yet — and we'll keep talking until it is.
Why prediction is hard — and what's coming.
One of the honest parts of this conversation is that I can't tell you ahead of time, with certainty, whether a specific treatment will work for you. I can tell you the odds. I can tell you what makes a good or less good fit. But I can't promise.
That's worth saying out loud because a lot of the marketing around these treatments implies more certainty than the science actually supports. Here's what's true:
Many people get meaningful help. Response rates for the main neuromodulation treatments land in the range of 50–80% depending on the treatment, the condition, the study, and how response is measured. These are meaningful numbers — especially for people who haven't responded to other things.
Some people don't. A smaller group won't have the response we hoped for on the first attempt. That can happen for different reasons — the treatment might not have been at the right dose or target, life circumstances outside the clinic might be working against it, or the biology might genuinely not respond to this particular approach. None of these are the end of the road. Most of the time, there's a next thing to try.
The research on predicting response is moving fast. One of the most active areas in this field is trying to figure out — before starting — who's likely to respond to which treatment. Researchers are using brain imaging, EEG patterns, and machine learning to look for signals. None of it is ready for routine clinical use yet, but it's closer than it used to be. Within a few years, the workup before treatment may look more individualized than it does now.
Six things we'll think through together.
Every treatment decision is a balance of these. Different people weigh them differently — and that's exactly the point.
How urgent is this?
If you're in crisis, some treatments can help faster than others. If you have time, we can weigh tradeoffs differently. Speed of response is real, and it's different across TMS, ECT, ketamine, and medications.
What have you already tried?
Your history matters — what worked partially, what didn't work, what caused unacceptable side effects. We're not starting from zero, we're building on what we already know about your biology and your experience.
What can your life accommodate?
TMS is 30–36 weekday sessions; ECT is typically 2–3 times per week with recovery time; ketamine has its own schedule. Work, family, childcare, driving, transportation — all real. A treatment you can't actually complete isn't a treatment.
What tradeoffs are acceptable to you?
Each treatment has a different side effect profile. ECT works better on average but has more cognitive effects. TMS has fewer side effects but takes longer. Ketamine is fast but short-acting. The "right" tradeoff isn't the same for everyone.
What does coverage look like?
Cost and insurance are a real part of the decision, not a footnote. Some treatments are well-covered; some aren't; some need prior authorization. We'll talk through what your coverage means practically before you commit.
What matters to you?
Some people are comfortable with anesthesia; some aren't. Some want the most evidence-backed option; some want the least invasive. Some have strong feelings about medications; some don't. Your values aren't a tiebreaker — they're a main input.
Questions worth sitting with.
You don't need answers to these before we meet. But thinking through them ahead of time often makes the conversation more useful.
Questions to bring with you
- How urgent does this feel to me, honestly?
- What have I tried, and what did I learn from each attempt?
- What would I do if I felt better in three months? Six months?
- What side effects would be dealbreakers for me?
- Who in my life would I want involved in this decision?
- What am I most afraid of about treatment? What am I most hoping for?
- How much certainty do I need before I'd be willing to try something?
If some of those feel uncomfortable to answer, that's normal. We'll work through them together.
The process, from first call to follow-up.
Evaluation
A thorough conversation about your history, what you've tried, what's going on now, what's at stake. Not a checklist — a real conversation. This usually takes 60–90 minutes.
Understanding your options
We go through the treatments that might be a fit. What each one does, who it tends to work for, what the realistic range of outcomes is, what the tradeoffs are, what the practical details look like, what it's likely to cost you. I'll tell you what I'd recommend and why — and why I might be wrong. By the end of this conversation, you should have what you need to give informed consent — not just sign a form.
A plan we both agree with
We decide together. If that takes more than one visit, that's fine. Some decisions deserve a second conversation, a second opinion, or time to sit with a family member. Nothing urgent is being decided under pressure unless it truly has to be.
Follow-up and adjustment
Whatever we start with is a plan, not a guarantee. We track your symptoms with standard questionnaires, watch for what's working and what isn't, and adjust as we learn more. This is a relationship, not a one-time intervention.
Frequently asked.
How do I know if neuromodulation is right for me?
The honest answer is: we figure it out together. There's no simple rule. The conversation usually starts with your history, what you've tried, and what you're looking for — and grows from there.
Do I have to commit to a treatment at my first visit?
No. Sometimes good decisions take more than one conversation. If you need more time, more information, or a second opinion, take it.
What if I'm not sure I want to go through with a treatment after we've discussed it?
Then you don't. You can take time to think about it, talk with family, come back with more questions, get a second opinion, or decide this isn't the right time. I'd rather you say no to the right treatment at the wrong moment than say yes before you're ready.
What happens if the treatment doesn't work?
Then we talk about what's next. Non-response to a first course is common enough that we plan for it up front — including whether continuing with adjustments might help, whether a different modality is worth trying, or whether we need to rethink the plan entirely. It's not a dead end.
What if I start a treatment and want to stop?
You can. I'd want to understand what changed — sometimes it's a side effect we can manage, sometimes it's a change of heart, sometimes it's something life threw at you — but you're not locked in. The goal is a plan that serves you, not the other way around.
Can I bring someone with me?
Yes. Family members, partners, close friends — whoever helps you think clearly is welcome in the conversation, with your consent.
What if I want a second opinion?
Get one. I'm not offended. For a decision this consequential, a second opinion is often a good idea, and I'll help you think about where to go for one.
Explore each option.
Plain-language pages on each treatment — what it is, what to expect, what the evidence shows.
Important
The information on this page is for educational purposes only. It is not medical advice and is not a substitute for evaluation, diagnosis, or treatment by a qualified healthcare professional. No physician-patient relationship is established through this website. If you are experiencing a medical or psychiatric emergency, call 911 or go to the nearest emergency room. If you are having thoughts of suicide or self-harm, call or text 988 to reach the Suicide and Crisis Lifeline.