How do you actually bring up TMS with your psychiatrist?

Most people find out about TMS online, not from their own doctor — which makes the first conversation feel oddly one-sided. A few things make it easier. Bring your medication history written down: every antidepressant you've tried, roughly the dose, how long, and why it ended. This single document drives both the clinical conversation and, later, insurance approval. A current PHQ-9 score also helps — "I scored 18" lands differently than "I've been feeling bad." The actual ask can be simple: "I'd like to talk about TMS. I've been on [N] antidepressants without enough improvement — do you think it's appropriate for me, and can you refer me?" Psychiatrists don't need to operate the machine themselves to refer you, the same way they don't run an MRI scanner. If you hear "it's expensive" — most major insurers, including Medicare, cover TMS for depression in 2026 with prior authorization, so out-of-pocket for insured patients is usually a copay, not the sticker price. If you hear "the evidence is weak" — TMS has FDA clearances for depression (2008), OCD (2018), anxious depression (2021), and adolescent depression (2024). If your prescriber is genuinely dismissive rather than just cautious, most TMS clinics accept self-referrals — their own psychiatrist handles the evaluation. https://tmslist.com/blog/how-to-talk-to-your-psychiatrist-about-tms/ Did your psychiatrist bring up TMS first, or did you? If you had to push for a referral, what finally worked? This is general information, not medical advice.