This article is for information only and isn’t a substitute for advice from your doctor or psychiatrist. If you’re in crisis or thinking about harming yourself, call or text 988 to reach the Suicide & Crisis Lifeline, available 24/7.
If you’ve tried antidepressants and they haven’t worked – or the side effects made them impossible to stick with – you may have stumbled across something called ‘TMS therapy’ and wondered whether it’s legit or just something else to be disappointed by.
It’s a very fair question. TMS is real, it’s FDA-cleared, and there’s quite a bit of solid research behind it. It’s also not a miracle, and it isn’t for everyone.
In this article, we’ll explain what TMS therapy is, what the studies actually show, what the side effects are, and how it fits alongside talk therapy.
Let’s get right into it.
What Is TMS Therapy?
‘TMS’ stands for transcranial magnetic stimulation. It’s a non-invasive treatment where a magnetic coil is placed against your scalp and delivers short, repeated pulses to a specific area of the brain, most often the left prefrontal cortex, which is involved in mood and tends to be underactive in depression.
This doesn’t involve anything else, and when people first learn about this therapy it can cause quite a lot of confusion – is something like this even real?
The fact is, TMS was first cleared by the FDA for depression in 2008, and the UK’s health guidance body NICE recommended it for depression in 2015. The FDA has since cleared it for obsessive-compulsive disorder (OCD) as well.
Who Is TMS For?
TMS is usually offered when medication hasn’t worked. In the research it’s mainly studied in what’s called treatment-resistant depression, which typically means you’ve tried at least two antidepressants at a proper dose and length of time without enough improvement.
That’s also usually what insurance requires before they’ll cover it.
So if you’re newly diagnosed and haven’t tried anything yet, TMS isn’t the place most doctors would start, and keep in mind that it is still relatively rare as a form of treatment.
Therapy and medication would still always come first.
Does TMS Therapy Actually Work?
So, does it actually work?
For treatment-resistant depression, yes, TMS works better than a placebo.
A 2023 meta-analysis pooling 19 randomized sham-controlled trials found that around 40% of people receiving real TMS responded to treatment, compared with roughly 14% of people receiving a sham version. That’s just over double the odds.
Two things to keep in mind from this though:
- It doesn’t work for everyone. If 40% respond, that means most people in these trials didn’t reach the threshold for a full response. Some improved partially; some didn’t improve at all.
- The numbers are debated. After that meta-analysis was published, other researchers pointed out that its largest study didn’t use a proper sham control and shouldn’t have been included. The true effect is likely real but a bit smaller than the headline figure.
How long the benefits last is also less well studied than the short-term effect. Some people stay well for months or years; others need occasional “maintenance” sessions. If a clinic promises you a permanent cure, you should be very skeptical.
For OCD, the evidence is more recent and thinner, but a sham-controlled trial was strong enough for FDA clearance in 2018. For anxiety, PTSD, and other conditions, TMS is still mostly experimental, and any claims should be treated with caution.
What a Course of TMS Looks Like
A standard course is a lot more of a commitment than people expect:
- Sessions are 20 to 40 minutes, though newer “theta burst” protocols can be much shorter.
- Five days a week, usually for four to six weeks.
- You’re awake the whole time. Most people read or listen to music.
- You’ll hear a loud clicking and feel a tapping sensation on your scalp. Clinics provide earplugs.
Because it’s daily and in-clinic, you really need to plan beforehand so you can attend all of tour sessions.
What Are the Side Effects?
TMS is generally well tolerated, but it isn’t side-effect free. The most common are:
- Scalp discomfort at the treatment site, reported by roughly four in ten people
- Headaches, which are common in the first week and usually fade
- Nausea or dizziness in a smaller number of people
The serious one to know about is seizures. They’re rare, estimated at around one in a thousand patients, but the risk is higher if you have epilepsy, a history of seizures, or a brain injury. TMS is also unsuitable if you have metal implants in or near your head, such as cochlear implants or aneurysm clips. A good clinic will screen you for all of this.
Where Does Therapy Fit In?
Here’s the thing that often gets lost on TMS clinic websites: in almost every study, TMS was added on top of ongoing care, not used instead of it. People kept taking their medication and, in many cases, kept seeing a therapist.
That matters because TMS changes brain activity, but it doesn’t teach you anything. It won’t help you spot the thought patterns that pull you under, rebuild routines that fell apart during a depressive episode, or repair relationships that took a hit. That’s the work of therapy, and it’s the part that helps you stay well once a course of TMS ends.
So if you’re considering TMS, the question isn’t “TMS or therapy?” It’s “who’s my therapist while I do this?”
Healing Starts Here
Here at Nexum, we don’t provide TMS. If you think it might be right for you, a psychiatrist can assess whether you’re a candidate and refer you to a clinic. If you’re not sure whether to see a psychiatrist or a psychologist first, we’ve written a guide on that too.
What we do offer is the therapy that goes alongside it. Our therapists provide depression counseling and anxiety therapy through online therapy and in-person sessions across Illinois, Texas, and New Mexico, and we accept all Medicaid and Medicare plans with no out-of-pocket costs. Reach out today and we’ll match you with a therapist who can support you through whatever treatment path you choose.
