Who is a Good Candidate for TMS Therapy?

Who is a good candidate for TMS therapy? According to  Owen Muir, MD, DFAACAP, chief medical officer at Radial, “the best candidates for TMS are people who want this to be over.” This could refer to any of the conditions TMS is FDA-cleared for, including treatment-resistant depression, obsessive compulsive disorder (OCD), smoking cessation, anxious depression, and migraines. There are also some contraindications to keep in mind.

Quick answers

• TMS eligibility depends on your diagnosis and other personal factors.
• There are some TMS contraindications that automatically rule someone out, including having an iron-containing brain implant.
• While effective in many cases, you also have to be comfortable getting TMS. 

What makes someone a good candidate for TMS?

The main requirements for TMS treatment are 1) previous antidepressant failure (of two or more drugs) and 2) a diagnosis for a condition that TMS is FDA-cleared for, such as treatment resistant depression or OCD. That said, in order to meet insurance coverage criteria for treatment resistant depression, the current episode must be classified as severe. Additionally, only certain payers will cover TMS for OCD even though TMS is FDA-cleared for this diagnosis.

Adolescents and younger adults may respond better to TMS, as well as older patients (up to the age of 86). Dr. Muir explains, “TMS does well on the extremes of the age spectrum.”

Those of us who aren’t on the extremes may still be good candidates, though. In these cases, Dr. Muir works collaboratively with his patients to determine whether TMS sessions can work around professional and caregiving responsibilities. 

Another benefit of TMS is that it doesn’t have the same side effects of traditional antidepressants, such as SSRIs and SNRIs. This makes it suitable for those who can’t (or don’t want to) tolerate side effects like weight gain or a movement disorder. 

Another surprisingly solid candidate? Those who have done a different type of TMS before.

“With accelerated TMS, we often get patients into remission who didn't remit with once daily  TMS and the different kinds of coils,” says Dr. Muir. Accelerated TMS is a faster version that usually lasts five to seven days, as opposed to the standard treatment duration of six weeks.

What might rule someone out for TMS eligibility?

“There are very few bad candidates,” says Dr. Muir. An absolute contradiction that he looks for during a TMS candidacy evaluation is any iron-containing implants (think: cochlear implants, intracranial aneurysm clips, metal plates). 

Additionally, if someone had tinnitus from previous TMS sessions, retreatment could make it worse. In these cases, Dr. Muir might recommend another option, such as the ProLivRx device or Spravato. 

Often, the decision of whether to try TMS often comes down to what logistically works for someone’s life and finances. TMS for anxiety (without any other qualifying diagnoses), for example, isn’t covered by most insurance providers, so it might not be a viable anxiety treatment for everyone. Alternatively, someone who travels a lot and can’t get to the TMS clinic often may be better served by a 1-day TMS treatment called AMPA, or an at-home device, such as a vagus nerve stimulator. 

Despite these limitations, TMS can be adjusted somewhat to fit your life. Dr. Muir has a patient who comes in on the weekends for maintenance sessions. He spends half his Saturday in treatment and the other half playing with his kids. TMS clinics like Radial offer flexibility so TMS complements your life instead of getting in the way of it.