When Does TMS Start Working and Does It Last?

Transcranial magnetic stimulation (TMS) therapy is a non-invasive, FDA-approved therapy that uses magnetic pulses to stimulate areas of the brain linked to mood regulation. The treatment has shown promise in treating major depressive disorder and other mood disorders, especially when traditional antidepressant medications or talk therapy haven’t provided relief.  

During a typical TMS session, you’ll have a small device placed against your scalp which delivers electromagnetic pulses to stimulate targeted regions of the brain. The treatment is painless, well-tolerated, and non-systemic, which means it doesn’t affect the whole body the way medications normally do. 

In this article, we explain how quickly you can expect to see results with TMS, what to expect during the treatment course, and how long its benefits usually last. 

How many sessions of TMS do I need? 

The number of TMS treatment sessions you need will depend on the type of protocol you’re  receiving and how your symptoms respond to treatment. There are different types of TMS:

• Repetitive TMS (rTMS): rTMS is the most common type of TMS. It involves receiving five sessions per week for four to six weeks, totalling around 20 to 30 sessions. Some patients experience relief after 20 sessions while others might need a few additional sessions for the best results. Once you’ve completed the initial course of rTMS, you may continue with maintenance sessions to keep up progress. 
• Deep TMS (dTMS): dTMS uses a specially designed coil that can penetrate deeper brain regions. These treatments usually last 12 weeks and occur in two phases: the acute phase involves 20 sessions over 4 weeks (similar to rTMS), while the continuation phase delivers two sessions per week for 8 weeks. This comes to about 36 sessions in total.
• Accelerated TMS (aTMS): aTMS condenses TMS treatment into a much shorter timeline, with patients receiving multiple sessions per day. One type of accelerated TMS is SAINT TMS, which delivers 10 sessions per day for 5 days, totalling 50 sessions. 

How long does it take for TMS therapy to work?

Most patients begin to notice improvements within the first two to four weeks of TMS treatment. These early changes are often gradual, such as sleeping better, feeling a bit more energized, or experiencing small lifts in mood. Sometimes, it’s the people around you who notice the changes before you do. 

That said, the timeline can vary from person to person, just like other treatments. Some people will respond more quickly while others might need more time or extra sessions to experience lasting results. If that’s the case, you might be recommended maintenance sessions to help extend the benefits. 

Timelines for TMS therapy to start working

Even though every person will respond to TMS differently, we tend to see a similar pattern of improvement over the course of treatment. The timeline below gives you a general idea of what to expect: 

Weeks 1-2 (5 to 10 sessions)

Many patients begin to notice subtle changes in the first couple of weeks, such as a slight lift in mood, increased energy, or feeling less reactive to stress. These early improvements start to unfold as TMS gradually stimulates nerve cells in the dorsolateral prefrontal cortex (DLPFC) region of the brain tied to mood regulation. 

Some patients notice side effects at this stage, such as mild headaches or scalp discomfort, but these usually disappear as treatment progresses. 

Weeks 3-4 (15 to 20 sessions)

Over the next two weeks, you might start to feel more noticeable changes. Patients often report better sleep, improved focus, or a renewed interest in daily activities during this period. This progress can be encouraging and show the treatment is working, but it’s important to know that not everyone will experience relief at this stage, and if you don’t that’s okay and normal.  

Weeks 5-6 (25 to 30 sessions)

By the end of a standard repetitive transcranial magnetic stimulation course, many patients will feel substantial improvement in their depressive symptoms. Research shows that around 50% of patients experience major symptom relief and about 30% of patients achieve complete remission. You might feel higher energy levels, clearer thinking, a brighter mood, and a stronger ability to manage daily challenges.  

After treatment 

After the initial treatment course, you might continue feeling the benefits of TMS for months or even years. Some patients, especially those who experience recurrent depressive episodes, are recommended weekly, biweekly, or monthly maintenance (‘booster’) sessions to help maintain progress and reduce the risk of relapse.    

Factors that can influence how quickly TMS therapy works

Not everyone will respond to TMS in the same way, and there are certain factors that can affect how quickly the treatment works. These include:

• Age: Younger patients often respond more quickly than those over 65. This might be linked to age-related changes in brain plasticity, which can affect how well the brain adapts to stimulation. 
• Severity of symptoms: Those with more severe depression or anxiety might take longer to notice results.
• Consistency of treatment: For best results, it’s important to attend all scheduled sessions as missing or delaying them can interrupt your progress. 
• Co-occurring mental health conditions: People with other mental health conditions, like anxiety, post-traumatic stress disorder (PTSD), or bipolar disorder, may take longer to feel results.
• Motivation & mindset: Patients who are engaged and persistent are more likely to respond to treatment. For example, one study found that people who score higher for ‘tenacity’ on the temperament and character inventory (TCI) personality scale respond faster to TMS. 
• Complementary therapies: Combining TMS with psychotherapy, antidepressant medication, or supportive lifestyle changes (e.g. eating and sleeping well) can sometimes help support relief.

How long do TMS results last?

One of the most-asked questions about TMS is how long its effects continue once treatment ends. It’s hard to give a broad answer to this, because it will be different for everyone. That said, the benefits can be long-lasting for many people.  

Patients that achieve remission during treatment might experience symptom relief for months or even years. Research has shown that about 62% of patients who reached remission with rTMS remained symptom-free a year later. Other studies show that roughly 50-60% of patients with treatment-resistant depression respond positively to TMS, and about a third achieve full remission. 

However, some people will notice their symptoms gradually returning over time. In these cases, booster or maintenance therapy sessions are recommended to help sustain the benefits of treatment.   

How do you know TMS is working?

TMS works gradually, so you won’t wake up and notice any sudden changes overnight. The first signs of improvement are usually subtle, but they build up over time to bring meaningful relief from depression and related symptoms. 

Some of the most common signs that TMS is starting to work include:

• Improved mood
• Increased energy
• Better sleep
• Reduced anxiety
• Sharper thinking and more focus
• Improved relationships
• Stronger confidence and self-worth

Your TMS treatment team will work with you to monitor your progress, for example, by asking you to rate your depression symptoms on a scale or track changes in mood. Depending on how you’re responding to treatment, they might adjust your treatment plan to make sure you achieve the relief you’re looking for.  

What if I feel worse after starting TMS?

Sometimes, you might feel your symptoms temporarily worsen during the early stages of TMS treatment. This is normal and often referred to as a ‘TMS dip’. Understandably, this can be very discouraging, but know that the dip is usually short-lived and part of the healing process. 

During TMS therapy, magnetic pulses stimulate the DLPFC, a region of the brain linked to mood regulation. As the brain starts to reorganize itself and form new neural pathways, some patients experience emotional discomfort or a brief return of depression symptoms. This adjustment period is similar to what can happen when you start a new antidepressant medication.  

If you’re experiencing a TMS dip, please know that this doesn’t mean the treatment isn’t working or that your depression is untreatable. In most cases, these symptoms will resolve as your brain continues adapting to the therapy, and many patients who experience the dip go on to experience meaningful and lasting improvements. 

You are also not alone. Let your care team know if you are experiencing a dip and they will monitor your response, offer strategies for coping with the temporary symptoms, and adjust your treatment plan if needed. It’s important to also stick with the therapy, even if it feels challenging at this stage. 

Explore TMS therapy 

If you’re interested in exploring TMS therapy, we offer this treatment at our clinics in Los Angeles and throughout Georgia. Our compassionate team is here to guide you every step of the way, answer your questions, and help you understand whether TMS is the right option for you. Contact us today to learn more about TMS therapy or schedule a consultation with our team.