Your practice uses proven treatments. Your team stays current with research. Yet when patients ask about TMS therapy for depression or anxiety that hasn’t responded to medication, you’re navigating questions about effectiveness, safety, and what results they can realistically expect.
I know this because mental health treatment demands precise, evidence-based answers – especially when patients have tried multiple approaches without sustained relief. Here’s what research shows about TMS therapy as a treatment option, who may benefit, and what the clinical evidence actually supports.
What TMS Therapy Is and How It Works
Transcranial Magnetic Stimulation (TMS) therapy uses focused magnetic pulses to stimulate specific regions of the brain associated with mood regulation. The procedure targets the dorsolateral prefrontal cortex, an area that shows reduced activity in individuals with depression.
During a session, an electromagnetic coil placed against your scalp generates magnetic fields similar in strength to those used in MRI machines. These pulses pass through the skull and stimulate nerve cells in the targeted brain region. The stimulation may help activate neural circuits that have become less active in people experiencing depression or anxiety.
The treatment requires no anesthesia, sedation, or recovery time. Sessions typically last 20-40 minutes, and you can return to your regular activities immediately afterward. A full course usually involves daily sessions over 4-6 weeks.
FDA Approval Status for TMS Therapy
TMS therapy has received FDA clearance for several specific applications:
- Major Depressive Disorder (MDD): FDA-cleared in 2008 for adults with depression who haven’t responded adequately to at least one antidepressant medication during the current depressive episode
- Obsessive-Compulsive Disorder (OCD): FDA-cleared in 2018 for adults with OCD
- Anxious Depression: FDA-cleared in 2019 for depression with comorbid anxiety symptoms
- Migraine: A separate TMS device received FDA clearance for acute treatment of migraine with aura in 2013
At Washington Behavioral Medicine Associates, we follow FDA-cleared protocols and treatment parameters for each approved indication.
Clinical Research on TMS Therapy Effectiveness
Multiple clinical trials have evaluated TMS therapy outcomes for treatment-resistant depression. Here’s what the research literature shows:
A 2007 study published in Biological Psychiatry found that approximately 50% of patients with treatment-resistant depression experienced significant symptom improvement with TMS therapy, compared to 25% in the sham treatment group. About 33% of patients achieved remission – meaning symptoms reduced to minimal levels.
Research published in the Journal of Clinical Psychiatry in 2014 examined real-world outcomes from over 250 clinical practices. The study found response rates (meaningful symptom reduction) in approximately 58% of patients, with remission rates around 37%.
For OCD treatment, a 2018 study in the American Journal of Psychiatry found that TMS therapy targeting specific brain circuits showed statistically significant symptom reduction compared to sham treatment, leading to FDA clearance for this indication.
These studies suggest TMS therapy may provide benefit for some patients who haven’t responded to other treatments. Individual results vary based on multiple factors including symptom severity, treatment history, and concurrent treatments.
Who May Benefit from TMS Therapy
TMS therapy is typically considered when:
- You’ve tried at least one antidepressant medication without adequate symptom relief
- You experience significant side effects from psychiatric medications
- You have a diagnosis of major depressive disorder, OCD, or anxious depression
- You’re looking for treatment options that don’t involve systemic medication effects
- You prefer non-invasive approaches to mental health treatment
TMS therapy may not be appropriate if you have metal implants in or near your head (excluding dental fillings), a history of seizures, or certain neurological conditions. A thorough evaluation determines whether you’re a candidate for treatment.
The TMS Therapy Treatment Process
Initial Evaluation and Motor Threshold Mapping
Your first appointment involves a detailed assessment of your symptoms, treatment history, and medical background. If you’re a candidate for TMS therapy, we’ll complete motor threshold mapping – a process that determines the appropriate magnetic field strength for your treatment.
During motor threshold determination, we place the TMS coil over the area of your brain that controls hand movement and gradually increase the magnetic field strength until we observe a small movement in your hand. This measurement ensures your treatment uses an appropriate, individualized magnetic field strength.
Treatment Sessions
Each session follows this process:
- You sit in a comfortable chair similar to a dental chair
- The TMS coil is positioned against your head at the predetermined location
- The device delivers magnetic pulses in a specific pattern (typically 4-second pulses with 26-second rest periods)
- You’ll feel a tapping sensation on your scalp and hear clicking sounds from the device
- The session lasts 20-40 minutes depending on the specific protocol
You remain awake and alert throughout treatment. Many patients read, listen to music, or work on their phone during sessions.
Treatment Schedule
A typical TMS therapy course involves:
- Daily sessions, Monday through Friday
- Duration of 4-6 weeks for the initial treatment course
- Total of 30-36 sessions for depression treatment
- Possible maintenance sessions if symptoms return after initial improvement
Side Effects and Safety Profile
TMS therapy has a favorable safety profile compared to many psychiatric medications. Clinical trials have documented the following side effects:
Common Side Effects (occurring in more than 5% of patients):
- Scalp discomfort or pain at the treatment site (reported by 39% of patients in clinical trials)
- Headache (reported by 23% of patients)
- Facial twitching during treatment (reported by 13% of patients)
These effects are typically mild to moderate and often decrease after the first week of treatment. They don’t require stopping treatment in most cases.
Rare but Serious Side Effects:
Seizure is the most significant potential risk, occurring in fewer than 0.1% of patients (less than 1 in 1,000). This extremely low risk is comparable to the seizure risk from many antidepressant medications.
Unlike systemic medications, TMS therapy doesn’t cause:
- Weight gain or loss
- Sexual dysfunction
- Gastrointestinal problems
- Sedation or cognitive impairment
- Drug interactions
You can continue your current medications during TMS therapy. The treatment doesn’t require dietary restrictions or lifestyle modifications.
Insurance Coverage and Cost Considerations
Insurance Coverage for TMS Therapy
Most major insurance plans now cover TMS therapy for treatment-resistant depression when specific criteria are met. Coverage typically requires documentation that you:
- Have a diagnosis of major depressive disorder
- Haven’t responded adequately to at least one antidepressant trial
- Are currently in a depressive episode
- Have participated in psychotherapy
We accept insurance from most major carriers including Blue Cross Blue Shield, Aetna, Cigna, United Healthcare, Medicare, and Tricare. Our billing team handles prior authorization and works with your insurance company to verify coverage before treatment begins.
Out-of-Pocket Costs
A complete course of TMS therapy (typically 36 sessions over 6-9 weeks) ranges from $8,000 to $12,000 when paying without insurance.
For insured patients, typical out-of-pocket costs include:
- Initial consultation: $200-300
- Per-session copays: $20-50 (varies by plan)
- Deductible amounts as applicable to your specific plan
Payment Options
We offer several payment solutions for patients:
- Monthly payment plans with 0% interest for qualified individuals
- Sliding scale fees based on financial need
- FSA/HSA acceptance
- Care Credit financing for up to 24 months
- Early payment discount of up to 15% for self-pay patients
Contact our financial services team to discuss your specific situation and explore options that work for your budget.
TMS Therapy at Washington Behavioral Medicine Associates
Our TMS therapy program provides treatment in a comfortable, professional setting with experienced clinical staff. We use FDA-cleared equipment and follow established treatment protocols.
As part of our full-spectrum mental health services, we coordinate TMS therapy with your other treatments including medication management, psychotherapy, and diagnostic services. This allows us to adjust your overall treatment plan based on your response to TMS therapy.
Our location in Chevy Chase, Maryland serves patients throughout the Washington, D.C. metro area including Bethesda, Potomac, Kensington, Rockville, and McLean, Virginia.
What to Expect: Timeline for Results
Research on TMS therapy response patterns shows:
- Some patients notice initial changes in sleep patterns or energy levels within 2-3 weeks
- Mood improvements typically become more apparent after 3-4 weeks of daily treatment
- Maximum benefit often occurs at the completion of the full treatment course (4-6 weeks)
- For patients who respond to treatment, benefits have been documented to last 6-12 months or longer
Individual response varies. Some patients experience earlier improvements, while others may require the full treatment course before noticing significant changes. Regular monitoring throughout treatment helps track your progress and adjust the treatment plan if needed.
After Completing TMS Therapy Treatment
Research on long-term outcomes after TMS therapy indicates:
Studies published in Depression and Anxiety (2014) followed patients for 12 months after TMS therapy completion. Among those who responded to treatment, approximately 68% maintained their improvement without additional TMS sessions during that year.
For patients who experience symptom return after initial improvement, research supports the effectiveness of maintenance TMS therapy sessions. These typically involve less frequent sessions compared to the initial treatment course.
After completing TMS therapy, you’ll continue working with your treatment team to monitor your progress and adjust other treatments as needed. This may include modifications to medication doses, continued psychotherapy, or periodic maintenance TMS sessions.
Comparing TMS Therapy to Other Treatment Options
TMS Therapy vs. Electroconvulsive Therapy (ECT)
Both TMS and ECT use electrical or magnetic stimulation to affect brain activity, but they differ significantly:
TMS Therapy:
- Targets specific brain regions
- No anesthesia required
- No memory side effects
- No recovery time needed
- Outpatient procedure you can drive yourself to and from
ECT:
- Affects the entire brain
- Requires general anesthesia
- May cause temporary memory problems
- Requires recovery time after each session
- Often more effective for severe, life-threatening depression
ECT remains an important option for severe depression, particularly when rapid response is critical or when TMS therapy hasn’t provided adequate benefit.
TMS Therapy vs. Ketamine Treatment
Both treatments offer options for treatment-resistant depression, with different mechanisms:
TMS Therapy:
- Uses magnetic stimulation
- Requires 4-6 weeks of daily sessions
- Effects build gradually over the treatment course
- No dissociative or psychoactive effects
- FDA-cleared for depression and OCD
- Uses medication administration
- Typically involves 6-8 sessions over 2-3 weeks
- May provide rapid symptom relief (within hours to days)
- Can cause temporary dissociative effects during treatment
- Esketamine (Spravato) is FDA-approved for treatment-resistant depression
Some patients benefit from combining both treatments. Your psychiatrist can help determine which approach or combination may be most appropriate for your situation.
Research Areas and Future Applications
Clinical research continues to evaluate TMS therapy for additional applications. Current areas of investigation include:
- Post-traumatic stress disorder (PTSD)
- Bipolar depression
- Smoking cessation
- Chronic pain conditions
- Cognitive rehabilitation after traumatic brain injury
These applications remain experimental and don’t currently have FDA clearance. If you’re interested in participating in research studies, speak with your provider about available clinical trials.
Frequently Asked Questions About TMS Therapy
Can I continue working during TMS therapy treatment?
Yes. TMS therapy sessions last 20-40 minutes and don’t require recovery time. Most patients schedule appointments before work, during lunch breaks, or after work and return immediately to their regular activities. The treatment doesn’t affect your ability to drive, work, or perform daily tasks.
What does TMS therapy feel like?
How long do the effects of TMS therapy last?
Research shows that for patients who respond to TMS therapy, many maintain their improvement for 6-12 months or longer after completing treatment. Some patients may benefit from maintenance sessions if symptoms begin to return. Response duration varies by individual.
Can I have TMS therapy if I’m taking antidepressant medications?
Yes. Most patients continue their current medications during TMS therapy. The treatment can be used alongside antidepressants, and there are no known medication interactions that prevent TMS therapy. Your psychiatrist will review your medications before starting treatment.
Is TMS therapy safe for older adults?
Research includes patients across age ranges, including older adults. Clinical trials haven’t identified age-related safety concerns. However, the evaluation process includes a review of your complete medical history to ensure TMS therapy is appropriate for you, regardless of age.
What happens if TMS therapy doesn’t help my symptoms?
Not all patients respond to TMS therapy. If you don’t experience adequate symptom improvement after completing a full treatment course, your psychiatrist will discuss alternative or additional treatment options. These may include trying different medications, considering other forms of neuromodulation therapy, adjusting your psychotherapy approach, or evaluating other factors that may be affecting your symptoms.
Can TMS therapy cause mania in people with bipolar disorder?
Clinical studies have documented rare cases of treatment-emergent mania in patients with bipolar disorder who received TMS therapy for depression. If you have bipolar disorder, your psychiatrist will carefully evaluate whether TMS therapy is appropriate and will monitor closely for any mood elevation during treatment.
Do I need to stop other treatments to try TMS therapy?
No. TMS therapy is typically added to your existing treatment plan rather than replacing other treatments. Most patients continue their medications and therapy sessions while receiving TMS treatment. Your provider may adjust other treatments based on your response to TMS therapy.
What’s the difference between TMS therapy and deep TMS?
Standard TMS uses a figure-eight coil that stimulates a focused area of the brain. Deep TMS (dTMS) uses an H-coil designed to reach deeper and broader brain regions. Both approaches have FDA clearance for depression treatment. The choice between them depends on individual factors including treatment goals, previous response to treatments, and availability. Research continues to compare outcomes between the two approaches.
How is TMS therapy different from transcranial direct current stimulation (tDCS)?
TMS uses magnetic pulses to stimulate brain activity, while tDCS uses low-level electrical current applied through electrodes on the scalp. TMS has more robust clinical trial data and FDA clearance for depression and OCD. tDCS remains primarily a research tool in the United States, though it’s used more commonly in some other countries. The two approaches differ in their mechanisms, effects, and clinical applications.
Schedule Your TMS Therapy Evaluation
If you’re considering TMS therapy for depression, anxiety, or OCD that hasn’t responded adequately to other treatments, schedule a consultation to determine whether you’re a candidate for treatment.
Our evaluation includes:
- Complete review of your symptoms and treatment history
- Discussion of treatment options including TMS therapy
- Insurance verification and cost estimate
- Answers to your specific questions about the treatment process
Contact Washington Behavioral Medicine Associates to schedule your TMS therapy consultation. Our team is available to discuss whether this treatment approach may be appropriate for your situation.
