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If you've tried more than one antidepressant and still don't feel like yourself, you may have heard about TMS for depression. Transcranial magnetic stimulation is a non-medication treatment that uses magnetic pulses to stimulate parts of the brain involved in mood. Here's a clear look at what it is, who it's for and how it compares with other options.
Key takeaways
- TMS uses magnetic pulses delivered through a coil on the scalp. You stay awake, and no anesthesia is needed.
- It's mainly used for adults whose depression hasn't improved enough with medication.
- A course usually involves frequent sessions over several weeks.
- Common side effects are mild. Seizures are rare but are the most serious risk.
- Our practice doesn't offer TMS, but our team can help you decide whether to ask about a referral.
If you're struggling right now: If you have thoughts of harming yourself, call or text 988 to reach the Suicide and Crisis Lifeline. Call 911 in an emergency, or text HOME to 741741. You can find more options on our crisis resources page.
What is TMS for depression?
TMS uses an electromagnetic coil placed against your head. The coil creates a magnetic field that passes through the skull and produces small electrical currents in nearby brain cells.
For depression, treatment usually targets an area near the front of the brain called the prefrontal cortex, which helps regulate mood. Activity in this area may be lower than usual in depression. Repeated sessions over time are thought to change activity in the brain networks that affect mood. You may also see it called repetitive TMS, or rTMS.
TMS doesn't involve surgery, implants or medication. It works locally on the brain rather than throughout the body, which is part of its appeal for people who've struggled with medication side effects.
Who TMS may be right for
The FDA has cleared specific TMS devices for specific uses. The main one is major depression in adults who haven't had enough relief from antidepressant medication. Some devices are cleared for other conditions, such as obsessive-compulsive disorder. Clearance applies to particular devices and uses, so ask any provider which use applies to you.
TMS may be worth discussing if:
- You've tried one or more antidepressants without enough improvement
- Side effects made medications hard to stay on
- You'd like an option that doesn't add whole-body medication side effects
TMS may not be a good fit if:
- You have metal or implanted devices in or near your head, such as certain aneurysm clips, cochlear implants or brain stimulators
- You have a history of seizures, which needs careful review first
- You need faster or more intensive care, for example during a suicidal crisis or with psychotic symptoms
Many people continue their antidepressant during a course of TMS. That decision is made with your prescriber.
What TMS sessions are like
Your first visit usually includes a mapping session. The provider finds the right spot on your head and sets the strength of the pulses for you, often by finding the level that makes your fingers or thumb twitch slightly.
During each session, you sit in a reclining chair, awake and alert. The coil rests against your head. You'll hear loud clicking or tapping sounds, so you'll wear earplugs, and you'll feel a tapping sensation on your scalp. Session length depends on the protocol, ranging from a few minutes to under an hour.
A typical course involves sessions several times a week, often every weekday, for several weeks. Some newer schedules pack more sessions into a shorter period. Because there's no sedation, most people can drive themselves and go back to work or school afterward.
Improvement usually builds gradually over the course rather than all at once. Not everyone responds, and some people who do respond later need another course or occasional follow-up sessions.
Side effects and safety
Most side effects are mild and tend to ease after the first week or two:
- Scalp discomfort or soreness where the coil sits
- Headache
- Lightheadedness
- Twitching of facial muscles during the session
The clicking is loud enough that ear protection is needed to protect your hearing. Seizures are rare, but they're the most serious known risk. Careful screening beforehand lowers that risk, and treatment staff are trained to respond if one happens.
As with other depression treatments, people with bipolar disorder may have a small risk of shifting into a high or elevated mood. TMS isn't known to cause the memory problems that can come with ECT.
How TMS compares with ECT, ketamine and esketamine
TMS is one of several options for depression that hasn't responded to standard medications. Each works differently.
- ECT uses a brief, controlled seizure under general anesthesia. It's one of the most effective treatments for severe depression and is often considered when a fast response is needed. Memory problems around the treatment period are a known side effect.
- Ketamine, usually given by IV, can ease depression quickly for some people. It's FDA-approved as an anesthetic, and its use for depression is off-label. Learn more in our post on ketamine for depression.
- Esketamine is an FDA-approved nasal spray for specific uses in depression, given under supervision in a certified setting. Read more in our guide to esketamine nasal spray.
| TMS | ECT | Ketamine (IV) | Esketamine (nasal spray) | |
|---|---|---|---|---|
| How it's given | Magnetic pulses through a coil on the scalp | Brief seizure induced under anesthesia | Infusion into a vein | Nasal spray in a medical office |
| Anesthesia | No | Yes | No | No |
| How quickly it may help | Gradually, over weeks | Often faster than medication, over a series of treatments | Sometimes within hours to days | Sometimes within hours to days |
| FDA status for depression | Specific devices cleared for specific uses | Long established for severe depression | Off-label | Approved for specific uses |
| Drive yourself home? | Usually yes | No | No | No, not until the next day |
| Common side effects | Scalp discomfort, headache; seizures are rare | Memory problems, confusion, anesthesia risks | Dissociation, rise in blood pressure, misuse potential | Dissociation, dizziness, sleepiness, rise in blood pressure |
The Mayo Clinic overview of TMS is another helpful source as you compare options.
Talking with a provider about a referral
Our practice doesn't offer TMS, ECT, ketamine or esketamine. What our team can do is take a fresh look at your care. That can include reviewing which medications you've tried and at what doses, checking for medical factors that affect mood and considering GeneSight testing to guide the next medication choice.
If TMS or another treatment seems like a good next step, ask your provider about a referral. Many insurance plans cover TMS for depression that hasn't responded to medication, but requirements vary, and prior approval is often needed. Our guide on what to do when antidepressants don't work covers other next steps.
Frequently asked questions
Does TMS hurt?
Most people describe it as a tapping or knocking feeling on the scalp, which can be uncomfortable at first. Discomfort often fades over the first sessions, and settings can sometimes be adjusted. Tell the treatment team if it's too much.
Can I keep taking my antidepressant during TMS?
Many people do. Your prescriber and the TMS provider should coordinate so your medication plan stays steady during treatment. Talk with your prescriber before starting, stopping or changing any medication.
Does insurance cover TMS?
Many plans do cover TMS for depression that hasn't improved with medication. Plans often require proof that you've tried a certain number of medications, along with prior approval. Call your insurer to check the details for your plan.
How long do the results of TMS last?
It varies. Some people stay well for months or longer after a course, while others need follow-up sessions or a repeat course. Continuing medication and regular psychiatric care can help protect your progress.
Find your next step with our team
Depression that hasn't responded to the first few treatments is still treatable. At Musec Medical, our psychiatrist and psychiatric physician assistants offer medication management and help with referrals when another treatment may fit, in person in Chicago and by telehealth anywhere in Illinois. Request an appointment to talk through your options.
