TMS treats resistant depression by modulating brain activity.
TMS benefits multiple mental and neurological conditions with few side effects.
TMS research faces criticism for rare severe side effects and conflicts of interest.
Depression is projected to be the leading global disease burden by 2030, surpassing cancer and heart disease (Malhi & Mann, 2018).
Research indicates that 1 in 3 women and 1 in 5 men will experience major depression during their lifetime (Dattani et al., 2023).
Some people will not respond to conventional treatments, such as medication and talking therapies.
Treatment-resistant depression (TRD) is present in about 30.9% of individuals diagnosed with major depressive disorder in the United States (Zhdanava et al., 2021).
Transmagnetic stimulation (TMS) is an FDA-approved noninvasive neurostimulation intervention used to treat TRD. TMS delivers magnetic pulses to specific areas of the brain that modulate neural activity to influence mood, behavior, and cognitive function.
While TMS is primarily used when conventional treatments don’t work, it’s increasingly used to treat other mental health and neurological conditions.
This article will explore how TMS treatment works, what a typical session looks like, the range of conditions it can treat, and the benefits and side effects of treatment.
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TMS uses a magnetic coil placed near the scalp to generate magnetic fields that modulate brain activity. The magnetic field penetrates the skull and induces electrical currents in the neuronal networks and cortical regions directly below the coil but also affects connected brain areas and wider network dynamics (Chervyakov et al., 2015).
TMS treatment can be used to stimulate underactive brain regions or calm overactive ones. Clinicians calibrate the treatment carefully to meet each individual patient’s needs.
What does a TMS session look like?
Firstly, the patient is seated in a special chair with a neck support and encouraged to relax before the clinician places a magnetic coil on the patient’s head. When used to treat depression, the magnetic coil is positioned to stimulate the dorsolateral prefrontal cortex (DLPFC) on the left side of the brain, just above the temple.
Next, the clinician performs motor threshold testing to determine the minimum intensity of stimulation required to cause a motor response, like a finger twitch. This process helps the clinician calibrate the treatment to the individual patient.
For the following 20 to 40 minutes, the TMS apparatus delivers magnetic pulses to the patient’s brain in a sequence of bursts called “trains” with short breaks between each sequence. The trains modulate brain activity in line with treatment goals. For patients with depression, TMS is often used to stimulate underactive areas of the brain. In other conditions, like obsessive-compulsive disorder (OCD), it may be used to calm overactive areas.
Patients can experience a tingling sensation in the area around the coil or muscle twitches, but these are usually mild and well tolerated. As the machine makes a clicking noise with each pulse, the patient may be provided with earplugs to reduce discomfort from the noise.
TMS sessions are conducted five times a week for around four to six weeks. Patients can return to normal daily activities immediately after the session. Some patients might experience a slight headache or dizziness, but this is rare and soon passes (Rossi et al., 2021).
For a short clinical introduction to TMS, watch this video provided by UF Health Jacksonville.
Treatment-resistant depression relief with TMS
Traditional TMS
Traditional TMS is more focused and treats a smaller, more localized area of the brain. It uses a figure 8-shaped coil that generates magnetic fields that can penetrate superficial cortical regions of the brain up to a depth of around 1.5 to 2.5 centimeters from the scalp. This can stimulate the DLPFC, which is targeted when treating depression. It has also been used to treat anxiety and post-traumatic stress disorder (Chail et al., 2018).
Traditional TMS has a favorable safety profile and is generally effective. Side effects are usually tolerable and may include a tingling or itchy scalp or headaches (Chail et al., 2018).
Deep TMS
Deep TMS uses an H-coil to generate magnetic fields that stimulate deeper brain structures, such as the anterior cingulate cortex and subgenual cingulate, which are involved in mood regulation and other complex cognitive functions. Deep TMS is useful for treating conditions where deeper brain structures are involved (Chail et al., 2018).
Deep TMS is FDA-approved in the United States for treating major depressive disorder, OCD, and some addictions (Levkovitz et al., 2015). Like traditional TMS, side effects include scalp tingling and headaches but may vary depending on the depth and area of stimulation.
For a real-life story about the benefits of deep TMS for treatment-resistant major depressive disorder, look at this CBS news story.
How deep transcranial magnetic stimulation changed one women's life
6 Benefits of Transmagnetic Stimulation
Evidence indicates that TMS has the following benefits:
It can successfully treat major depression in those who remain unresponsive to, or cannot tolerate, conventional antidepressant medications (De Risio et al., 2020).
It can treat conditions that have not responded to talk therapies like cognitive behavioral therapy (Mehta et al., 2022).
For the vast majority of patients, TMS has very few side effects, and those that may arise, such as headaches and a tingling scalp, are mild and tolerable (Van Rooij et al., 2024).
TMS has durable treatment benefits and can alleviate symptoms for months following a course of treatment (Yang et al., 2024).
TMS can be used on a top-up basis to prevent relapse (Wilson et al., 2022).
Emerging evidence indicates that TMS can benefit cognitive function and neuroplasticity in degenerative conditions like Alzheimer’s disease and poststroke recovery (Bashir et al., 2022; Hoyer & Celnik, 2011).
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How Effective Is TMS? What the Research Says
Research since 2020 has contributed further to the evidence base demonstrating the efficacy of TMS for TRD in particular and promise as an intervention in other mental health and neurological conditions.
TMS remains a highly effective treatment for major depressive disorder (Yang et al., 2024) and especially TRD (De Risio et al., 2020). A large registry study found that TMS resulted in between 58% and 83% response rates and between 28% and 62% remission rates in patients with TRD, indicating strong clinical efficacy (Sackeim et al., 2020). TMS is also useful for alleviating suicidal ideation in patients with TRD (Bozzay et al., 2020; Mehta et al., 2022).
TMS is also a promising intervention in treatment-resistant bipolar depression, with a recent study finding significant improvements in depressive symptoms and a good safety profile (Zengin et al., 2022).
TMS is also being used to treat neurological conditions, including stroke recovery, movement disorders, and Alzheimer’s disease (Bashir et al., 2022; Stultz et al., 2020). Emerging evidence indicates promise, but these areas require further exploration (Somaa et al., 2022).
A meta-analysis of the effectiveness of individualized TMS treatment protocols found that carefully calibrated treatment supported by neuroimaging increased effectiveness in patients with depression (zheng et al., 2021) but made little to no difference in patients with other psychiatric conditions.
In brief, a roundup of recent research suggests evidence supports TMS as the treatment of choice in TRD, especially when individualized using neuroimagery (zheng et al., 2021). TMS also has a promising emerging evidence base for the treatment of cognitive function in Alzheimer’s disease and stroke rehabilitation (Bashir et al., 2022).
Other conditions where TMS may be used on a case-by-case basis are discussed below.
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Who Is Transmagnetic Stimulation Therapy For?
Most of the established evidence supports TMS as an effective treatment for TRD. However, TMS is also being used as a treatment for other mental health conditions that do not respond to conventional treatment, including the following:
TMS for OCD
Recent research demonstrates the efficacy of TMS, especially repetitive TMS (rTMS) and deep TMS (dTMS), as viable treatments for treatment-resistant OCD.
A meta-analysis of randomized controlled trials indicated that rTMS reduces OCD symptoms when targeting the bilateral dorsolateral prefrontal cortex (Perera et al., 2021). Also, low-frequency rTMS over the left DLPFC significantly reduces Yale-Brown Obsessive-Compulsive Scale scores (measuring the severity of obsessive and compulsive symptoms) for up to six months (Jahanbakhsh et al., 2023).
Meanwhile, a study of dTMS involving 167 patients found that 72.6% of them achieved a significant reduction in OCD symptoms after about 18 to 20 sessions (Roth et al., 2021).
In addition, TMS protocols that target different brain regions, including the supplementary motor area and the orbitofrontal cortex, indicate therapeutic potential for treatment-resistant OCD (Liang et al., 2021).
TMS for anxiety
TMS has emerged as a viable treatment option for a range of anxiety disorders, both as a standalone treatment and in combination with other therapies.
A systematic review concluded that TMS protocols targeting the prefrontal cortex with excitatory stimulation on the left side and inhibitory stimulation on the right are effective in reducing symptoms in panic disorder and generalized anxiety disorder (Di Lorenzo et al., 2020).
Research focusing on patients with comorbid anxiety and major depressive disorder found that TMS significantly reduced both anxiety and depressive symptoms. Improvements were maintained for several weeks post-treatment (Hutton et al., 2023).
Meanwhile, a study on generalized anxiety disorder (GAD) tested the efficacy of infra-low-frequency TMS (ILF-TMS) versus a placebo treatment. The response rate was higher in the ILF-TMS treatment group, indicating it may be a promising therapy for GAD (Zhang et al., 2022).
Another systematic review found that TMS and other neuromodulation therapies, such as transcranial direct current stimulation, result in a significant reduction in anxiety levels across various disorders, including GAD, particularly in cases where traditional treatments have failed (Gay et al., 2022).
TMS for PTSD
TMS affects three brain networks involved in post-traumatic stress disorder (PTSD): the default mode network, the executive control network, and the salience network. High-frequency TMS applied to the left DLPFC can modulate these networks and alleviate PTSD symptoms (Edinoff et al., 2022).
A meta-analysis found that rTMS had a significant effect on reducing PTSD symptoms, with high-frequency stimulation more effective than low-frequency stimulation (Harris & Reece, 2021).
Meanwhile, another meta-analysis of the effectiveness of TMS for PTSD found that symptom relief provided by rTMS remains for long periods, at least six months, with no significant differences between follow-up and the completion of treatment (Xu et al., 2023).
However, another study explored combining TMS with brief exposure therapy for PTSD and found that while both treatment groups improved, additional TMS did not have a significant difference in outcome to that of exposure therapy alone (Isserles et al., 2021).
TMS for Alzheimer’s disease
Studies support rTMS as a potentially effective treatment for Alzheimer’s disease, especially in the early stages (Wei et al., 2022). TMS enhances cognitive function and might be better tolerated than traditional drug therapies.
A meta-analysis found that rTMS significantly improved global cognitive function in patients with Alzheimer’s disease for at least six weeks post-treatment (Yan et al., 2023).
Another meta-analysis revealed that rTMS improved global cognitive function and daily living abilities in patients with Alzheimer’s disease. It significantly improved cognitive domains such as language, memory, and executive function (Wei et al., 2022).
Also, rTMS has the potential to slow the progression of Alzheimer’s disease when used as part of a long-term treatment plan. The combination of rTMS with cognitive training and personalized treatment protocols informed by neuroimaging and biomarkers enhanced therapeutic outcomes (Lazzaro et al., 2021).
Studies exploring the underlying mechanisms of rTMS in Alzheimer’s disease suggest that it may modulate neurobiological processes such as neuroinflammation, synaptic plasticity, and gene expression that enhance cognitive function (Bashir et al., 2022).
Personalized treatment protocols and long-term studies are required to establish the mechanisms driving these changes.
TMS for stroke recovery
Recent studies demonstrate the promise of rTMS as an effective and safe adjunct therapy for stroke recovery. It improves motor function, cognitive recovery, and language rehabilitation (Wang et al., 2023).
One study found that TMS could significantly improve poststroke motor recovery, improve motor function, and reduce neurological deficits when combined with traditional rehabilitation therapies (Lebedeva et al., 2023).
One meta-analysis confirmed that rTMS improves motor functions after stroke, especially when applied bilaterally or when targeting the affected hemisphere (Chen et al., 2022). Another meta-analysis found that TMS could significantly improve cognitive function after stroke, particularly when applied to the DLPFC (Wang et al., 2023).
Both low-frequency rTMS and continuous theta burst stimulation (cTBS) applied to the right hemisphere facilitate language recovery after a stroke (rTMS and cTBS encourage neural plasticity so that cognitive functions are reorganized), although results vary depending on the patient and protocol used (Georgiou & Kambanaros, 2022).
However, it is important to keep a balanced perspective when reviewing the evidence. TMS is by no means a miracle cure. Although rare according to the research literature, some patients have been severely adversely affected by TMS and disabled in life-altering ways.
“TMS Ruined My Life”: Investigating Side Effects & Criticisms
In the interest of balance, this section reviews what have been deemed relatively rare but serious side effects of TMS.
A true-life story published on the Mad in America blog by James Hall (2020), “Too Good to Be True: How TMS Damaged My Brain,” recounts the author’s experience of being treated for depression with TMS. It’s a shocking read.
Having been persuaded by his doctor to try TMS as an alternative treatment for his chronic depression, Hall started out very hopeful. Unfortunately, he began to suffer persistent, severe, and life-changing side effects, including lightheadedness (which he describes as like being intoxicated all the time), tinnitus, cognitive impairments, and memory loss.
Despite reassurances from medical staff that his side effects were temporary and would pass, Hall’s condition worsened, culminating in job loss and ongoing neurological problems. Hall (2020) warns of the potential dangers of TMS and advocates for greater awareness of its risks. He is especially critical of the conflicts of interest behind TMS research and development studies.
Hall claims that many of the research studies claiming TMS is a great success have been funded by TMS technology manufacturing companies. Another article by Phil Hickey (2014) on Mad in America, “Transcranial Magnetic Stimulation,” explores this situation in detail.
Hickey (2014) argues that while TMS is often promoted as a safer alternative to electroconvulsive therapy (ECT), its effectiveness is overstated and can be explained by the conflicts of interest among researchers. Often, they are conducting TMS studies funded exclusively or in part by TMS machine manufacturing companies. The author claims these studies underreport adverse effects like seizures and memory loss.
Hickey (2014) concludes that while TMS shows some promise, its benefits may not be as robust or as durable as claimed.
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If you have had your curiosity aroused about alternative treatments for depression, then please take a look at the following articles, which cover less conventional approaches to depression recovery with free linked resources.
TMS uses electromagnetic pulses to modulate brain activity to treat a range of psychiatric and neurological disorders. There is some controversy about the ethics of research evidence, with critics claiming that many studies have been funded by TMS machine manufacturing companies, thus subjecting researchers to a conflict of interest.
However, the majority of patients seem to benefit from TMS, especially when other conventional treatments have failed.
Recent research has focused on individually calibrated treatment that uses neuroimagery alongside TMS to optimize patient safety and achieve sustainable outcomes that benefit the patient’s health long term.
Research evidence indicates TMS meets FDA safety standards and results in very mild side effects in the majority of patients (Chail et al., 2018). However, like any treatment, rare adverse effects are possible, including seizures, brain fog, dizziness, and memory loss.
How long does TMS last?
Research indicates that TMS had durable effects for months or years after treatment, but this depends on the individual patient and their diagnosis (Yang et al., 2024).
How do you feel after TMS?
The majority of patient testimonies report being able to return to daily activities straight after a treatment session, while a minority may experience mild side effects like headaches, dizziness, and scalp tingling that require them to rest afterward until these pass (Rossi et al., 2021). In rare cases, severe adverse effects have prevented patients from returning to normal life long-term (Hall, 2020).
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About the author
Jo Nash, Ph.D., began her career in mental health nursing before working as a service user advocate and in mental health policy research. After gaining her Ph.D. in Psychotherapy Studies, Jo was a Lecturer in Mental Health at the University of Sheffield for over a decade. She has trained in two mindfulness-based interventions, ACT and MBCT. Jo currently coaches neurodivergent and highly sensitive adults where she applies positive psychology using a strengths-based, solution-focused approach.
Depression is projected to be the leading global disease burden by 2030, surpassing cancer and heart disease (Malhi & Mann, 2018).
In the interest of balance, this section reviews what have been deemed relatively rare but serious side effects of TMS.
