Frequently Asked Questions about TMS
Medically reviewed by Dr. Sireesha Kolli — Board-Certified Psychiatrist, Kolli Psychiatric & Associates, Red Bank, NJ
Last reviewed: May 2026
If you’re considering transcranial magnetic stimulation, or TMS, one of the first questions you may have is simple: does it actually work? This FAQ explains what patients can realistically expect from TMS, including how effective it may be for depression, OCD, anxious depression, and adolescent depression.
It also covers what can affect your response, how long results may last, what happens if TMS does not work, and practical questions about medication, insurance coverage, and how TMS compares with options like Spravato.
How Effective Is TMS?
For many patients, TMS offers meaningful improvement when other treatments haven’t worked. Research over the past two decades has consistently shown that TMS can reduce symptoms of depression, OCD, and related conditions — often in people who haven’t fully responded to medication or therapy.
That said, effectiveness varies from person to person. Some patients experience dramatic improvement, others see steady, gradual gains, and a smaller group doesn’t respond as hoped. Understanding the typical range of outcomes can help set realistic expectations before starting treatment.
TMS effectiveness for Depression
TMS has the strongest and longest-standing evidence base for treating major depression, particularly in patients who haven’t responded to one or more antidepressant medications.
Across clinical studies, roughly 50 to 60 percent of patients with treatment-resistant depression experience a meaningful response to TMS, meaning their symptoms improve by at least half. About one-third of patients reach full remission, meaning their depression symptoms largely resolve. Real-world data from large patient registries — where outcomes are tracked across many clinics and many types of patients — have shown similar or even better numbers, with response rates often above 60 percent.
These results are notable because they’re achieved in patients who, by definition, have already tried other treatments without enough benefit.
TMS effectiveness for OCD
For OCD, deep TMS has been shown to produce meaningful symptom reduction in patients who haven’t fully responded to medication or therapy. In the studies that led to FDA clearance, about one in three patients experienced a clinically significant improvement in their OCD symptoms over six weeks of treatment, with continued gains in some patients over the weeks following treatment.
OCD is a notoriously difficult condition to treat, and these results represent a meaningful option for patients who have struggled despite standard care.
TMS for Anxious Depression
When TMS was specifically studied for depression with anxiety symptoms — the form of depression that earned FDA clearance in 2021 — patients experienced meaningful improvements in both their depression and their anxiety. For many patients with anxious depression, the anxiety symptoms ease alongside the low mood, often making the overall experience of treatment feel more manageable than medication trials that can initially worsen anxiety.
TMS effectiveness for Adolescent Depression
In the studies that led to FDA clearance for adolescents in 2024, teens with depression experienced meaningful improvement in their symptoms over a standard course of treatment, with a safety profile similar to what’s seen in adults. While the long-term data in adolescents is still growing, the early evidence is encouraging — particularly for teens who haven’t responded to therapy or who can’t tolerate antidepressant side effects.
What Affects How Well TMS Works?
Several factors can influence how well a person responds to TMS:
- The severity and duration of symptoms before starting treatment
- How many other treatments have already been tried
- Whether TMS is used on its own or alongside therapy or medication
- Adherence to the full course — completing all sessions matters
- The specific protocol used (standard rTMS, iTBS, deep TMS, or accelerated)
- Individual differences in brain anatomy and circuit activity
Patients who continue therapy alongside TMS, who complete the full course, and who maintain healthy routines (sleep, movement, social connection) during treatment tend to do best.
How Long Do TMS Results Last?
For many patients, the benefits of TMS last well beyond the treatment course itself. Studies have shown that a significant portion of patients who respond to TMS maintain their improvement for six months to a year or more after finishing treatment, particularly when they continue therapy or medication during that time.
Some patients eventually experience a return of symptoms and benefit from a second course of TMS (sometimes called a re-treatment) or from periodic maintenance sessions. The response to a second course is typically as good as — or sometimes better than — the first.
TMS May Be One Part of the Plan
› Depression treatment often works best with a full-picture approach
› A psychiatric evaluation can help clarify the next step
What If TMS Doesn’t Work?
Not everyone responds to TMS, and that’s important to acknowledge upfront. If a full course doesn’t produce meaningful improvement, it doesn’t mean other treatments won’t work. There are still many options to consider, including different medication strategies, more intensive psychotherapy, other neuromodulation approaches like esketamine or ECT, and lifestyle and integrative interventions. Our team can help you understand the next steps and make a thoughtful plan based on what you’ve already tried.
What are the pros and cons of TMS therapy?
Patients deserve a fair answer rather than a sales pitch. Here is a balanced view.
Possible pros:
- Noninvasive, with no surgery and no anesthesia
- Outpatient, with no recovery time after sessions
- Does not typically cause the systemic medication side effects some patients struggle with, such as weight gain or sexual side effects
- May help when medication and therapy alone have not been enough
- Can usually be combined with ongoing medication management
Possible cons:
- Requires frequent appointments, often five days per week for several weeks
- Does not work for everyone, and partial response is common
- Can cause headache or scalp discomfort, particularly early in treatment
- Insurance often requires documentation of prior medication trials before approving
- Not appropriate for everyone, especially patients with certain seizure risks or specific implanted devices
- Some patients may need maintenance sessions or additional treatment later
Can I stay on medication during TMS?
In most cases, yes. Many patients continue antidepressants or other psychiatric medications during a course of TMS. Mayo Clinic notes that after a TMS treatment course, standard care such as medication and talk therapy may be recommended as ongoing treatment.
TMS is not always a replacement for medication. For many patients, it works best as part of a broader plan that may include medication management, therapy, sleep support, lifestyle changes, and ongoing psychiatric follow-up.
This is where the role of your psychiatrist matters. Before and during TMS, your psychiatrist can help decide:
- Whether medications should stay the same during TMS or be adjusted
- Whether the diagnosis is depression, bipolar depression, anxiety, OCD, or something else, since this affects what TMS protocol makes sense
- What the plan looks like if TMS helps significantly
- What the plan looks like if TMS does not help enough
- Whether maintenance treatment may be needed later
Considering TMS Therapy?
› Understand whether TMS may be appropriate for your symptoms
› Get guidance from a psychiatrist before starting treatment
Is TMS covered by insurance?
Sometimes, yes, but it depends on the insurance plan, the diagnosis, your treatment history, and the documentation submitted.
Coverage is generally most straightforward for treatment-resistant depression. Coverage for anxiety, OCD, or off-label uses can be more limited. Before starting, it is reasonable to ask the TMS provider:
- Is TMS covered under my insurance plan
- What diagnosis is being submitted
- How many medication trials does my insurance require to authorize coverage
- Will you need records from my psychiatrist
- What will my out-of-pocket cost be
- Are the consultation, mapping session, and treatment sessions billed separately
- What happens if insurance denies the claim
Asking these questions upfront prevents most billing surprises later.
Spravato vs TMS
Patients often compare TMS and Spravato because both are options that may be discussed when depression has not improved enough with standard treatment. They are very different treatments.
TMS uses magnetic stimulation. You do not take a medication during the session, you stay awake throughout, and you can usually leave and resume normal activities right after.
Spravato is esketamine, a nasal spray related to ketamine. It is FDA-approved for treatment-resistant depression in adults and must be administered in a certified healthcare setting because of risks including sedation, dissociation, blood pressure changes, and potential for misuse. The FDA requires patients to be monitored for at least two hours after each dose under the Spravato REMS program, and patients cannot drive themselves home the same day.
A practical way to think about it. TMS feels more like a repeated procedure with no medication in your system afterward. Spravato feels more like a monitored medication treatment that produces noticeable acute effects during the session. The right choice depends on your diagnosis, medical history, prior medication response, side effect tolerance, insurance coverage, and personal preferences. A psychiatric consultation can help sort through which option is the better fit.
What questions should I ask before starting TMS?
Before your first TMS appointment, or shortly after, consider asking:
- What diagnosis are we treating, and is TMS FDA-cleared for that condition
- Which TMS protocol or device do you use, and why
- What does the first session feel like, and how long does it last
- How many sessions are you recommending, and how will we measure progress
- How soon should I expect to notice any change
- What side effects should I expect, and what should I do if I have them
- What should I do if I feel more anxious or low during treatment
- Should I continue my current medications during TMS
- Who will coordinate with my psychiatrist?
- Is TMS covered by my insurance, and what will I owe?
- What happens if TMS does not help enough
- What happens if TMS does help
- Will I need maintenance sessions later
It is reasonable to bring this list with you. A good TMS provider will welcome the questions.
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