How Successful is TMS Therapy?

Transcranial magnetic stimulation (TMS) is an innovative depression treatment with a success rate of approximately 70% to 80%. It offers a safe and well-tolerated alternative for treating major depressive disorder, particularly for those who haven’t found relief with traditional antidepressants or experience unpleasant side effects. 

If you’re exploring TMS therapy for depression, you may be wondering how it works, what to expect, and how effective it is. In this article, we help you understand what you need to know about TMS therapy, including its benefits, factors that affect its success, and what to do if TMS doesn’t work for you. 

What is TMS?

Transcranial magnetic stimulation (TMS) is a non-invasive, FDA-approved treatment that uses magnetic pulses to stimulate parts of the brain involved in mood regulation. These gentle pulses stimulate nerve cells to rebalance brain activity and help relieve symptoms of depression and other mental health conditions. 

TMS is most commonly used for treatment-resistant depression (TRD), a type of major depressive disorder (MDD) that hasn’t responded to medication or psychotherapy. However, it’s also being explored for its potential benefits for anxiety, obsessive-compulsive disorder (OCD), migraines, and other mental health conditions. 

During a TMS session, an electromagnetic coil is placed against the scalp and magnetic pulses are delivered to the prefrontal cortex, a part of the brain known to play a role in mood regulation. These pulses help encourage the release of neurotransmitters like serotonin and dopamine, both of which are often disrupted in people with major depression.   

Unlike treatments like medication or electroconvulsive therapy (ECT), TMS doesn’t involve surgery, anesthesia, or the use of systemic drugs. It also has minimal side effects, which are generally mild and short-lived. This is why TMS is considered a safe and well-tolerated treatment option for many people. 

Types of TMS therapy

There are a few different types of TMS therapy, including:

• Repetitive transcranial magnetic stimulation (rTMS): rTMS is the most common form of TMS. It involves delivering repeated magnetic pulses over a period of 20 to 40 minutes, five days a week, for a duration of about 4 to 6 weeks. 
• Deep TMS (dTMS): dTMS uses a specially designed coil that reaches deeper and broader areas of the brain. It’s often used for specific conditions like OCD or smoking cessation. 
• Accelerated TMS (aTMS): aTMS is a more intensive version of TMS, delivering multiple sessions per day over a shorter timeframe.  

What conditions can TMS therapy help treat?

TMS therapy is FDA-approved to treat patients aged 15 and older with major depressive disorder (MDD), particularly when other treatments have been unsuccessful (a condition known as treatment-resistant depression or TRD). TMS is also approved as an adjunct treatment for adults with OCD when standard therapies haven’t provided relief. 

In addition to these approved uses, TMS is also being studied for a range of other mental health and neurological conditions. While these uses are not yet FDA-approved, some patients can still receive TMS for these conditions under the guidance of a qualified provider.

Other conditions TMS might help treat include:

• Bipolar disorder
• Generalized anxiety disorder (GAD)
• Post-traumatic stress disorder (PTSD)
• Autism spectrum disorders
• Parkinson’s disease
• Attention-deficit hyperactivity disorder (ADHD) 
• Chronic pain conditions (such as migraines or fibromyalgia) 
• Substance use disorders, including alcohol and nicotine addiction
• Schizophrenia.

It’s important to note that, while research into TMS for these conditions is promising, they are still considered off-label uses. This means that TMS may not be covered by insurance and its effectiveness can vary depending on the individual. 

If you’re managing one of these conditions and are curious about whether TMS can help, feel free to contact our team at Psychiatry Treatment Centers and we can provide further guidance.

What are the benefits of TMS therapy?

The benefits of TMS therapy include long-term relief, minimal side effects, personalization, and that it’s a non-systemic and non-invasive treatment. 

Long-term relief

TMS can provide sustained improvement in symptoms over a long period of time. In one study, 62.5% of patients treated with TMS were still doing better a year later. On top of that, 84.2% of those who didn’t go into remission during their first treatment cycle achieved remission after a second round. This suggests that TMS can continue to help even if initial results aren’t encouraging.

Few side effects

TMS therapy has very few side effects compared to antidepressants and other interventions, and most side effects are mild and short-lived. 

Common TMS side effects include:

• Temporary scalp discomfort
• Mild headaches
• Light facial twitching or tingling
• Occasional fatigue after sessions. 

These symptoms typically resolve within a few hours and tend to disappear over time as the body adjusts to treatment. 

Personalization

TMS therapy can be customized to each individual, with the intensity, frequency, and duration of magnetic pulses adjusted based on how someone responds to treatment. It can also be safely combined with other therapies, including medication and psychotherapy, to create an individualized care plan. 

Non-systemic

TMS targets specific regions of the brain without affecting the rest of the body. This means it avoids many of the systemic side effects that can come with medications, such as weight gain, sexual dysfunction, gastrointestinal discomfort, and sleep disturbances. Because it doesn’t involve medication, there are also no withdrawal effects if treatment is stopped.

Non-invasive

TMS is also completely non-invasive, which means there’s no surgery, needles, or anesthesia required. Patients remain awake and alert during treatment and there’s no downtime afterwards. 

What to expect during TMS therapy

Here’s what a typical TMS treatment journey looks like: 

Brain mapping session

The first TMS session involves a process called brain mapping. This helps determine the exact region of your brain that needs to be targeted and the right level of stimulation for your body. 

You’ll be seated comfortably in a chair and your technician will place a magnetic coil on your scalp. You may be given a pair of earplugs to protect against the loud clicking sound of the machine, and your technician will answer any questions you have before starting treatment. 

Next, a few test pulses are delivered to locate your motor threshold, which is the lowest intensity needed to produce a small twitch in your fingers or hand. This ensures your treatment is both safe and effective and helps guide your future sessions.  

Daily TMS sessions

After the mapping session, you’ll begin your regular treatment schedule. This usually involves five sessions per week for four to six weeks, depending on your individual needs. In some cases, you might begin your first TMS session straight after brain mapping while in others you might return the following day. 

Here’s what happens in a TMS session:

• The magnetic coil is placed over the part of your brain linked to mood regulation (called the dorsolateral prefrontal cortex or DLPFC)
• Repetitive magnetic pulses are delivered through the coil to stimulate underactive brain cells
• You might feel a light tapping or hear a clicking sound as the pulses are delivered
• Some people notice mild tingling or twitching in the scalp or facial muscles, especially in the first couple of sessions. This is completely normal and tends to subside over time. 

You’ll stay seated and awake for the whole session, which lasts about 20 to 40 minutes depending on the type of TMS being used. Your technician will check in with you throughout the treatment and can adjust the pulse intensity if needed. 

After a TMS session

Once your session is finished, you’re free to go about your day as usual. There’s no downtime and you won’t need someone to drive you home. In fact, most people head straight back to work, school, or other daily activities. 

Some people might experience mild side effects like a headache or temporary scalp discomfort, but these are usually short-lived and become less frequent as treatment continues. 

TMS treatment protocol and follow-up 

TMS works gradually, so it can take a few weeks before you start to feel the full effects. Often, those close to you – like friends or family – notice improvements in mood or energy before you do. 

Most TMS treatment plans involve a total of 30 to 36 sessions. After the initial course, some people also benefit from maintenance sessions to help sustain results and prevent relapse. Your provider will work with you to determine what’s best based on your progress and needs.

How successful is TMS therapy?

Various research shows that TMS has a success rate of about 70% to 80%, meaning most patients experience a meaningful reduction in depression symptoms. Of these patients, about 50% achieve full remission, which means their depression symptoms disappear completely for up to a year after completing a standard course of treatment.  

One of the best ways to understand the effectiveness of TMS is to compare it to traditional antidepressant medications. In a study funded by the National Institute of Mental Health, standard antidepressants like selective serotonin reuptake inhibitors (SSRIs) were found to have a success rate of just 27.5%. 

For individuals with treatment-resistant depression, the odds become even lower. After trying two or more medications without relief, the success rate of each additional medication drops significantly, falling below 7% by the fourth attempt. 

Considering that most antidepressants require one to two months before seeing potential results, some patients can spend months cycling through different prescriptions only to end up with limited chances of remission. On top of that, many medications come with uncomfortable side effects like weight gain, sexual dysfunction, nausea, or headaches. 

In contrast, TMS offers a drug-free, targeted approach that offers long-term results.

What factors affect TMS success?

Although TMS is effective for the majority of patients, it’s important to remember that results can vary from person to person. Certain factors can influence how well someone responds to treatment, including: 

Age

TMS tends to be most effective in individuals under the age of 60. While those aged 60+ can still benefit from treatment, some studies suggest that response rates may be slightly lower in this age group. This is thought to be due to age-related changes in brain structure or function.

Personality traits

Interestingly, certain personality traits can improve the effectiveness of TMS therapy. Research shows that patients who score higher for persistence on the temperament and character inventory (TCI) personality scale may respond more quickly to TMS. This trait is marked by perseverance and resilience, which suggests that a person’s mindset and motivation could influence how well they respond to treatment. 

Level of treatment resistance

While it might seem counterintuitive, people who haven’t responded to medications often respond better to TMS than expected. This could be because the treatment targets brain circuits that medication may not reach as directly. 

Use of antidepressants

For some patients, combining TMS with antidepressant medications can improve outcomes by enhancing the overall effectiveness of treatment. 

How many TMS sessions do I need?

TMS therapy is designed to work gradually over time, which is why it’s delivered in a series of sessions spread out over several weeks. Most people receive five sessions per week with a total of 30 to 36 sessions recommended for long-term relief from depressive symptoms.

Most patients begin to notice improvement after 10 to 15 sessions, which would be about two to three weeks into treatment. Everyone is different, some people respond earlier while others might need a little more time to feel the full effects. The reason for this is that TMS works through a cumulative effect, which means each session helps stimulate and strengthen the brain circuits involved in mood regulation to gradually promote healthier brain activity. 

For many patients, TMS provides lasting relief for up to 6 to 12 months. In some cases, it can be even longer. If symptoms do return, a second round of treatment or maintenance sessions may help prevent relapse and sustain long-term progress. 

The truth is, there is no one answer for how many sessions you’ll need. At Psychiatry Treatment Centers, we tailor all TMS therapy plans to the individual. Your care team will monitor your progress closely and make adjustments as needed to support the best possible outcome for your mental health. 

What happens if TMS doesn’t work?

If you don’t experience the results you were hoping for after completing TMS therapy, you’re not alone, and it’s okay. No single treatment works for everyone, and that includes TMS. Depression is a complex condition that affects each person differently, and the fact that TMS didn’t work the first time doesn’t mean you’ve run out of options. 

Some people may need more than one round of TMS to notice significant changes, especially if symptoms have been present for a long time. Others may benefit more when TMS is combined with other therapies, such as:

• Antidepressants
• Talk therapy or counseling
• Lifestyle changes, including regular exercise, sleep routines, or nutrition support. 

In some cases, you may be recommended other evidence-based treatments such as Spravato® (esketamine nasal spray). This is an FDA-approved therapy for treatment-resistant depression that’s delivered under clinical supervision. 

Either way, you don’t have to figure this out alone. Our team at Psychiatry Treatment Centers is here to work closely with you to find the right approach, whether that means continuing TMS or exploring new therapies. 

Explore TMS with Psychiatry Treatment Centers

If you’re ready to explore TMS as a treatment option for depression, OCD, or another mental health condition, our team is ready to help. Contact us today to discuss your options or schedule a consultation now.