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 · 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 keep taking their existing medications during TMS. In pooled trials, TMS beat sham whether it was added to an antidepressant or given on its own, and the largest NIH-funded trial tested it as a stand-alone treatment in people off medication; whether adding is better than switching has not been directly tested.1112

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 brief magnetic pulses (of the same general kind as an MRI scanner's magnetic field, but switched on and off in fractions of a second) 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. A session lasts about 3 minutes for theta-burst protocols and roughly 19 to 37.5 minutes for the original 10 Hz protocol; deep TMS and other protocols fall in between.127 A standard course is 5 days a week for about 6 weeks, plus a taper. TMS has been FDA-authorized for depression since October 2008 and is covered by Medicare and most large commercial plans when medication has not been enough and the plan's criteria are met; which protocols a plan covers varies (some cover standard 10 Hz but not theta-burst or accelerated schedules).
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 brief magnetic pulses that do not cause a seizure, and it 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 side effects in the trials,31 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.

Where TMS acts

roughly 3 cm from the scalp TMS coil on the scalp A figure-8 coil. It never touches the brain; the magnetic pulse passes through skin and bone. Left DLPFC (the target) Dorsolateral prefrontal cortex, on the brain’s surface. With a standard coil the field is strongest there and has faded to half about 1.4 cm deeper. Subgenual cingulate (deeper) Too deep to stimulate directly. It is wired to the DLPFC, and tends to be overactive in depression; TMS is thought to reach it indirectly. Connection between the two In healthy brains the DLPFC helps regulate the subgenual region. Restoring that balance is the leading explanation for how TMS works. Schematic, not to scale. Field depth for 70-mm figure-8 coils is from head-model simulations (Deng, Lisanby and Peterchev 2013), in which the brain surface lies 1.5 cm below the scalp.

The coil sits on the scalp over the left dorsolateral prefrontal cortex (DLPFC). The magnetic field is strongest at the brain surface and fades quickly with depth, so it acts on the DLPFC directly and on deeper regions such as the subgenual cingulate only through their connections.25

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 is thought to help restore the normal balance of communication between these brain regions. In small imaging studies, the overactive deeper area became less overconnected after a course of TMS, although one placebo-controlled study found the same change in people who improved on sham, so this explanation is still being tested.2830 Patients who respond often describe the "weight" or "fog" of depression lifting gradually.

Put simply, TMS is not adding a chemical; it is nudging your brain's own circuits toward the way they worked before the depression started. That is the leading explanation, and researchers are still working out the details.

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. One idea is that this may be why several different symptoms (low mood, poor concentration, low energy, rumination, and some anxiety) often improve together, though this remains a hypothesis.

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 some 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 in your head such as aneurysm clips or coils, stents, or metal fragments within about a foot of where the coil sits (dental fillings are fine; tell us about dental implants or any other metal in your head so we can check)
  • You have a cochlear implant, deep brain stimulator, or vagus nerve stimulator; device labeling rules these out
  • You have a history of seizures or a condition that significantly raises seizure risk (like poorly controlled epilepsy)
  • You have a pacemaker or implanted defibrillator: safety guidelines allow figure-8-coil TMS when the coil stays well away from the device, but the published experience is a handful of pacemaker cases, so it needs review with your cardiologist first, and some insurers treat these devices as an exclusion29
  • 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. Medicare and most large commercial plans (Aetna and Cigna, for example) cover TMS for depression when their criteria are met; which protocols a plan covers varies, so we confirm your plan's rules before you start. 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. It is done at your first session and rechecked during the course if your medications change or your clinician thinks it may have shifted.33 Most people feel a tapping that is painless or mildly uncomfortable.

  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 about 3 minutes (theta-burst) or roughly 19 to 37.5 minutes (the original 10 Hz protocol), with deep TMS and other protocols in between.127 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 is not sedating and does not need a driver; memory and thinking tests did not change in the clinical trials.31 Some people feel tired after a session, so see how you feel the first day or two.

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 course Medicare (in South Carolina) and most commercial insurers cover, usually as up to six weeks of daily treatment; coverage of the taper sessions varies by plan. 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. The original placebo-controlled trials used 3 to 6 weeks of daily treatment (15 to 30 sessions), and people who improved were then tapered off over about 3 weeks while starting medication;36 30 plus 6 became the insurance standard afterward, and a large registry now suggests outcomes are best at 36 or more sessions.12132 In practice, the right number varies from patient to patient. Some 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

Mon
Tue
Wed
Thu
Fri
Week 1
✓
✓
✓
✓
✓
Week 2
✓
✓
✓
✓
✓
Week 3
✓
✓
✓
✓
✓
Week 4
✓
✓
✓
✓
✓
Week 5
✓
✓
✓
✓
✓
Week 6
✓
✓
✓
✓
✓
Week 7
✓
—
✓
—
✓
Week 8
—
✓
—
✓
—
Week 9
—
—
✓
—
—
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 — intended to ease the transition off treatment. 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). In the one-year follow-up study of 257 patients, about 6 in 10 of those who had responded were still meeting response criteria a year later under a plan of continued antidepressant medication, and about 1 in 3 of all patients received additional TMS at some point (an average of about 16 treatment days).10 Across published studies, roughly two-thirds of responders are still responding at 3 months, about half at 6 months, and just under half at 12 months, often with some maintenance treatment.18 We do not have good data beyond one year. If symptoms start to return, a repeat course works for most people who responded the first time (see the questions below), and adjusting medication or therapy is sometimes the right next step. The taper is intended to ease the transition; the evidence that it prevents relapse is limited.

Newer, faster options

Research is moving toward accelerated protocols — treatments compressed into a few days rather than several weeks. The most studied is called SAINT (also known as SNT): personalized brain-imaging targeting and 10 short sessions per day for 5 days, cleared by the FDA in September 2022.323 In a small blinded trial (14 people on real SNT, 15 on sham) that was stopped early because the difference was so large, depression scores fell 52% on average with real treatment versus 11% with sham, and 11 of 14 met remission criteria during the 4 weeks after treatment versus 2 of 15 on sham.3 A second blinded trial in 2026 (48 people) found remission at one month in 50% versus 21% on sham.16 Durability is the open question: in an open-label follow-up of 46 people, 70% were in remission the week after SNT but only 33% were still in remission 12 weeks later.17 Accelerated protocols are not universally available, coverage is limited, and the research base is much smaller than for the standard course. An independent 2026 sham-controlled trial of a similar five-day, imaging-guided protocol (51 people randomized) found no difference from sham.34 Other manufacturers have since had accelerated schedules cleared by the FDA as well.

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 rare. The largest survey of clinical TMS practice (18 seizures in more than 586,000 sessions) found a rate of about 0.3 seizures per 10,000 sessions, or about 7 in 10,000 patients over a course of treatment.4 An earlier survey found fewer than 1 seizure per 60,000 sessions when people without risk factors were treated within published guidelines; most seizures happened during a person's first few sessions.5 The risk differs by coil type: in the 2021 survey it was about 5.6 per 1,000 patients with the BrainsWay deep TMS (H-coil) system versus about 0.14 per 1,000 with the standard figure-8 coils.4 If deep TMS is recommended for you, we will go over this difference before you consent. Fainting (a vasovagal reaction) is more common than a seizure and can look similar; it is not dangerous in itself. We screen carefully for factors that increase seizure risk (seizure history, certain medications, sleep deprivation, alcohol withdrawal) before starting TMS.

Rarely, mood can go the other way

In people with a bipolar tendency, any antidepressant treatment can occasionally trigger hypomania or mania. In a 2008 pooled analysis of the ten placebo-controlled trials (published up to 2006) that reported on it, this happened in under 1% of people and no more often than with sham (0.84% vs 0.73%).21 We screen for bipolar history, and we watch for worsening mood or suicidal thoughts during any course of treatment; if anything concerning comes up, we adjust or pause.

What TMS does not cause

It's helpful to know what was measured. In the clinical trials, memory and thinking tests did not change, hearing tests did not change,31 and the side effects reported were mostly scalp discomfort and headache; in the pivotal trial about 1 in 20 people stopped because of side effects.1213 Weight gain and sexual side effects, which are common with medication, were not reported with TMS. There is nothing to taper when a course ends. TMS does not change your personality, and you remain awake and in control throughout.

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 effects are different in kind: mostly scalp discomfort and headache rather than weight, sleep, or sexual effects, and there is no medication to taper.

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, starting with the placebo-controlled trials

The fairest test of any treatment is a blinded trial against a placebo. In TMS trials the placebo is a "sham" coil that clicks and taps but does not stimulate the brain. Pooling 29 such trials (1,371 patients, about 13 sessions each), 29% responded and 19% reached remission with real TMS, versus 10% and 5% with sham. That works out to about one extra responder for every 6 people treated, and one extra remission for every 8.11 In the NIMH-funded OPT-TMS trial (190 patients), remission was 14% with real TMS versus 5% with sham.12 In the industry trial that led to FDA clearance (301 patients), remission at 6 weeks was roughly twice as common with real TMS (on two of the three rating scales), and the main week-4 result was significant only after a statistical correction for a baseline imbalance.13

Real TMS versus sham, per 10 people

Out of every 10 people with hard-to-treat depression in the placebo-controlled trials Pooled results of 29 blinded trials, 1,371 patients, about 13 sessions of high-frequency TMS (Berlim 2014) Responded (symptoms at least halved) Real TMS: 29%, about 3 in 10 Sham (placebo) TMS: 10%, about 1 in 10 Reached remission (few or no symptoms) Real TMS: 19%, about 2 in 10 Sham TMS: 5%, about 1 in 20 (shown as half a person) Put another way: for every 6 people treated, about 1 extra person responds because of the stimulation itself; for every 8 treated, 1 extra person reaches remission. Trial courses were shorter than today's standard 30 to 36 sessions. In the NIMH-funded OPT-TMS trial (190 patients), remission was 14% with real TMS versus 5% with sham (George 2010). Figures per 10 people are rounded from the pooled percentages.

Rounded from the pooled placebo-controlled trials.1112 These trials used fewer sessions than today's standard course, and they show the part of the benefit that comes from the stimulation itself.

Everyday clinic numbers run much higher, and it is important to understand why. In the manufacturer's registry of routine NeuroStar practice (5,010 patients at 103 voluntary sites, no placebo group), 58 to 83% responded and 28 to 62% reached remission.6 The lower figures count everyone who started treatment on a self-report questionnaire; the higher figures count people who finished treatment, rated by clinicians in a smaller subgroup. In an earlier naturalistic study of 307 patients, clinicians rated 58% as responders and 37% as remitters.22 Real-world numbers include everything that helps people in a clinic: the treatment itself, expectation, daily contact with staff, and the passage of time. The blinded trials separate out the first of these. Both sets of numbers are true; they answer different questions.

Between those two is the THREE-D trial, which compared two real TMS protocols head-to-head in 414 patients (more than half had failed two or more adequate medication trials). Response was 47 to 49% and remission 27 to 32%, with the 3-minute theta-burst protocol matching the 37.5-minute standard protocol.114 It had no placebo arm, so those figures include the placebo effect. Deep TMS (the BrainsWay H-coil system) has its own placebo-controlled trial: in 212 patients, response was 38% with real treatment versus 21% with sham, and remission 33% versus 15%.26

Accelerated, imaging-guided SNT (SAINT) has produced the most striking numbers, but from small trials: in the first blinded trial, 11 of 14 people on real SNT met remission criteria during the following 4 weeks versus 2 of 15 on sham, and in a 2026 replication remission at one month was 50% versus 21%.316 These numbers are not yet shown to be durable: in open-label follow-up, a third of people were still in remission 12 weeks later.17 SNT participants had moderate-to-severe treatment-resistant depression; the protocol is not "for the most severe cases" and is not widely available.

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.2 Two caveats: the group that stopped at 36 had the largest improvement overall (those who went longer were slower starters who kept improving), and this is an observational registry run by the manufacturer, not a trial in which people were assigned to different course lengths.
  • 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), the clinic was free to change the target and protocol along the way, and there was no comparison group.7 In other words, being a "non-responder" at session 36 doesn't necessarily mean TMS won't work for you — sometimes it means you need more sessions.
  • A post-marketing dataset from 56 clinics of 1,257 patients aged 11 to 21 treated with deep TMS (Roth et al., 2025, Psychiatry Research) reported clinician-rated response rates of about 58% after 30 sessions and 75% after 36 (patient-rated: 64% and 75%).8 Read this cautiously: it was open-label with no placebo group, the 30- and 36-session figures come from different subsets of patients rather than the same teens followed longer, and deep TMS was not cleared for this age group when the data were collected. See the teenager question below for the placebo-controlled evidence.

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, registry data suggest that continuing is reasonable. 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). Many people with treatment-resistant depression eventually improve with a different treatment or 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.
  • Its side effects are different from medication side effects: mostly scalp discomfort and headache, no weight, sleep or sexual effects, and nothing to taper. About two-thirds of people in one large trial reported headache, with no difference between the two active protocols compared.1 In the sham-controlled trials, side effects did not differ meaningfully by treatment arm.12
  • It doesn't work for everyone, and we can't perfectly predict who will respond.
  • Improvement is usually gradual, not sudden — in the trials, improvement accrued over the 4–6-week course.
  • Getting better with TMS doesn't necessarily mean medications stop being useful. Many patients do best on a combination of treatments.
  • For the most severe depression, especially with psychosis, ECT has had higher response and remission rates in randomized head-to-head comparisons;32 TMS trades some of that power for no anesthesia and no memory side effects.

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. We usually recommend that you continue your current medications during TMS. There is no evidence that stopping them helps, and the trials of TMS added to medication were positive; in a pooled analysis of 29 trials TMS worked about as well when added to medication as when given alone; the two approaches have not been compared head-to-head.11 Any changes to your medication regimen should be discussed with your prescribing psychiatrist.

How long does the benefit last?

This varies. A 42-clinic study followed 257 people who had completed a TMS course for one year. Of the 120 who had responded or remitted, 62.5% still met response criteria throughout the year; patients were allowed to continue antidepressant medication, and about 1 in 3 (36%) of all patients had a re-treatment course (average 16 treatment days) when symptoms crept back.10 Pooling 18 follow-up studies, about two-thirds of responders were still responding at 3 months and half at 6 months; in the 9 studies that followed people for a full year, just under half were still responding at 12 months, though in most of those studies some people received maintenance TMS.18 We do not have good data beyond one year. We'll track your progress and talk about options if symptoms start to return.

Of the people who respond to a TMS course, how many are still responding later? Pooled follow-up of 18 studies at 3 and 6 months and 9 studies at 12 months (Senova 2019). Bars show the average; thin lines show the 95% confidence range. 0%25%50%75%100% 66% 3 months732 patients 53% 6 months695 patients 46% 12 months247 patients In many of the studies, patients received some maintenance TMS during follow-up, so these figures are not "no further treatment" figures.

Share of initial responders still responding at 3, 6 and 12 months, pooled across 18 studies.18

What if symptoms come back later?

Repeat courses usually work for people who responded the first time. In the one-year follow-up study, about 1 in 3 people had a short booster course, and in a 2016 pilot study 63 to 78% of those re-treated responded again.1019 In a 2026 study across 20 clinics, 82.5% of 177 prior responders responded again to a second course and 54% reached remission.20 Scheduled maintenance sessions are used in some programs, but the evidence is thin: a single monthly session was no better than watchful observation in the one randomized pilot study.19 We decide on boosters with you based on how your symptoms are tracking.

Can I drive myself home?

Yes. TMS is not sedating and does not require a driver; memory and thinking tests did not change in the trials. 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 someone to drive you home.

Is TMS covered by insurance?

For depression, usually yes, but the criteria differ by plan. Medicare in South Carolina (administered by Palmetto GBA) covers TMS for severe major depression when you have tried at least two antidepressants from different classes without success (or could not tolerate two, or responded to TMS before, or are receiving ECT), have had a trial of psychotherapy, and the treatment is ordered and supervised by a psychiatrist (MD or DO) who has examined you and reviewed your records.24 Some other Medicare regions require only one failed medication; many commercial plans (Aetna, for example) require two antidepressants from different classes plus an augmentation trial, and some also require psychotherapy. For OCD, coverage varies by region: Medicare in South Carolina has covered FDA-cleared TMS for OCD since March 2022 under its own criteria (two medication trials of at least 8 weeks and 8 weeks of OCD-focused therapy), while some other Medicare regions and several commercial plans still consider it investigational.24 Medicare's TMS coverage policies, including South Carolina's, apply to adults only. 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, in one clinic's experience, about half (15 of 28) of patients who had not responded by session 36 went on to respond when treatment was extended (to about 70 sessions on average).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. Many people improve with a later treatment, even when the first few haven't been enough.

Can TMS make depression worse?

Not typically. Some patients report feeling more anxious or emotionally raw during the first week or two of treatment, and this usually settles. Rarely, TMS can trigger hypomania or mania, mainly in people with a bipolar tendency; in a review of the placebo-controlled trials published up to 2006 this occurred in under 1% (0.8%) of people and no more often than with sham (0.7%).21 As with any depression treatment, we watch closely for worsening mood or suicidal thoughts, and if anything concerning comes up we adjust or pause treatment.

What about TMS for teenagers?

In March 2024 the FDA cleared one TMS device (NeuroStar) as an add-on to antidepressant medication for ages 15 to 21, and in 2025 the FDA cleared the same adjunctive 15-to-21 indication for Magstim, MagVenture and Apollo devices by equivalence to NeuroStar, and for BrainsWay deep TMS on the basis of its own registry data (1,120 patients).9 Honest caveat: the largest blinded, sham-controlled trial in 12- to 21-year-olds (103 patients, 30 sessions, TMS on its own) found no difference from sham; both groups improved about the same amount (response 42% vs 36%, remission 29% vs 29%).15 A smaller 2025 sham-controlled pilot in 40 adolescents also found no significant difference.35 The 2024 clearance rested on treatment records of 1,169 patients aged 12 to 21 (average age 19) treated in routine practice, plus a literature review: 78% had a meaningful drop (at least 5 points) on the PHQ-9 depression questionnaire and 30% reached remission. It did not rest on that trial.9 Medicare's TMS coverage policies apply to adults only, and commercial coverage for adolescents is uneven. If you're asking about a teenage family member, we're happy to discuss what this evidence does and does not tell us.

Can I keep my job during treatment?

Yes — this is one of the practical advantages of TMS. Sessions are relatively short (about 3 to 37 minutes depending on the protocol), 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: peer-reviewed studies, FDA documents and the Medicare coverage policy for South Carolina. Every entry was checked against PubMed or the issuing agency in September 2026, 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. PubMed
  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. PubMed
  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, based on retrospective real-world data from 1,169 patients. March 2024. FDA 510(k) summary
  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
  11. Berlim MT, Van den Eynde F, Tovar-Perdomo S, Daskalakis ZJ. Response, remission and drop-out rates following high-frequency repetitive transcranial magnetic stimulation (rTMS) for treating major depression: a systematic review and meta-analysis of randomized, double-blind and sham-controlled trials. Psychological Medicine. 2014;44(2):225–239. PubMed
  12. George MS, Lisanby SH, Avery D, et al. Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: a sham-controlled randomized trial (OPT-TMS). Archives of General Psychiatry. 2010;67(5):507–516. PubMed
  13. O’Reardon JP, Solvason HB, Janicak PG, et al. Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biological Psychiatry. 2007;62(11):1208–1216. PubMed
  14. Trevizol AP, Downar J, Vila-Rodriguez F, Thorpe KE, Daskalakis ZJ, Blumberger DM. Predictors of remission after repetitive transcranial magnetic stimulation for the treatment of major depressive disorder: an analysis from the randomised non-inferiority THREE-D trial. EClinicalMedicine. 2020;22:100349. PubMed
  15. Croarkin PE, Elmaadawi AZ, Aaronson ST, et al. Left prefrontal transcranial magnetic stimulation for treatment-resistant depression in adolescents: a double-blind, randomized, sham-controlled trial. Neuropsychopharmacology. 2021;46(2):462–469. PubMed
  16. Kratter IH, Austelle CW, Lissemore JI, et al. Stanford neuromodulation therapy for treatment-resistant depression: a randomized controlled trial confirming efficacy, and an EEG study providing insight into mechanism of action and a potentially predictive biomarker of efficacy. World Psychiatry. 2026;25(1):105–116. PubMed
  17. Geoly AD, Stimpson KH, Espil FM, Bentzley BS, Williams NR. Durability of clinical benefit with Stanford Neuromodulation Therapy (SNT) in treatment-resistant depression. Brain Stimulation. 2025;18(3):875–881. PubMed
  18. Senova S, Cotovio G, Pascual-Leone A, Oliveira-Maia AJ. Durability of antidepressant response to repetitive transcranial magnetic stimulation: systematic review and meta-analysis. Brain Stimulation. 2019;12(1):119–128. PubMed
  19. Philip NS, Dunner DL, Dowd SM, et al. Can medication free, treatment-resistant, depressed patients who initially respond to TMS be maintained off medications? A prospective, 12-month multisite randomized pilot study. Brain Stimulation. 2016;9(2):251–257. PubMed
  20. Lyndon S, Gibbons JB, Straub L, et al. Transcranial magnetic stimulation retreatment for recurrent depression: a large real-world multisite cohort study. Acta Psychiatrica Scandinavica. 2026 (published online July 30). PubMed
  21. Xia G, Gajwani P, Muzina DJ, et al. Treatment-emergent mania in unipolar and bipolar depression: focus on repetitive transcranial magnetic stimulation. International Journal of Neuropsychopharmacology. 2008;11(1):119–130. PubMed
  22. Carpenter LL, Janicak PG, Aaronson ST, et al. Transcranial magnetic stimulation (TMS) for major depression: a multisite, naturalistic, observational study of acute treatment outcomes in clinical practice. Depression and Anxiety. 2012;29(7):587–596. PubMed
  23. U.S. Food and Drug Administration. Magnus Neuromodulation System with SAINT Technology — 510(k) clearance K220177 (September 1, 2022). FDA 510(k) summary
  24. Palmetto GBA (Medicare Administrative Contractor for South Carolina). Local Coverage Determination L34869: Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults (major depressive disorder and obsessive-compulsive disorder criteria). Original effective 10/01/2015; OCD coverage effective 03/13/2022; current revision 2025. CMS Medicare Coverage Database
  25. Deng ZD, Lisanby SH, Peterchev AV. Electric field depth-focality tradeoff in transcranial magnetic stimulation: simulation comparison of 50 coil designs. Brain Stimulation. 2013;6(1):1–13. PubMed
  26. Levkovitz Y, Isserles M, Padberg F, et al. Efficacy and safety of deep transcranial magnetic stimulation for major depression: a prospective multicenter randomized controlled trial. World Psychiatry. 2015;14(1):64–73. PubMed
  27. U.S. Food and Drug Administration. MagVita TMS Therapy System with Theta Burst Stimulation — 510(k) summary K173620 (standard 10 Hz session 19–37.5 minutes; iTBS 3 minutes). August 2018. FDA 510(k) summary
  28. Liston C, Chen AC, Zebley BD, et al. Default mode network mechanisms of transcranial magnetic stimulation in depression. Biological Psychiatry. 2014;76(7):517–526. PubMed
  29. Rossi S, Antal A, Bestmann S, et al. Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: expert guidelines. Clinical Neurophysiology. 2021;132(1):269–306. PubMed
  30. Taylor SF, Ho SS, Abagis T, et al. Changes in brain connectivity during a sham-controlled, transcranial magnetic stimulation trial for depression. Journal of Affective Disorders. 2018;232:143–151. PubMed
  31. Janicak PG, O’Reardon JP, Sampson SM, et al. Transcranial magnetic stimulation in the treatment of major depressive disorder: a comprehensive summary of safety experience from acute exposure, extended exposure, and during reintroduction treatment. Journal of Clinical Psychiatry. 2008;69(2):222–232. PubMed
  32. Ren J, Li H, Palaniyappan L, et al. Repetitive transcranial magnetic stimulation versus electroconvulsive therapy for major depression: a systematic review and meta-analysis. Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2014;51:181–189. PubMed
  33. Trapp NT, Purgianto A, Taylor JJ, et al. Consensus review and considerations on TMS to treat depression: a comprehensive update endorsed by the National Network of Depression Centers, the Clinical TMS Society, and the International Federation of Clinical Neurophysiology. Clinical Neurophysiology. 2025;170:206–233. PubMed
  34. Appelbaum LG, Stolz LA, Sun Y, et al. Connectivity- and frequency-individualized accelerated intermittent theta burst stimulation in treatment-resistant depression: a randomized controlled trial (51 randomized; no difference from sham). Journal of Affective Disorders. 2026;415:122515. PubMed
  35. Gu LM, Deng CJ, Shang DW, et al. Efficacy and safety of low-frequency repetitive transcranial magnetic stimulation in adolescents with first-episode major depressive disorder: a randomized, double-blind, sham-controlled pilot trial (n=40). Journal of Affective Disorders. 2025;370:190–197. PubMed
  36. Janicak PG, Nahas Z, Lisanby SH, et al. Durability of clinical benefit with transcranial magnetic stimulation (TMS) in the treatment of pharmacoresistant major depression: assessment of relapse during a 6-month, multisite, open-label study. Brain Stimulation. 2010;3(4):187–199. PubMed

Last updated: October 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.