Everything you need to know about How to Track Your TMS Progress: PHQ-9 Scores, Mood Journals, and Real Milestones — how it works, what it costs, and how to find a provider who actually knows what they're doing.
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One of the strangest things about TMS treatment is that the people around you often notice your improvement before you do. Depression recalibrates your sense of “normal” so gradually that a 30% improvement can feel like nothing changed — until you look at the data.
That’s why tracking matters. Patients who measure their progress make better decisions mid-course, catch early response signals, and give their care team what they need to adjust protocols. Here’s how to do it well.
The PHQ-9: your primary instrument
The Patient Health Questionnaire-9 is the standard depression measure used in TMS clinics — nine questions, scored 0–27, taking about two minutes.
How to use it during TMS:
- Get a true baseline before session one. Take it during a normal week, not your best or worst day.
- Retest weekly, same day and time. Consistency beats frequency — Friday after your last session of the week works well.
- Know the bands: 20+ severe, 15–19 moderately severe, 10–14 moderate, 5–9 mild, under 5 remission.
- Understand the definitions clinics use: response = a 50% or greater drop from baseline; remission = a score under 5. These are the same thresholds behind the success rates you see quoted.
A patient starting at 19 who reaches 9 by week six has had a textbook response — even though a 9 can still feel imperfect. The trajectory is the point.
What to track beyond the score
The PHQ-9 is necessary but not sufficient. The earliest TMS response signals usually show up in behavior before they show up in mood questions:
Sleep quality. Often the first domain to move, sometimes by week two. Track time to fall asleep and whether you wake rested. (More in TMS and sleep quality.)
Task initiation. Note when previously avoided tasks — dishes, email, phone calls — start happening without internal negotiation. This is a classic early responder sign.
Social behavior. Did you text someone back the same day? Accept an invitation? These beat any questionnaire at detecting behavioral activation.
Physical energy. Rate it 1–10 daily, one number.
Anhedonia moments. Write down any moment something felt genuinely funny, interesting, or beautiful. Early in recovery these are rare enough to count individually — which is exactly why they’re worth recording.
A simple daily format that takes 60 seconds
Date / Session #: Mood (1–10): · Energy (1–10): · Sleep (1–10): One thing I did today that I’d been avoiding: One moment that felt good, even briefly: Side effects (if any):
Keep it in your phone’s notes app. The side-effects line matters early on — scalp discomfort and mild headaches typically fade in week one, and your log will show the trend (see the complete side-effects guide).
The realistic timeline
Progress is nonlinear. Based on typical response patterns:
- Weeks 1–2: Little subjective change; maybe sleep improvements. This is normal — don’t panic.
- Weeks 3–4: The most common window for first noticeable shifts. Often others notice first.
- Weeks 4–5: The “dip” — some patients report a temporary plateau or regression around this point before continuing to improve.
- Weeks 5–6+: Gains consolidate. Roughly a third of responders keep improving for several weeks after the course ends.
Our week-by-week TMS timeline covers each phase in detail.
What to do with your data
Share it at your check-ins. Your treating physician reviews progress at set intervals — usually weeks two to three and again at the midpoint. Real numbers beat “I think I feel a little better.”
Use it for mid-course decisions. If your scores haven’t moved by session 15–20, that’s not automatically failure — but it’s a data point that may prompt your doctor to adjust intensity, location, or protocol.
Keep it after treatment ends. Your log becomes your early-warning system. A two-week upward drift in scores months later is the signal to call about booster sessions — well before a full relapse. Know the relapse signs worth acting on.
Frequently asked questions
My clinic already administers the PHQ-9. Should I still self-track?
Yes. Clinic assessments are snapshots every week or two; your daily log captures the texture between them, especially sleep and behavior changes that questionnaires miss.
What if my numbers aren’t improving?
Bring it up — don’t wait to be asked. Non-response at the midpoint has real options: protocol changes, targeting review, or added strategies. See what affects TMS success.
Are there apps for this?
Any notes or mood-tracking app works. The tool matters far less than the consistency. Fellow patients share their tracking setups in our community forum.
