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.

TMS · For Patients and Families

Transcranial magnetic stimulation: a patient's guide

This page is written for people who are thinking about TMS, or whose family member is considering it — and who want real information without a sales pitch. It covers what TMS is, what to expect, what the research actually shows, and how to reach our team if you'd like to talk about whether it might be right for you.

Adam Hart, MD · Section Chief, Neuromodulation Program, Prisma Health · Greenville, SC

What is TMS?

TMS stands for transcranial magnetic stimulation. It's a treatment for depression (and a few other conditions) that uses focused magnetic pulses to gently stimulate a specific area on the outside of your brain. The treatment is non-invasive and does not require anesthesia. Most patients continue their existing medications during TMS — in fact, combining TMS with medication may produce better results than either alone.

During a TMS session, you sit in a comfortable chair while a small coil is placed against the side of your head. The coil delivers magnetic pulses — about the strength of an MRI machine — that travel through your skull and activate nerve cells in a brain region called the prefrontal cortex. This area is thought to be underactive in depression. Over a series of treatment sessions, TMS appears to help rebalance activity in this region and in connected brain circuits.

The essentials: You're awake the whole time. You can drive yourself home. Each session can range from about 3 to 40 minutes depending on the protocol and patient factors, though approximately 20 minutes is typical for standard protocols. A standard course is 5 days a week for about 6 weeks. TMS has been FDA-cleared for depression since 2008 and is covered by most major insurance plans when medication hasn't been enough.
TMS treatment room at the Behavioral Health and Wellness Pavilion

Our treatment room at the Behavioral Health and Wellness Pavilion — designed for comfort during your sessions.

What TMS is not

TMS is sometimes confused with electroconvulsive therapy (ECT). They're very different treatments. ECT uses electrical current to induce a brief, controlled seizure under general anesthesia. TMS uses magnetic pulses at a much lower intensity, doesn't induce a seizure, and is done while you're awake. People often confuse the two because both are "brain stimulation" treatments, but the patient experience is completely different — no anesthesia, no memory effects, no hospital stay.

What a session actually looks like

You sit in a comfortable chair while the coil rests against the left side of your head. You stay awake the whole time.

If you've never had TMS before, a session is probably simpler than you're picturing. You sit in a comfortable chair in a quiet room. A small coil — about the size of a hairdryer — is placed against the side of your head. You stay awake and alert the whole time. Most people listen to music, chat with a staff member, or just rest with their eyes closed. When the session is over, you stand up and go about your day. No recovery time, no sedation, no restrictions on driving or going back to work.

How does it work?

The honest answer is that researchers are still working out all the details, but here's what we understand so far.

TMS coil Left DLPFC (the target) Magnetic pulses pass through the skull

The coil rests on the left side of your head, positioned over the left dorsolateral prefrontal cortex (DLPFC). Magnetic pulses travel painlessly through your scalp and skull to activate this region of the brain — the area thought to be underactive in depression.

In depression, certain brain circuits — especially ones involved in mood, motivation, and how we think about ourselves — aren't communicating the way they're supposed to. One specific area (called the left dorsolateral prefrontal cortex, or L-DLPFC for short) tends to be underactive. Another area deeper in the brain (the subgenual anterior cingulate) tends to be overactive. These two areas are normally connected in a way that lets one "regulate" the other — when it's working right, the DLPFC helps quiet down the other area.

TMS targets that outer area (the DLPFC) because it's accessible from the scalp. By stimulating it repeatedly over a course of treatment, TMS appears to help restore the normal rhythm of communication between these brain regions. Over time, the overactive area tends to calm down, and patients often report that the "weight" or "fog" of depression begins to lift.

Importantly, TMS isn't doing something artificial — it's essentially helping your brain's own circuits work more the way they did before the depression started.

A quick note on brain networks

Your brain doesn't work as isolated regions doing separate jobs. Instead, different regions work together in networks, like sections of an orchestra. Depression seems to involve a few specific networks playing out of rhythm with each other. TMS works on a key "conductor" region within those networks — the DLPFC — to help them find the right rhythm again. This is why TMS can improve symptoms that seem quite different from each other: low mood, poor concentration, low energy, rumination, and even some anxiety symptoms often improve together.

Is TMS right for me?

TMS is usually considered when antidepressant medications haven't fully worked — but that doesn't mean it's a last resort. It's a legitimate treatment option with a different mechanism than pills, and for many people, it opens a door that medications couldn't.

TMS might be a good fit if:

  • You have depression that hasn't responded well to two or more antidepressant medications
  • You've had side effects from medications that made them hard to continue
  • You prefer a non-medication treatment approach, or want to add one to what you're already doing
  • You have OCD that hasn't fully responded to therapy and medication
  • You're able to commit to the schedule (most protocols are 5 days per week)

TMS may not be right if:

  • You have metal implants in your head (not including dental fillings). Vagus nerve stimulators and deep brain stimulators also rule it out.
  • You have a history of seizures or a condition that significantly raises seizure risk (like poorly controlled epilepsy)
  • You have an active implanted device like a cochlear implant or pacemaker (some are compatible, but need careful review)
  • You can't commit to the treatment schedule, which requires coming in most weekdays for about 6 weeks

If you're uncertain, an evaluation is the best way to know. Our team will go through your full history — what you've tried, what's working, what isn't — and give you an honest recommendation about whether TMS is a good option for you. Sometimes it's the right next step; sometimes something else is.

What a typical visit looks like

The first visit and a regular treatment visit are different. Here's what each one actually looks like, step by step.

Before your first appointment (screening call)

  1. Screening call with the coordination team

    Once a referral comes in or you reach out directly, you'll typically receive a call from the TMS coordination team — often a program nurse or nurse practitioner. They'll ask a few questions about your symptoms, treatment history, and what you're hoping to get out of an evaluation. This call typically takes 10–20 minutes.

  2. Records gathering

    The coordination team will work with you to collect relevant medical records before your appointment — past psychiatry notes, a current medication list, any relevant imaging or neurology records, and your insurance information. They'll often contact your current providers directly with a records release, so you don't have to chase paperwork yourself. Having this information in hand before the visit makes your consultation much more productive.

  3. Scheduling your consultation

    Once records are in, the team will schedule your initial consultation with a psychiatrist. They'll also give you a realistic picture of what to expect at the visit and what questions to come prepared with.

Your first appointment (initial consultation)

  1. We talk about your history

    Your symptoms, your treatment history, what's worked and what hasn't, any medical conditions, and your goals for treatment. This usually takes about 45–60 minutes. We'll answer your questions and make sure TMS is a good fit before going any further.

  2. Insurance check

    Our team will handle the prior authorization process with your insurance. Most major insurers (Medicare, BCBS, Aetna, Cigna, United, and many others) cover TMS for depression when certain criteria are met. We'll let you know what your out-of-pocket cost will be before any treatment starts.

  3. Treatment planning

    If TMS is a good fit and insurance approves, we'll schedule your first treatment session. Many patients start within 1–2 weeks of the consultation.

Your first treatment session (the "mapping" visit)

  1. Motor threshold test

    Before your first treatment, we need to find the right setting for your specific brain. We do this by placing the coil over your motor cortex and delivering a few test pulses to find the minimum strength that makes your thumb twitch. This takes about 10–15 minutes and is a one-time step. You might feel a light tapping on your head. It doesn't hurt.

  2. Target location

    Using a measurement method from the mapping test, we determine exactly where to place the coil for your treatment. We'll note this position so it's reproducible at every session.

  3. Your first treatment

    You'll sit in the chair, the coil will be placed against your head, and the treatment will begin. You'll hear a clicking sound and feel a tapping sensation on your scalp. The first session is often longer than later ones because of the mapping, but the treatment itself is the same length.

A regular treatment visit

  1. Check in

    You'll check in at the front desk and head back to the treatment room. You'll often see the same staff members, who will ask how you've been feeling.

  2. Get comfortable

    You'll sit in a comfortable chair, similar to a dental chair but designed for TMS. The coil will be positioned against your head using the settings from your mapping session.

  3. Treatment

    Depending on the protocol, your session will last between about 3 minutes (for newer theta-burst protocols) and approximately 20 minutes for standard protocols, though some patients require longer.1 You'll hear a clicking sound and feel a tapping sensation on the side of your head. You can listen to music, watch TV, or just rest with your eyes closed — whatever helps you relax.

  4. Done

    That's it. You can drive yourself home, go back to work, pick up the kids, or do whatever was on your day's agenda. TMS doesn't cause drowsiness or cognitive side effects, so your day picks up right where it left off.

Your full treatment course

TMS isn't a one-and-done treatment — it works through repeated stimulation over a series of sessions. Most people do not feel changes right away. The cumulative effect builds over the course.

Standard course

A typical course of TMS for depression is 5 sessions per week for 6 weeks (30 sessions total), followed by a 6-session taper over the next 3 weeks for a total of 36 sessions. This is the protocol most major insurers cover. Newer theta-burst sessions are about 3 minutes each,1 so even with travel, a treatment visit fits into a lunch break for most people.

It's worth knowing that the exact number 30 (or 36) isn't magical — it was set by the original FDA approval studies, and most insurers have simply adopted it as the standard. In practice, the right number of sessions varies from patient to patient. Some patients respond strongly by session 20; others need more than 36 to reach their best response.2 We'll be transparent with you about what the research actually shows, and if extending treatment beyond the standard 36 sessions seems likely to help you, we'll discuss that option openly (more on this in the evidence section below).

What your treatment calendar looks like

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Treatment session (30 total) Taper session (6 total) No treatment

A standard course is 30 daily sessions across weeks 1–6, followed by a tapering schedule across weeks 7–9 that gradually reduces from 3 sessions in week 7, to 2 sessions in week 8, to 1 session in week 9 — helping consolidate your response. 36 sessions total, about 9 weeks from start to finish.

When will I feel better?

Most people don't notice big changes in the first week or two. Some start to feel subtle improvements around weeks 2–3 — often described as a little more energy, better sleep, or others noticing a change before you do. More substantial improvement typically comes during weeks 4–6. A small group of patients responds quickly; another group responds more gradually; and unfortunately there are some patients that don't respond at all. We'll track your progress along the way with brief questionnaires so we can see how things are going objectively.

After the course

After finishing the acute course and taper, most patients continue with their regular psychiatric care (medication, therapy, or both). The benefit from a course of TMS often lasts a year or longer for patients who respond.10 If symptoms start to return down the road, we'll talk through options together — sometimes a shorter re-treatment course is appropriate, sometimes adjustments to medication or therapy are the right next step. It's a conversation we have based on how things are going.

Newer, faster options

Research is moving toward accelerated protocols — treatments compressed into a few days rather than several weeks. The most established of these is called SAINT (also known as SNT), which uses personalized brain imaging and 10 sessions per day for 5 days. Early results are encouraging.3 Accelerated protocols aren't universally available, are often not covered by insurance, and have more limited research behind them than the standard course — but the field is moving quickly, and options continue to expand.

Side effects and safety

TMS has a well-established safety profile. Most side effects are mild, limited to the treatment area, and usually go away within the first week or two of treatment.

Common side effects

  • Scalp discomfort or headache at or near the treatment site. Usually mild, often resolves with over-the-counter pain relievers. Most people find it becomes less noticeable after the first few sessions.
  • Tapping sensation during treatment. Some people find this uncomfortable at first but adjust quickly.
  • Facial muscle twitching during treatment, especially near the jaw or eye. This stops as soon as the pulse ends.
  • Lightheadedness briefly after standing up, in a small number of patients.
  • Fatigue that some people notice after sessions, usually mild.

Rare side effects

The most serious potential side effect is a seizure, but this is very rare — the largest survey of clinical TMS practice (more than 586,000 sessions) found a rate of about 0.3 seizures per 10,000 sessions, or roughly 1 in 30,000.4 Earlier surveys put the rate even lower — fewer than 1 seizure per 60,000 sessions when patients without risk factors were treated within published guidelines.5 This is comparable to the seizure risk associated with many commonly prescribed antidepressant medications. We screen carefully for factors that increase risk (seizure history, certain medications, sleep deprivation, alcohol withdrawal) before starting TMS.

What TMS does not cause

It's helpful to know what the research has not found. TMS does not cause weight gain, sexual side effects, memory problems, cognitive impairment, or withdrawal effects when stopped. It is not addictive. It does not change your personality. You remain fully in control of your thoughts and behaviors throughout treatment and after.

If you've had bad experiences with medication side effects and are hesitant about trying another treatment — that's one of the reasons TMS is worth a conversation. The side effect profile is genuinely different, and for many patients, much more tolerable.

Does it actually work?

This is the question that matters most. The short version is: yes, TMS works for many people — but not everyone. Here's what the research actually shows, in plain language.

The numbers

In the largest real-world registry of TMS for depression (more than 5,000 patients across more than 100 clinics in the United States), about 58–83% of people had a meaningful response (their depression symptoms dropped by at least half), and 28–62% reached remission (meaning their depression symptoms became minimal or disappeared).6 The wide ranges reflect differences between patient self-report and clinician-rated measures. These are strong numbers, especially considering that the patients in this registry had typically already failed multiple medications.

It's worth noting that the more rigorous randomized trial that compared protocols head-to-head — the THREE-D trial — reported lower response rates (around 47–49%) and remission rates (around 27–32%).1 Real-world registry numbers tend to run higher than tightly controlled trials because of differences in how patients are selected and how outcomes are measured. The truth is probably somewhere in between — meaningful improvement for most, but not a guarantee.

For the most severe, treatment-resistant depression, a specialized protocol called SAINT (also called SNT) — using personalized brain imaging compressed into 5 days — produced remission in about 79% of patients in a sham-controlled clinical trial.3 These numbers are among the best ever reported for any depression treatment, though SAINT is newer, the trials have been small, large-scale replication is still underway, and it is often not covered by insurance.

How many sessions do I actually need?

This is worth addressing honestly because the standard "30 sessions + 6 taper" number has become so entrenched that patients often assume it's a scientifically optimized dose. It's not. It was the number used in the original FDA studies, and it became the insurance standard — but real-world evidence suggests the right number is genuinely different from patient to patient.

What the research actually shows about treatment length

  • A 2023 registry study of 7,215 patients (Hutton et al., Brain Stimulation) looked at outcomes across different session counts (from under 20 up to more than 41). Patients who received fewer than 30 sessions had noticeably worse outcomes than those who completed longer courses.2 So 30 is a reasonable floor for most people.
  • The same study found that extending treatment beyond 36 sessions was associated with continued improvement, with no clear plateau.2 Patients who needed more sessions tended to respond more gradually, but kept making progress when given additional treatments.
  • In a Massachusetts General Hospital study (Razafsha et al., 2023, Journal of Psychiatric Research), patients who didn't respond to a standard 36-session course were offered additional sessions, which converted about 54% to responders, with 32% reaching remission — though the study was small (28 patients).7 In other words, being a "non-responder" at session 36 doesn't necessarily mean TMS won't work for you — sometimes it just means you need more sessions.
  • The pattern also holds for teens: in the largest real-world dataset of adolescents and young adults treated with deep TMS (Roth et al., 2025, Psychiatry Research), response rates rose from about 58% at 30 sessions to 75% at 36 sessions — meaningful improvement continuing with additional sessions.8

Practically, what this means for you: if you're trending in the right direction at session 30 but not yet where you want to be, the evidence supports continuing rather than stopping. We'll talk with you about what we're seeing on your symptom questionnaires along the way, and make treatment-length decisions together. Insurance coverage for extended treatment varies — our team will help navigate that if it becomes relevant.

Being honest about what this means

Even with the most favorable numbers, a meaningful share of patients don't have a significant response to a first course of TMS. We don't yet have a reliable way to predict who will respond before treatment starts — though research on this is active and promising. If TMS doesn't work, that doesn't mean nothing will. It may mean a different approach is next (a different protocol, medication, ECT, or ketamine-based treatment). Treatment-resistant depression is genuinely treatable for most people — sometimes it just takes finding the right combination.

What we can say honestly about TMS

  • It works for many people who didn't respond to medication, including some who hadn't responded to several medications.
  • It has a much milder side effect profile than most antidepressant medications.
  • It doesn't work for everyone, and we can't perfectly predict who will respond.
  • Improvement is usually gradual, not sudden — most people feel the full effect over 4–6 weeks.
  • Getting better with TMS doesn't necessarily mean medications stop being useful. Many patients do best on a combination of treatments.

Questions patients often ask

These are the questions we hear most often in our clinic. If yours isn't here, please ask — there's no such thing as a silly question when you're considering a new treatment.

Does TMS hurt?

Most people describe it as a tapping or knocking sensation on the side of the head — uncomfortable at first, but not painful for most. Many people find it becomes less noticeable after the first few sessions as they get used to it. If the sensation is uncomfortable for you, we can often adjust the settings or coil position to make it more tolerable. A small number of patients find it uncomfortable enough that they decide not to continue — but this is rare.

Will I need to stop my other medications?

No. In fact, we usually recommend that you continue your current medications during TMS. The research actually supports better outcomes when TMS is added to existing treatment rather than replacing it. Any changes to your medication regimen should be discussed with your prescribing psychiatrist.

How long does the benefit last?

This varies, but the research is encouraging. In a multi-site study that followed 257 TMS responders for a full year, the majority maintained their improvement at 12 months, and among the subset who met response or remission criteria at the end of the acute course, about 62% continued to meet response criteria throughout the year of follow-up.10 For some patients, the benefit lasts considerably longer than that. We'll track your progress and talk about options if symptoms start to return.

Can I drive myself home?

Yes. TMS doesn't cause drowsiness or cognitive impairment. You can drive, go back to work, take care of children, or do anything else you'd normally do. This is one of the biggest practical differences between TMS and treatments like ECT, which require you to have someone drive you home.

Is TMS covered by insurance?

For depression, yes — Medicare and almost all major commercial insurers cover TMS when you've had at least two unsuccessful medication trials and meet their clinical criteria. For OCD, coverage varies (Medicare currently doesn't cover it, but some commercial plans do). Our team handles the prior authorization paperwork and will let you know your out-of-pocket cost before any treatment begins. We don't surprise patients with bills.

What if it doesn't work for me?

First, it's worth knowing that "not responding by session 36" isn't always the end of the story. As noted above, a meaningful number of patients who don't yet respond at 36 sessions do respond with additional sessions.7 So if you're trending in the right direction but not there yet, we may talk about continuing beyond the standard course.

If TMS genuinely isn't helping, there are other options — including different TMS protocols (deep TMS, accelerated/SAINT, different targeting), ECT, ketamine-based treatments like Spravato, and combinations of therapies. We'll help you understand which makes the most sense given your history. Depression is genuinely treatable for most people, even when the first few treatments haven't been enough.

Can TMS make depression worse?

Not typically. Very rarely, some patients report feeling more anxious or emotionally raw during the first week or two of treatment, but this usually settles. In the largest real-world studies, worsening depression during TMS is uncommon. If anything concerning comes up, we'll adjust or pause treatment.

What about TMS for teenagers?

In March 2024, the FDA cleared TMS for adolescents ages 15–21 with depression.9 This was an important advance because options for teens with depression have been limited. If you're asking about a teenage family member, we're happy to discuss whether it's an option.

Can I keep my job during treatment?

Yes — this is one of the practical advantages of TMS. Sessions are relatively short (typically around 20 minutes, sometimes shorter), there's no downtime, and most people come during a lunch break or before/after work. We also offer some flexibility in scheduling to work around your existing commitments. Some patients do find that they want to prioritize self-care during the treatment course — that's worth a conversation too.

Helpful resources

A curated list of reputable, patient-friendly resources for learning more about TMS, depression, and mental health treatment. These are organizations and sources we consider trustworthy — not a substitute for personalized medical advice, but good starting points for understanding your options.

Mental health support and advocacy

TMS-specific patient information

Patient stories and testimonials

  • NeuroStar — Real Patient Stories Testimonials Video interviews with patients who have been through a NeuroStar TMS course. Former MLB player Drew Robinson's story is particularly well-known. Keep in mind these are selected success stories from the manufacturer — but they offer a real look at what recovery from depression with TMS can look like.
  • YouTube — TMS patient experience videos Video A range of patient-recorded experiences with TMS, including day-in-the-life videos from patients who've been through treatment. Unfiltered, first-person perspectives. Helpful if you want to hear from patients (not just companies) about what sessions and the overall experience are really like.

Educational videos

Podcasts worth listening to

These resources are for education, not medical advice. If something you read or hear raises questions about your own treatment, bring it to our team — we're happy to discuss it.

References

The numeric claims on this page are linked to their primary sources below. These are peer-reviewed studies and FDA documentation; we list them so anyone — patient, family member, or referring clinician — can verify what we're saying.

  1. Blumberger DM, Vila-Rodriguez F, Thorpe KE, et al. Effectiveness of theta burst versus high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D): a randomised non-inferiority trial. Lancet. 2018;391(10131):1683–1692. PubMed
  2. Hutton TM, Aaronson ST, Carpenter LL, et al. Dosing transcranial magnetic stimulation in major depressive disorder: relations between number of treatment sessions and effectiveness in a large patient registry. Brain Stimulation. 2023;16(5):1510–1521. PubMed
  3. Cole EJ, Phillips AL, Bentzley BS, et al. Stanford Neuromodulation Therapy (SNT): a double-blind randomized controlled trial. American Journal of Psychiatry. 2022;179(2):132–141. PubMed
  4. Taylor JJ, Newberger NG, Stern AP, et al. Seizure risk with repetitive TMS: survey results from over a half-million treatment sessions. Brain Stimulation. 2021;14(4):965–973. PubMed
  5. Lerner AJ, Wassermann EM, Tamir DI. Seizures from transcranial magnetic stimulation 2012–2016: results of a survey of active laboratories and clinics. Clinical Neurophysiology. 2019;130(8):1409–1416. ScienceDirect
  6. Sackeim HA, Aaronson ST, Carpenter LL, et al. Clinical outcomes in a large registry of patients with major depressive disorder treated with transcranial magnetic stimulation. Journal of Affective Disorders. 2020;277:65–74. ScienceDirect
  7. Razafsha M, Barbour T, Uribe S, et al. Extension of transcranial magnetic stimulation treatment for depression in non-responders: results of a naturalistic study. Journal of Psychiatric Research. 2023;158:314–318. PubMed
  8. Roth Y, Tendler A, Pell GS, et al. Safety and efficacy of Deep TMS for adolescent depression based on large real-world data analysis. Psychiatry Research. 2025;350:116567. PubMed
  9. U.S. Food and Drug Administration. NeuroStar Advanced Therapy System — 510(k) clearance K231926: adjunctive treatment for adolescents (ages 15–21) with major depressive disorder. March 2024. FDA 510(k) document
  10. Dunner DL, Aaronson ST, Sackeim HA, et al. A multisite, naturalistic, observational study of transcranial magnetic stimulation for patients with pharmacoresistant major depressive disorder: durability of benefit over a 1-year follow-up period. Journal of Clinical Psychiatry. 2014;75(12):1394–1401. PubMed

Last updated: May 2026 · Information on this page is educational and does not substitute for a conversation with your clinician. Treatment decisions should be made individually, based on your history and circumstances.