What Is TMS Therapy? Benefits, Side Effects, and Results

Transcranial magnetic stimulation (TMS) therapy uses magnetic pulses to help rewire and regulate brain activity. It has many of the qualities you’d want in a mental health treatment: it’s backed by years of research, offers a quick response time, has minimal side effects, and is FDA-cleared. Let’s unpack why TMS works for depression, OCD, and other conditions—even when medications and other treatment options don’t. Let’s unpack why TMS works for depression, OCD, and other conditions—even when medications and other treatment options don’t.

Transcranial magnetic stimulation (TMS) therapy is a noninvasive treatment where an electromagnetic coil is placed near the scalp. The coil uses magnetic pulses to adjust  activity in specific regions of the brain. It works differently from more traditional psychiatric treatments, such as talk therapy and medications, and the treatment’s uniqueness can feel intimidating at first. But it’s also the reason TMS helps so many.

Take Harriet, for example. She’s a 20-something professional who has struggled with depression and has been in  talk therapy and taking a variety of medications. After multiple failed treatments, a mental health provider recommended TMS. 

“After two weeks of TMS, it was like the weight of the depression significantly started to lift for her,” says MaryEllen Eller, MD, regional medical director at Radial and a psychiatrist involved in Harriet’s treatment, “She started reporting having more energy and being able to take better care of herself, which was a dramatic improvement over the past few months.” After three weeks, Harriet told her therapist she no longer had suicidal thoughts.

With newer TMS protocols like SAINT, up to 60-80% of people experience remission of their depression within four weeks, and this treatment works for other conditions too. Continue reading to understand how TMS works, what it treats, and next steps if you want to learn more. 

What is TMS therapy, and how does it work?

To understand how a TMS works, we have to bring it back to physics 101, specifically magnets and electricity. Any object that generates its own magnetic field qualifies as a magnet, whether it’s that fridge magnet bought on last summer’s vacation to the much stronger electromagnetic coil in a TMS device. During TMS, electricity is used to turn the coil into a powerful and precise magnet, hence the name electromagnetic coil. 

When the TMS device is close to the scalp, targeting the areas associated with the condition being treated, the electromagnetic coil influences the brain’s electrical activity. It delivers rapid, repeated pulses of a strong electromagnetic current, stimulating the brain.

“TMS strengthens the connections between the emotion center and the thinking and planning center, and those are the connections that break down under stress and depression,” says Chris Aiken, MD, a psychiatrist and medical editor of the Carlat Psychiatry Report, “It's a bit like weight lifting for the brain. If you lift weights every day your muscles grow. Not right away, but gradually. With daily TMS, the neural connections grow and strengthen.” 

TMS is delivered through a TMS machine, usually in the shape of a cap, that rests close to your scalp. The cap houses a coil that delivers brief, focused magnetic pulses that pass through the skull and induce tiny electrical currents in specific regions of the cortex. 

“For TMS, you're sitting comfortably in a chair with a funny little hat on your head,” says Dr. Eller, “You may hear a woodpecker type noise, feel some tingling on your scalp, but it's rarely painful, it's not invasive, and it's not super loud.” This process is the same for all types of TMS, including traditional and accelerated TMS protocols.

What conditions does TMS treat?

The FDA has approved or cleared TMS devices for various conditions. FDA-approved devices undergo a rigorous process to test safety and efficacy, when it’s a brand new or risky technology, for treating a specific condition. For lower-risk devices, manufacturers can use the FDA 510(k) clearance pathway by showing their device is substantially equivalent to one already on the market. For us non-medical folks, there isn’t a huge difference between the two.

TMS is FDA-cleared for:

• Major depressive disorder (MDD): One of the most common reasons TMS is used is for depression. The treatment is FDA-cleared for MDD in adults and adolescents. In one study, over 81% of those with MDD improve within 20 sessions of deep TMS. 
• Anxious depression: Certain types of TMS can target anxiety and depression symptoms when the two conditions co-occur. TMS for anxiety may also be effective, though it’s not a FDA-cleared purpose.  
• OCD: For people living with OCD, TMS offers life-changing results. In one study, about 58% of OCD patients responded to TMS. You can learn more in our TMS for OCD guide.
• Migraines: TMS may reduce the severity and frequency of migraines, though researchers are still learning how well it works.
• Smoking cessation: Smoking cessation medications offer a 15.7-21.8% six month abstinence rate. TMS’ rate of smoking cessation at the end of treatment (six weeks) is 25.3%, and it has fewer side effects. 

TMS may be safe and effective for other conditions that the FDA has yet to approve or clear:

• PTSD 
• Postpartum depression, which you can learn more about in our TMS for postpartum depression guide
• Bipolar disorder
• Schizophrenia (specifically for auditory hallucinations)
• Addiction
• Parkinson’s disease
• Stroke recovery

Does TMS actually work? 

With TMS, remission rates for depression can be as high as 90% in some patient populations. When it comes to OCD, people with this condition are three times as likely to experience reduced symptoms with TMS than a sham. Plus, the treatment is safe, non-invasive, and may be used in tandem with talk therapy and other treatment modalities. 

That 90% figure, however, applies to SAINTS TMS, which is an accelerated TMS protocol that may work faster and be more effective for certain conditions. It also comes from a specific study, and a 80% remission rate may be a more realistic expectation for the protocol. Other factors, such as the reason for TMS, may impact when TMS starts working too. 

Is TMS safe? Side effects and risks

 When administered by trained clinicians and with proper screening, TMS is a safe treatment for OCD, depression, and other conditions. It has relatively few side effects, most of which only lasts a few minutes and are manageable. 

Common side effects include mild to moderate scalp discomfort at the treatment site, headache, neck or jaw pain, tinnitus (ringing in the ears), tingling or twitching of facial muscles during stimulation, and brief light-headedness. TMS may make you feel tired right after treatment as well. These reactions usually fade within minutes to hours, and many side effects respond to over-the-counter pain relievers. 

Serious events are very uncommon; the most significant risk is a seizure, which occurs in an  extremely low number of cases. Fewer than 1 out of 1,000 patients experience seizures, which is less than 0.1%. Unlike ECT, a treatment TMS is sometimes confused for, TMS does not cause memory loss.

If you want the full picture on the treatment’s side effects, see our complete TMS safety and side effects guide. 

What to expect: sessions, timelines, and what it feels like

Not knowing what to expect can make any medical treatment overwhelming, and TMS is not an exception, and TMS reviews online can be confusing. To avoid any pre-TMS dread, here’s what to expect prior to, during, and after your treatment:

• Pre-treatment: Aside from attending that initial screening, there’s nothing else you need to do to prepare. You can eat normally, drive to and from your sessions, and won't be put to sleep during TMS.
• The treatment space: TMS is performed in a TMS therapy center with licensed technicians operating the device and overseeing treatment. The treatment space is designed to be calming, and there’s nothing you have to do during treatment. “You could be listening to music, relaxing, or just chatting with the technician during treatment,” says Dr. Eller.
• What TMS feels like: Many people say the sensation is weird, but not painful. “It's a unique feeling that might take you a moment or two to get used to, but isn't going to cause significant pain,” Dr. Eller explains, “It doesn't leave any marks or redness either.” Learn more about what TMS feels like in this guide.
• Course length: Depending on the recommended treatment course, patients undergo 30-50 sessions of TMS. 
• After completing TMS: After TMS treatment, you have an opportunity to establish long-lasting lifestyle changes. “TMS helps your brain lay down new brain connections, which helps those healthy lifestyle habits stick better in your brain,” explains Dr. Eller. 

This is just a brief overview of what TMS might feel like. We also have more in-depth guides on what TMS feels like, how long TMS lasts, and what to expect after TMS treatment.

What does TMS cost, and does insurance cover it?

Insurance often covers TMS for FDA-cleared conditions, when certain criteria are met. We break down those requirements and how to get TMS covered by insurance in another article.  

Whether or not insurance will cover treatment impacts how much TMS actually costs. If insurance covers treatment, there may still be an out-of-pocket copay or coinsurance that a patient is responsible for. Insurance is less likely to cover TMS therapy costs for people who don’t meet the set criteria and for accelerated TMS protocols. 

How TMS compares to other treatments 

“TMS is better tolerated, it has less side effects, the benefits last longer, and we can see the benefits more quickly than if we were to just do medications or psychotherapy,” says Dr. Eller. 

Here’s more on how TMS compares to (and might work in tandem with) other treatment options:

• Antidepressant medications: “If your antidepressant isn't working, TMS offers a much better chance of recovery than changing antidepressants or adding new medications like an antipsychotic (eg, aripiprazole),” says Dr. Aiken. He adds that TMS is also better tolerated than most medications and has fewer side effects.  
• Talk therapy: This one isn’t an either/or, because the two often deliver more durable relief when combined. “TMS is a way of optimizing the improvements that you can get in psychotherapy,” explains Dr. Eller, “It helps all of those positive changes stick in the brain by giving your brain the ability to lay down new connections more quickly and to hold those connections over a long period of time.”
• ECT: TMS is often mistaken for electroconvulsive therapy (ECT) because both are forms of brain stimulation. Yet the two procedures are different. ECT delivers an electrical current while the patient is under general anesthesia, intentionally producing a brief seizure that can alleviate severe depression and other conditions. These differences are why TMS and ECT have such different side-effect profiles and efficacy rates.
• Spravato: Spravato is FDA-approved to treat major depressive disorder that doesn’t respond to at least one other medication. Like TMS, it’s an in-clinic treatment. Unlike TMS, someone self-administers the Spravato nasal spray. Afterwards, clinic staff monitor the patient. TMS and Spravato are both effective, though one or the other may be more suitable for some patients.

Who is a good candidate for TMS treatment? 

Many people are potentially good candidates for TMS. Dr. Eller says it's a great option for those with depression or OCD who haven’t found relief from therapy or medication alone. TMS is promising for other conditions too (see list of emerging uses above), but insurance typically only covers treatment for FDA-cleared uses.

That said, it isn’t the right fit for everyone. If you have any iron-containing metal implants in your brain (think:, cochlear implants, metal plates, and implanted pacemakers), the implant may disrupt TMS treatment. TMS, with FDA-cleared high frequency stimulation,isn’t safe for those with a history of seizures, since a seizure is a potential—but very rare—side effect.

The bottom line

Whether used as a standalone treatment or alongside other interventions, TMS is a safe, effective option for OCD, major depressive disorder, anxious depression, adolescent depression, and smoking cessation, with  FDA clearance. 

Key takeaways

• TMS is FDA-cleared for major depressive disorder, depression with anxiety, migraines, and smoking cessation. For conditions like bipolar depression, postpartum depression, addiction, and PTSD, TMS demonstrates promising outcomes.
• TMS may be more effective than medication or talk therapy alone, with faster results and fewer side effects. 
• Results vary depending on the individual and the type of TMS therapy, with SAINT TMS providing the highest remission rate. Fewer TMS centers offer SAINT TMS, with Radial in that exclusive group.

Frequently asked questions (FAQs) 

Why is TMS controversial?

TMS is sometimes confused for ECT, aka “shock therapy,” which is an invasive procedure that causes seizures. By contrast, TMS is non-invasive and does not intend to induce seizures. Additionally, TMS may come with high costs if not covered with insurance, and while it does have a high remission rate, it doesn’t work for everyone. Together, these three factors make some people hesitant to try it. 

What is TMS therapy used for?

TMS is FDA-cleared for major depressive disorder, anxious depression, OCD, migraines, and smoking cessation. It is also being actively studied for a wide range of other conditions, including postpartum depression, bipolar disorder, PTSD, schizophrenia, addiction, Parkinson’s disease, anxiety, and stroke recovery.

Can I work after a TMS session?

It’s safe to work after TMS since it’s a non-invasive treatment that doesn’t require sedation. Some people do report feeling fatigued, especially after the first few sessions, which is important to keep in mind if heading back to work afterwards. 

Will TMS change my personality?

TMS does not change the core of someone’s personality. It may address symptoms related to major depressive disorder, anxious depression, and OCD, which may sometimes feel like a personality shift (in a positive way). For example, someone who identified as a nonenergetic person before may find they have more energy after TMS.

Is TMS shock therapy?

TMS is not shock therapy. TMS is a non-invasive, painless procedure in which a small electromagnetic coil rests against the scalp and delivers brief magnetic pulses to precise brain regions.

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