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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Transcranial magnetic stimulation (TMS) is an effective treatment for major depression. Unlike psychotherapy or medication, TMS works by deploying magnetic fields to stimulate the brain. Despite its sci-fi-sounding name, transcranial magnetic stimulation is not a scary or invasive procedure. It’s also not the first option prescribed for treating depression, but when medications and psychotherapy fail, TMS can offer benefits.
What does transcranial magnetic stimulation do?
There are several types of psychotherapy, antidepressants, and other medications that lessen symptoms of depression for many people. But for some people, those approaches just don’t work. In such cases, transcranial magnetic stimulation provides a treatment option (Stern, 2018).
TMS has also been tested as a possible treatment for schizophrenia, attention deficit-hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD), but results on these three possibilities are as-yet not conclusive (Cole, 2015; Alyagon, 2020; Namgung, 2019; Cleveland Clinic, 2018).
Transcranial magnetic stimulation (TMS) uses magnetic fields, delivered from electromagnetic coils set near the forehead, to stimulate nerve cells in the brain. It targets areas of the brain thought to control our moods, specifically where activity decreases when we’re depressed (Mann, 2021).
The procedure is non-invasive and typically painless, with mild side effects (Trevino, 2011). A newer variation is called deep transcranial magnetic stimulation (dTMS), in which the magnetic pulses are administered through a helmet (Levkovitz, 2015).
Exactly how TMS works, biologically, is not fully understood. Repeated magnetic pulses, similar in strength to an MRI (magnetic resonance imaging) machine, appear to increase blood flow in the targeted areas and increase synapses’ plasticity (Rizvi, 2019). Synapses are the junction boxes between neurons, and their plasticity determines how effectively the neurons communicate, and thus the brain’s ability to adapt to new information (University of Queensland, n.d.).
Sometimes called rTMS, or repetitive transcranial magnetic stimulation, the procedure is prescribed by a physician and administered by a trained technician, typically under the physician’s supervision (Johns Hopkins Medicine, n.d.).
Treatment-resistant depression: what are my options?
Does TMS therapy work?
A person can be diagnosed with serious depression—formally major depressive disorder or persistent depressive disorder—if they experience ongoing sadness or depressed mood accompanied by one or more several other common symptoms. These can include losing interest in normal activities, poor sleep, and fatigue (American Psychiatric Association, DSM-5, 2013).
There’s evidence that repetitive transcranial magnetic stimulation can be a productive alternative for many people with depression who didn’t respond to other therapies and medicines.
One review found that at least 50% of people with severe depression saw some benefit from TMS, and around a third experienced remission. Other trials found that 30 to 40 percent of participants treated with TMS saw sustained improvement in depressive symptoms, similar to the success of antidepressants but without serious side effects (Rizvi, 2019).
Another review concluded the popularity of TMS is increasing, and a growing body of evidence supports its use for treating depression, alone or in conjunction with medications. (Somani, 2019).
The third review, in the journal BMC Psychiatry, found support for using transcranial magnetic stimulation to treat depression even in people who have not had extensive attempts with pharmacological treatments (Voigt, 2019).
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What to expect in a TMS therapy session
You’ll be awake during your TMS treatment, sitting in a chair. Here’s what happens (Mayo Clinic, 2018):
- A technician or doctor will place the electromagnetic coil next to your head and begin and make adjustments called mapping.
- The machine will make clicking sounds, and you’ll feel something like tapping on your forehead. Here’s the weird part: The intensity will be adjusted until your hand or fingers start to twitch—that’s when they know the right intensity level has been achieved.
- The formal treatment then involves about 40 minutes of ongoing pulses.
The full TMS treatment runs several days a week for four to six weeks. You’ll walk out after each session—no need to recover before resuming normal activities (Johns Hopkins Medicine, n.d.).
Mild side effects and serious precautions
Side effects are usually mild but can include seizures in people who have a history of them. You might experience light-headedness or even headaches, tingling in your face, and scalp pain that can be easily managed (Trevino, 2011; NAMI, n.d.).
TMS can be riskier for some people. For example, it should not be used on people with metal or electronic implants. But when patients are properly assessed and monitored, the procedure is considered safe (Taylor, 2018).
TMS should also not be used on someone whose depression is accompanied by psychosis or bipolar disorder, or if they’re at high risk of suicide (NAMI, n.d.).
Make sure your doctor knows if you have any history of seizures or brain injury, whether you are pregnant, and be detailed about any medical conditions you have or medications you take (Mayo Clinic, 2018).
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Other brain stimulation therapies
Perhaps you’ve heard of electroshock therapy, the treatment with the negative image dating back to the 1940s. That procedure has evolved notably into a useful treatment now called electroconvulsive therapy (ECT).
It involves passing electric currents through the brain while a person is sedated. ECT is also used to treat people with severe depression who don’t respond to medication, but typically when they also have psychosis or bipolar disorder (NAMI, n.d.).
Transcranial magnetic stimulation (TMS) is nothing like ECT.
There are other brain stimulation therapies used for depression (NAMI, n.d.):
Vagus nerve stimulation (VNS) can also treat depression, but it involves an invasive procedure. A stopwatch-sized device is inserted in the chest to stimulate the vagus nerve, which carries sensory and motor instructions and information to and from the brain (U.S. Centers for Medicare & Medicaid Services).
Any brain-stimulation therapy is considered only after a diagnosis. So if you think you might benefit from transcranial magnetic stimulation, seek advice from a healthcare professional on your condition and the many treatment options. Oh, and as with any mental health treatments, check with your health insurance provider before choosing a path—many companies do not cover TMS therapy (Johns Hopkins Medicine, n.d.).
- Alyagon U, Shahar H, Hadar A, Barnea-Ygael N, Lazarovits A, Shalev H, Zangen A. (2020). Alleviation of ADHD symptoms by non-invasive right prefrontal stimulation is correlated with EEG activity. NeuroImage Clinical; 26:102206. doi: 10.1016/j.nicl.2020.102206. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32062566/
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013. Summarized at https://www.psychiatry.org/patients-families/depression/what-is-depression
Cleveland Clinic. (2018). Transcranial magnetic stimulation (TMS). Retrieved from https://my.clevelandclinic.org/health/treatments/17827-transcranial-magnetic-stimulation-tms
Cole JC, Green Bernacki C, Helmer A, Pinninti N, O’reardon JP. (2015). Efficacy of transcranial magnetic stimulation (TMS) in the treatment of schizophrenia: A review of the literature to date. Innovations in Clinical Neuroscience; 12(7-8):12-9. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26351619/
Johns Hopkins Medicine. (n.d.). Frequently asked questions about TMS. Retrieved from https://www.hopkinsmedicine.org/psychiatry/specialty_areas/brain_stimulation/tms/faq_tms.html
Levkovitz Y, Isserles M, Padberg F, Lisanby SH, Bystritsky A, Xia G, et al. (2015). Efficacy and safety of deep transcranial magnetic stimulation for major depression: a prospective multicenter randomized controlled trial. World Psychiatry; 14(1):64-73. doi: 10.1002/wps.20199. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25655160/
Mayo Clinic. (2018). Transcranial magnetic stimulation. Retrieved from https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625
Mann SK, Malhi NK. (2021). Repetitive transcranial magnetic stimulation. [Updated 2021 Mar 6]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK568715/
Namgung E, Kim M, Yoon S. (2019). Repetitive transcranial magnetic stimulation in trauma-related conditions. Neuropsychiatric Disease and Treatment; 15:701-712. doi:10.2147/NDT.S189498. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6430993/
National Alliance on Mental Illness (NAMI). (n.d.). ECT, TMS and other brain stimulation therapies. Retrieved from https://www.nami.org/About-Mental-Illness/Treatments/ECT-TMS-and-Other-Brain-Stimulation-Therapies
Rizvi S, Khan AM. (2019). Use of transcranial magnetic stimulation for depression. Cureus; 11(5):e4736. doi: 10.7759/cureus.4736. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6649915/
Somani A, Kar SK. (2019). Efficacy of repetitive transcranial magnetic stimulation in treatment-resistant depression: the evidence thus far. General Psychiatry; 32(4):e100074. doi:10.1136/gpsych-2019-100074. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6738665/
Stern, A. (2018). Transcranial magnetic stimulation (TMS): Hope for stubborn depression. Harvard Health Blog. Retrieved from https://www.health.harvard.edu/blog/transcranial-magnetic-stimulation-for-depression-2018022313335
Taylor R, Galvez V, Loo C. (2018). Transcranial magnetic stimulation (TMS) safety: a practical guide for psychiatrists. Australas Psychiatry; 26(2):189-192. doi: 10.1177/1039856217748249. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29338288/
Trevino, K., McClintock, S. M., & Husain, M. M. (2011). The use of topical lidocaine to reduce pain during repetitive transcranial magnetic stimulation for the treatment of depression. The Journal of ECT, 27(1), 44–47. doi: 10.1097/YCT.0b013e3181f5581c. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21233765/
University of Queensland, Queensland Brain Institute. (n.d.). What is synaptic plasticity? Retrieved from https://qbi.uq.edu.au/brain-basics/brain/brain-physiology/what-synaptic-plasticity
U.S. Centers for Medicare & Medicaid Services. (2020). Vagus nerve stimulation (VNS) for treatment resistant depression (TRD). Retrieved from https://www.cms.gov/Medicare/Coverage/Coverage-with-Evidence-Development/VNS
Voigt, J., Carpenter, L. & Leuchter, A. (2019). A systematic literature review of the clinical efficacy of repetitive transcranial magnetic stimulation (rTMS) in non-treatment resistant patients with major depressive disorder. BMC Psychiatry 19, 13. doi: 10.1186/s12888-018-1989-z. Retrieved from https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-018-1989-z
Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.