What Does TMS Therapy Feel Like? A Patient’s Guide to Treatment, Side Effects, and What to Expect

Medically reviewed by Dr. Sireesha Kolli — Board-Certified Psychiatrist, Kolli Psychiatric & Associates, Red Bank, NJ
Last reviewed: May 2026

Transcranial magnetic stimulation (TMS) is an FDA-cleared, non-medication treatment for depression, OCD, and anxious depression that uses targeted magnetic pulses to stimulate brain circuits involved in mood and thought regulation. Patients typically consider TMS for one of two reasons: medications have not worked well enough, or they want an effective treatment option that does not involve taking a daily psychiatric medication.

This guide is meant to answer the practical questions that people have about TMS. What is TMS? What does it actually do? What does it feel like? What are the side effects? How does it compare to other options? How do you know if you are a good candidate?

At Kolli Psychiatric & Associates, a psychiatry practice serving Monmouth County and all of New Jersey via telehealth, we do not provide TMS therapy in our office — which means our guidance is not tied to recommending one specific treatment.

We regularly evaluate patients who are considering TMS, currently in treatment, or trying to decide whether to add TMS to their existing medication plan. When TMS is clinically appropriate, we refer to trusted local TMS providers across New Jersey and continue to coordinate psychiatric care throughout the course of treatment.

How Does TMS Work?

TMS works by using gentle magnetic pulses to stimulate specific areas of the brain involved in mood, thinking, and behavior — helping circuits that have become underactive or dysregulated return to healthier, more balanced activity.

One of the things that makes TMS different from many other treatments is that it’s noninvasive, which means nothing enters your body. There are no needles, no incisions, and no anesthesia. You sit in a comfortable chair, fully awake, while a small device rests against the outside of your head.

To understand why TMS helps, it helps to know how the brain works. The brain is made up of networks of nerve cells, called neurons, that constantly send signals to one another. In a healthy brain, these networks stay in balance to regulate mood, thinking, and behavior. In many mental health conditions, that balance gets disrupted.

During a TMS session, a small coil is placed against your scalp over the area being treated. The coil generates brief magnetic pulses — similar in strength to those used in an MRI — that pass painlessly through the skull and create tiny electrical currents in the neurons just beneath. This gentle stimulation prompts those neurons to fire and strengthens their connections with the rest of their network. The coil’s position and the pulse frequency are tailored to the specific condition being treated.

What makes TMS more than a quick fix is neuroplasticity — the brain’s natural ability to reshape itself by forming new connections and reinforcing existing ones. Over a typical course of short daily sessions across several weeks, the repeated stimulation gradually retrains these circuits to work more reliably on their own. Think of it like physical therapy for the brain: just as repeated exercise rebuilds strength in an unused muscle, repeated TMS sessions help rebuild healthier patterns of brain activity.

Most patients don’t feel anything dramatic during a session — usually just a light tapping sensation where the coil sits. You stay fully awake and alert, and because nothing enters your body and no sedation is used, you can drive yourself home and return to your normal activities right after.

How TMS Works for Depression

In depression, an area near the upper-left part of the forehead — called the dorsolateral prefrontal cortex — tends to be less active than it should be. This region helps drive motivation, decision-making, and emotional balance, and it plays a key role in regulating the deeper mood centers of the brain.

When it’s underactive, those deeper circuits fall out of balance, which is what produces the persistent sadness, low energy, loss of interest, and trouble concentrating that come with depression.

TMS for depression targets this underactive area directly. During each session, the coil is positioned over the left side of the forehead, and rapid magnetic pulses are delivered in short bursts — usually a few seconds of stimulation followed by a brief pause, repeated throughout the session. This pattern is specifically designed to wake up the underactive region and encourage it to fire more consistently on its own.

A standard course of TMS for depression typically involves sessions five days a week for about six weeks, with each session lasting anywhere from three to about forty minutes depending on the protocol used. Newer, shorter protocols (sometimes called intermittent theta-burst stimulation, or iTBS) can deliver an effective dose in as little as three minutes per session.

Patients often ask how soon they’ll feel a difference. While every person responds at their own pace, many begin to notice subtle improvements in the first two to three weeks — often in energy, sleep, or appetite before mood itself lifts.

These early changes are an encouraging sign that the underlying brain circuits are starting to work more reliably. By the end of a full course, the majority of patients experience meaningful improvement, and a significant portion achieve full remission of their depression symptoms.

TMS may be a good option for patients whose depression hasn’t responded fully to antidepressant medication or therapy, as well as for those who can’t tolerate the side effects of medication. It can be used on its own or alongside ongoing treatments — your provider will help determine the right approach based on your history and goals.

How TMS Works for OCD

In OCD, the brain circuits that connect the front of the brain to its deeper emotional centers get stuck in an overactive loop. Instead of a thought arriving and passing through, the same signal keeps cycling — which is why intrusive thoughts feel impossible to dismiss and why compulsions feel so urgent. The front of the brain, which normally helps you let a thought go and move on, has trouble quieting the deeper regions that keep the thought running on repeat.

TMS for OCD is designed to calm this overactive loop. It uses a specially shaped coil (often called a deep TMS or H-coil) that can reach slightly deeper into the brain than the coil used for depression, allowing the pulses to influence the circuits most involved in OCD. The coil is positioned over the top-front of the head rather than the side, and the pulses are delivered at a frequency intended to quiet the overactive circuit rather than stimulate it.

One important difference from TMS for depression is that OCD treatment includes a brief symptom provocation at the start of each session. Your provider will guide you through thinking about or briefly engaging with a personal trigger — something that would normally bring on an obsessive thought or urge. This activates the exact circuit that needs treatment, so the magnetic pulses can act on it directly. The provocation is gentle, brief, and always done in a controlled, supportive way.

A standard course of TMS for OCD typically involves sessions five days a week for about six weeks, with each session lasting around twenty minutes. Patients often begin to notice changes gradually — intrusive thoughts may feel less intense, compulsions may feel easier to resist, or the urge to perform a ritual may pass more quickly. These shifts often happen quietly at first, and many patients describe feeling like they have more “space” between a thought and their response to it.

TMS may be a good option for patients whose OCD haven’t fully responded to typical first-line treatments like medication, therapy (especially exposure and response prevention), or a combination of both. It can be used on its own or alongside ongoing treatments — your provider will help determine the right approach based on your history and goals.

How TMS Works for Anxious Depression

Anxious depression refers to depression that comes with significant anxiety symptoms — persistent worry, restlessness, racing thoughts, or a constant sense of being on edge alongside the low mood. It’s one of the most common forms of depression, and it can be especially difficult to treat with medication alone, since some antidepressants can temporarily worsen anxiety before they help.

In anxious depression, two things go wrong in the brain at the same time. The area that normally helps regulate mood — the dorsolateral prefrontal cortex, near the upper-left forehead — is underactive, the same pattern seen in regular depression.

At the same time, the brain’s alarm system — a deeper area called the amygdala — becomes overly sensitive, sounding warnings even when there’s no real danger. That combination is what creates the low mood and the constant worry at the same time.

TMS for anxious depression uses the same coil placement and treatment schedule as standard depression treatment, targeting the underactive area on the left side of the forehead. As that region wakes up and starts working more reliably, it does two jobs at once: it helps lift mood, and it strengthens the brain’s ability to quiet the overactive alarm system below.

In 2021, the FDA specifically cleared TMS for treating depression with anxiety symptoms after studies showed patients had meaningful improvement in both their depression and their anxiety over a standard course of treatment.

Many patients with anxious depression describe the anxiety easing alongside the depression — feeling less keyed up, less reactive, and finally able to rest. As with standard TMS for depression, treatment is typically five days a week for about six weeks, and it can be used on its own or alongside ongoing therapy or medication.

How TMS Works for Adolescent Depression

Depression in teens can look different than it does in adults. Alongside sadness, parents and teens often notice irritability, withdrawal from friends and activities, drops in school performance, changes in sleep or appetite, and a sense that nothing feels enjoyable anymore.

When standard treatments like therapy and medication haven’t been enough — or when side effects from antidepressants are getting in the way — TMS can be an effective next step.

The teenage brain is still developing, and the same mood-regulating area involved in adult depression — the dorsolateral prefrontal cortex, near the upper-left forehead — also plays a central role in adolescent depression.

In teens with depression, this area tends to be underactive, which makes it harder for the brain to keep mood, motivation, and emotional responses steady. Because the adolescent brain is especially adaptable, it can respond well to the kind of targeted stimulation TMS provides.

TMS for adolescents uses the same coil placement and overall approach as adult treatment, with settings adjusted appropriately for younger patients.

In 2024, the FDA cleared TMS for treating depression in adolescents ages 15 and older, making it the first noninvasive brain stimulation treatment specifically approved for this age group. Clinical studies showed that teens experienced meaningful improvement in their depression symptoms over a standard course of

Considering TMS Therapy?

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What Does TMS Feel Like?

During a session, you’ll sit in a comfortable chair, fully clothed and fully awake, while a technician positions the treatment coil against your scalp. Once the session begins, you’ll hear a rapid clicking sound and feel a tapping sensation where the coil sits — many patients describe it as a light woodpecker-like tap.

The sensation can feel unusual during the first session or two, and some people notice mild twitching in the forehead, jaw, or around the eye on the side being treated. This is normal and typically becomes less noticeable as treatment continues.

You won’t feel anything happening inside your brain itself — no shock, no warmth, no dizziness, and no change in awareness. You stay fully alert the entire time. Most patients spend their sessions reading, listening to music, watching something on their phone, or simply resting.

Sessions are short, ranging from about three minutes with newer express protocols (like iTBS) to around 20 to 40 minutes with standard protocols. The pulses are delivered in short bursts with brief pauses in between, so there are natural moments of rest throughout.

Afterward, most patients feel completely normal and return to work, school, or their day. A small number notice a mild headache or scalp tenderness in the first week, which usually fades on its own or responds to over-the-counter pain relief. There’s no sedation and no recovery time.

By the second week of treatment, most patients describe the sessions as routine — even relaxing.

What Happens During TMS Treatment?

Knowing what to expect can make TMS feel much less intimidating. While the exact steps vary slightly depending on the type of TMS and the clinic providing it, the overall flow is similar across most treatment settings. Here’s what a typical session looks like from start to finish.

Getting Ready

Before the session, you’ll be asked to remove any metal items — eyeglasses with metal frames, jewelry, hairpins, or anything else that could interact with the magnet. You stay fully clothed, and there’s no need to change into a gown or fast beforehand. Most patients eat normally, take their usual medications, and come straight from work or school.

Settling Into the Chair

You’ll sit in a reclining chair, similar to one you’d find at a dentist’s or oral surgeon’s office. The TMS machine sits next to you, with a treatment coil that your provider will position near or against your head. Depending on the type of TMS being used, the coil may be inside a helmet you wear, or it may be attached to a flexible arm that holds it against the side or top of your head.

Putting on Hearing Protection

The TMS machine makes a loud clicking sound when it fires, so your provider will give you earplugs or headphones to wear throughout the session. Hearing protection is required for every session, and with it in place, lasting hearing changes are not expected.

Positioning the Coil

Your provider will carefully position the coil over the area of your head being targeted, based on the condition you’re being treated for. For depression and anxious depression, this is usually over the upper-left forehead. For OCD, the coil is typically positioned over the top-front of the head. Precise placement is important, and providers use anatomical landmarks — and sometimes neuro-navigation technology — to make sure the coil is in the right spot every session.

Calibrating the Settings

Before treatment begins, your provider will deliver a few test pulses to find the right strength for you. You may feel a tapping sensation on your scalp or notice a small twitch in your hand or thumb during these test pulses. This is completely normal — it helps your provider calibrate the machine to your individual brain and ensures the pulses are strong enough to be effective without being uncomfortable. This calibration is usually only done in detail during the first session and rechecked periodically thereafter.

The Treatment Itself

Once everything is set, the actual stimulation begins. The machine will deliver repeated magnetic pulses through the coil, and you’ll hear rapid clicking sounds and feel a light tapping sensation where the coil sits. The pulses are usually delivered in short bursts with brief pauses in between, so there are natural moments of rest throughout the session. You’ll stay fully awake and alert the entire time, and you can read, listen to music, watch something, or simply relax.

Wrapping Up

When the session ends, your provider will turn off the machine, move the coil away from your head, and remove your hearing protection. There’s no recovery period — you can stand up, gather your things, and head right back to your day.

How Long a Session Takes

Session length depends on the type of TMS being used:

• Standard rTMS sessions typically last 20 to 40 minutes
• Theta-burst (iTBS) sessions can be as short as three to ten minutes
• Deep TMS sessions usually run about 20 minutes
• Accelerated TMS protocols involve multiple short sessions in a single day, usually spaced an hour or so apart, over the course of about a week

A standard course of TMS is typically five days a week for about six weeks, though accelerated protocols can deliver a full course in roughly a week in specialized centers.

Types of TMS Treatments

Not all TMS is the same. While the underlying principle — using targeted magnetic pulses to stimulate specific brain circuits — is shared across approaches, several different protocols and devices have been developed over the years. The main differences come down to how the pulses are delivered, how long each session lasts, and how deeply the stimulation reaches into the brain. A TMS provider will recommend the type best suited to your condition, your history, and how your brain responds to treatment.

Repetitive TMS (rTMS)

This is the original and most widely used form of TMS, sometimes referred to as standard or conventional TMS. It delivers repeated magnetic pulses to the same area of the brain, with the pulse rate adjusted to either stimulate or quiet the targeted region depending on the condition being treated.

Sessions typically last 20 to 40 minutes and run five days a week for about six weeks. rTMS is FDA-cleared for depression, anxious depression, and OCD, and it’s the protocol with the longest track record of clinical use and research.

Theta-Burst Stimulation (TBS / iTBS)

Theta-burst stimulation is a newer, faster form of TMS that delivers magnetic pulses in very rapid bursts, modeled after the brain’s own natural rhythms. Because the pulses are packed into a much shorter window, sessions can take as little as three to ten minutes while delivering an effective treatment dose.

The most common form is intermittent theta-burst stimulation (iTBS), which is FDA-cleared for depression. For patients with busy schedules or those who find longer sessions tiring, iTBS can make a full course of TMS much easier to complete.

Deep TMS (dTMS)

Deep TMS uses a specially designed coil — often shaped like a helmet — that can reach slightly deeper into the brain than the figure-eight coil used in standard rTMS. This allows the magnetic pulses to influence brain circuits that sit a bit further beneath the skull’s surface. Deep TMS is FDA-cleared for depression and OCD, and one deep TMS protocol is also cleared as a short-term aid for smoking cessation. The most widely used deep TMS system is made by BrainsWay.

Accelerated TMS (aTMS)

Accelerated TMS compresses what would normally be six weeks of treatment into a much shorter timeframe by delivering multiple short sessions per day over the course of about a week. The best-known example is Stanford Neuromodulation Therapy (often called the SAINT protocol), an accelerated theta-burst approach delivered in specialized centers. In 2025, the FDA also cleared an accelerated deep TMS protocol for major depressive disorder. Accelerated TMS is especially appealing for patients who need faster results or who can’t commit to daily sessions over several weeks, though it’s currently offered at a limited number of centers.

How the Right Type Is Chosen

The right type of TMS depends on several factors: the condition being treated, your medical history, how urgently you need symptom relief, your schedule, and what’s available in your area. A TMS provider will walk you through the options and recommend the protocol most likely to help. If you’re considering TMS, our team can help you understand the differences, weigh the trade-offs, and connect you with a trusted TMS provider in our referral network.

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

Side Effects of TMS

One of the reasons TMS has become a popular option for treating depression, OCD, and related conditions is that it’s generally very well tolerated. Because the treatment is noninvasive and doesn’t involve medication entering the body, it avoids many of the side effects that patients often struggle with on antidepressants — things like weight gain, sexual side effects, fatigue, and emotional blunting.

That said, no treatment is completely free of side effects. Most side effects of TMS are mild, temporary, and tend to ease over the first one to two weeks of treatment as the brain adjusts.

Common Side Effects

The most common side effects patients experience during or after a TMS session include:

• Scalp discomfort or a tapping sensation at the treatment site, especially during the first few sessions
• Mild headache, usually relieved with over-the-counter pain relievers
• Tingling, twitching, or tightness in the facial muscles, jaw, or scalp during stimulation
• Lightheadedness immediately after a session
• Temporary fatigue

These effects typically lessen as treatment continues. If any side effect is bothersome, your provider can adjust the settings — including the intensity or coil position — to make sessions more comfortable.

Rare but Serious Side Effects

Serious side effects from TMS are uncommon, but it’s important to be aware of them:

• Seizures. The risk of a seizure during TMS is very low — well under 1 in 30,000 sessions — and is comparable to the seizure risk of many antidepressant medications. The risk is highest in people with a personal history of seizures, certain neurological conditions, or who take medications that lower the seizure threshold. We screen carefully for these risk factors before starting treatment.
• Hearing changes. The TMS device makes a loud clicking sound during stimulation. We provide earplugs at every session to protect your hearing, and with proper ear protection, lasting hearing changes are not expected.
• Mania. In people with undiagnosed bipolar disorder, TMS — like antidepressants — can occasionally trigger a manic episode. This is why a thorough psychiatric evaluation before starting treatment is essential.

What TMS Does Not Cause

Patients often ask about side effects associated with other treatments, so it’s worth being clear about what TMS does not involve:

• It does not cause memory loss or cognitive side effects.
• It does not require sedation or anesthesia.
• It does not cause weight gain, sexual side effects, or emotional numbing.
• It does not require any downtime — you can drive yourself home and return to work, school, or your normal activities right after each session.

When to Contact Your Provider

Most side effects can be managed easily, but you should reach out to your provider if you experience a severe or persistent headache, any change in your mood that feels sudden or extreme, or any unusual neurological symptoms. If you have a personal or family history of seizures, bipolar disorder, or any neurological condition, let your provider know before starting treatment so we can plan accordingly.

Why see a psychiatrist before starting TMS?

Searching “TMS therapy near me” will pull up local TMS centers, but it does not answer the most important question. Is TMS the right next step for you.

A psychiatric evaluation can help clarify whether your symptoms are due to major depression, bipolar depression, anxiety, OCD, ADHD, trauma, sleep problems, substance use, medication side effects, or a medical issue.

That matters because the best treatment depends on the correct diagnosis. Starting TMS for what looks like depression when the underlying issue is bipolar depression, untreated sleep apnea, or unrecognized trauma is unlikely to produce a good result.

TMS centers are focused on delivering TMS. They are generally not set up to manage medications, monitor for emerging or shifting symptoms during treatment, or adjust the overall plan if TMS is not working as hoped. A psychiatrist can do that coordination, which often improves outcomes for patients who do pursue TMS.

At Kolli Psychiatric & Associates, our providers offer psychiatric evaluations and ongoing medication management for patients across Monmouth County, Ocean County, and the broader New Jersey area via telehealth.

We do not provide TMS in our office, but we can help patients determine whether TMS is a reasonable next step, support coordination during treatment, and refer to trusted TMS providers when appropriate.

Trusted TMS referral options

We do not provide TMS therapy in our office. However, when TMS appears clinically appropriate, we refer patients to trusted local TMS providers based on location, insurance, and clinical fit. We continue to provide psychiatric care alongside treatment so that medication, therapy, and TMS work together rather than in isolation.

TMS Center of New Jersey

Shore TMS

Relief Mental Health

This list is provided as a resource and not as an endorsement of any single provider. We encourage patients to ask the questions listed earlier in this article during their consultation.

Considering TMS? Start with a psychiatric evaluation.

If a doctor has suggested TMS, or if you are wondering whether it might help, the best place to start is a psychiatric evaluation. Our providers can help you understand whether TMS is appropriate for your situation, how it would fit with medication management, and which local TMS provider may be the best fit.

Schedule a consultation with Kolli Psychiatric & Associates to discuss whether TMS, medication management, or another approach is the right next step for you.

External Resources

Cleveland Clinic

National Library of Medicine

Health Harvard