How TMS Helps People Heal When Therapy and Medication Aren’t Enough From Dr. Robynne O’Byrne, Clinical Psychologist and Co-Founder/Clinical Director of Golden State TMS

By Dr. Robynne O’Byrne | 2025

Several years ago, a patient I’ll call Diane came to me with debilitating depression and anxiety. We explored the issues driving her symptoms, looked closely at family-of-origin dynamics, and worked through childhood trauma. I referred her to a psychiatrist for medication, shared practical tools for daily symptom management, and educated her on lifestyle changes- food as medicine, sunlight for mood regulation, meditation, and breathing techniques. She did everything I suggested, and she improved, but not enough. She was still living with significant depression and starting to feel very demoralized.

At that point, I recommended something that felt radical to both of us: Transcranial Magnetic Stimulation (TMS). It changed her life, and in many ways, it changed mine too.

Back when I was a senior at UC San Diego majoring in Psychology, I signed up for a neuropsychology course. I thought it would be about normal brain function. Instead, it was all about what happens when things go wrong.

Two lectures are still vivid to me. In one, Dr. Ramachandran described Phantom Limb Syndrome, which was just beginning to be studied in the 1980s. Patients who had lost a limb still felt pain in that missing arm or leg. The explanation: misfiring in the brain’s somatosensory cortex where the limb was still “mapped.”

In another lecture, Dr. R described almost the opposite problem. A stroke patient woke one night convinced his left arm wasn’t his. He used his right hand to throw the “unwanted” arm out of bed, and of course, because it was attached, he threw himself out as well.

These stories stuck because they showed me how powerfully the brain can create experiences outside conscious control. Neither of those patients was “crazy.” Their brains were malfunctioning. That realization reshaped how I thought about mental health.

I did consider a career in neuropsychology, but ultimately I was drawn to the healing power of talk therapy. Still, I never forgot the lesson that many “mental health” problems are rooted in neurobiology.

Over the last 30 years as a clinical psychologist, I’ve treated hundreds of patients. My practice has always been grounded in a passion for both neuroscience and psychology. I consider myself an integrative therapist- pulling from different theoretical orientations, but also going beyond talk therapy when needed. I bring in breathing techniques for anxiety, exercise as an antidepressant, psychiatric medication when indicated, and mindfulness practices like meditation and visualization.

My patients span a wide spectrum: some are long-term therapy clients seeking deeper understanding of themselves and their families; others are short-term clients facing a specific issue or life change. For many, therapy is transformative. Having a safe place to process grief and trauma, to see unhealthy patterns clearly, and to learn new coping skills can change a life.

But for a subset of patients, despite their best efforts, symptoms persist. Whether it’s depression, anxiety, ADHD, OCD, addiction, or another condition, some people stay stuck. I let go long ago of the idea that these patients “don’t want to get better.” In my experience, most people desperately want to be happy and will try almost anything to get there.

That realization is what drew me to TMS.

TMS is a treatment for depression, anxiety, and other psychiatric conditions. It’s a brain stimulation technique that activates the networks in the brain responsible for mood regulation. Instead of electricity, like in ECT, or chemicals, like in psychiatric medication, it uses gentle magnetic pulses to stimulate an electrochemical response across the synapse. In simple terms: it helps neurons remember how to communicate.

Everybody’s brain has networks, like airline routes, and hubs where traffic flows through. If one hub is offline, the whole network falters. While there are many causes of depression, sometimes the thinking part of the brain can essentially “go offline,” leaving deeper, non-thinking structures in charge. It’s like the engine is driving the car instead of the driver. By stimulating the right hub, TMS helps bring the conductor back online, restoring balance.

Research shows that by targeting the left side of the brain with 10 hertz stimulation, neurons with many dopamine receptors can be upregulated. On the right side, 1 hertz can quiet networks linked to anxiety and norepinephrine activity. There are now dozens of studied protocols—not just for depression and anxiety, but also for OCD, insomnia, migraines, chronic pain, and more.

When I suggested TMS to Diane, it was still mostly offered through research studies at academic institutions. I found one nearby, and she qualified. After six weeks of treatment, her symptoms lifted in a way nothing else had accomplished. Her depression and anxiety almost disappeared. Just as important, she could now use therapy differently, absorbing tools and insights that had never fully taken root before.

Her progress inspired me to dive deep. I read everything I could, studied the brain networks involved in mood regulation, and kept sending patients for TMS when therapy alone wasn’t enough. Again and again, I saw significant relief. TMS was not only effective but also safe, FDA-approved, free of serious side effects, and often covered by insurance.

Eventually, my husband Matthew, also a clinical psychologist, and I decided to bring this treatment into our own practice. For me, it felt like the perfect integration of therapy and neuroscience.

I’m fortunate to work with family: my sister-in-law Gabrielle, a psychiatrist, and my niece, a psychiatric nurse. Together we formed Golden State TMS, a family-owned, independent clinic with a deep commitment to patient care. We treat the whole person, taking a careful history, considering every factor, and approaching care from a multidisciplinary perspective.

Earlier this year, we added a new individualized technology that allows us to tailor TMS to each patient’s native brain activity. The results have been phenomenal.

One Golden State TMS patient, Pamela, recently wrote me:

“It feels as though I have my life back. The interventions now have a chance to work, whereas I've felt stuck for so long in patterns of thinking that I couldn't shift. For context, I have dealt with GAD, depression, complex PTSD and being on the spectrum for decades, and have been doing some form of therapy for my entire adult life. I completed the TMS protocol for depression in the spring, and it worked! Despite challenges in my life, I am more content than I’ve been in decades. I’m two-thirds through the anxiety protocol and now have the mental space to pause rather than immediately react to the triggers. My brutal inner critic has morphed into a reasonable and compassionate inner parent who can negotiate with my inner child. I am so grateful that TMS works for me—I was beyond weary of suffering.”

Pamela’s experience is why we started Golden State TMS. There is nothing more meaningful than helping people find relief.

We love what we do, and we’re excited to bring this treatment and new technology to the greater Marin community. You don’t need to be in ongoing therapy to benefit from TMS, and if you are already working with a therapist or psychiatrist, TMS can be done right alongside your current treatment to make those interventions even more effective. If you think TMS might be right for you or someone you love, please reach out here on our website. We’d be honored to talk with you and explore how we can help.