What is TMS?
TMS stands for transcranial magnetic stimulation. A padded coil rests against your head and sends brief magnetic pulses to the part of the brain that helps regulate mood. In depression this area is often less active than usual. Repeated stimulation over several weeks may help it work more normally.
The FDA first cleared TMS in 2008 for adults with major depression who had not improved with antidepressant medication. Certain TMS systems are also cleared as an add-on treatment for obsessive-compulsive disorder (OCD).
TMS is not electroconvulsive therapy (ECT). There is no anesthesia and no seizure, and it does not affect memory the way ECT can.
Who it is for
TMS may be worth considering if you:
- have depression that has not improved enough after trying antidepressants
- have had side effects from medication that you could not live with
- want a treatment that is not a drug
- have OCD that has not responded well to medication and therapy
TMS is not suitable for everyone. It is generally not used for people with metal implants in or near the head, such as aneurysm clips, cochlear implants or deep brain stimulators. Tell us if you have a history of seizures. A clinician reviews your history before recommending it.
What a session is like
You sit in a comfortable chair, awake the whole time. At the first visit the clinician measures where to place the coil and how strong the pulses should be for you. During treatment you hear a clicking sound and feel a tapping on your scalp. You can talk, listen to music or watch something.
A session is short. Depending on the protocol your clinician chooses, it lasts from a few minutes to about 40 minutes. Afterwards you can drive, go back to work and carry on with your day.
How many sessions
A typical course is five sessions a week for about four to six weeks, sometimes followed by a few sessions spaced further apart. Your clinician sets the schedule for you and reviews your progress along the way. Some people notice a change within the first few weeks. For others it takes the full course, and TMS does not help everyone.
Side effects and safety
Most side effects are mild and ease after the first week or two:
- scalp discomfort or tapping at the treatment site
- headache
- twitching of the facial muscles during the pulses
- lightheadedness
Seizures are a known risk but are rare. TMS does not cause the weight gain, sexual side effects or drowsiness that some people have with antidepressants. We give you earplugs to protect your hearing from the clicking.
Insurance coverage
Most major insurance plans cover TMS for depression when you meet their criteria, which usually include having tried a set number of antidepressants and psychotherapy. Many plans ask for approval before treatment starts. We handle that for you, and we tell you what your plan covers before your first session. See insurance and cost.
TMS vs ketamine vs Spravato
TMS is the only one of the three that is not a medication, and the only one you can drive home from. Ketamine and Spravato tend to act faster but need monitoring in the office after each dose. Our comparison page sets them side by side. If your depression has not responded to at least two antidepressants, read about treatment-resistant depression too.
Frequently asked questions
Does TMS hurt?
Most people describe a tapping or knocking on the scalp. It can be uncomfortable in the first few sessions and usually eases as you get used to it. The clinician can adjust the settings if it bothers you.
Can I keep taking my medication during TMS?
Usually yes. Many people stay on their antidepressant during TMS. Do not change any medication without talking to your prescriber.
How long do the results last?
It varies from person to person. Some people stay well for a long time after a course, and some come back for further sessions if symptoms return. Your clinician will talk through what to expect and what to do if symptoms come back.
Is TMS the same as ECT?
No. ECT uses an electric current under general anesthesia to cause a brief seizure. TMS uses magnetic pulses while you are awake, with no anesthesia and no seizure.