Frequently Asked Questions
About TMS
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TMS utilizes magnetic pulses to treat depression, anxiety, OCD, and other mood disorders. TMS stands for Transcranial Magnetic Stimulation, so it uses magnets, it is NOT electricity like ECT! These magnetic pulses gently stimulate a specific area of the brain that has stopped working properly in individuals with depression symptoms. If you’re depressed, areas of your brain don’t function the way they should. The communication, using neurotransmitters, is just not active enough. TMS therapy encourages the brain to stimulate electrochemical signaling, which is how different parts of the brain communicate with each other. Notice how little brain activity you have when you’re depressed?
At CalTMS, a typical TMS session lasts approximately 20 minutes. The sessions continue for five days a week over a duration of four to six weeks. Occasionally, a two-week tapering period may follow, consisting of just a few sessions a week.
Yes. TMS is an FDA-approved treatment, which means it’s completely safe to administer to patients. It’s also noninvasive and virtually pain-free.
To date, there is no evidence that TMS causes any kind of long-term damage to the brain. TMS does carry a very minor risk of seizure during treatment, specifically less than 0.1%. This risk seems to be more associated with those who are already at risk of seizure, whether due to a medication, a chronic condition such as epilepsy, or secondary to drug and alcohol use.
Yes, a person can have additional courses of TMS. In fact, patients who respond well to TMS initially are more likely to continue to respond positively to TMS if needed again in the future.
Yes, there is a lot of data to support the benefits of TMS for anxiety. There is a separate treatment protocol for anxiety, though it is not FDA-approved at this time. However, it is approved for Anxious Depression Use.
It is very unlikely for TMS to worsen symptoms, but there is a remote possibility for some patients that their symptoms can seem to get worse before they get better. This is commonly referred to as a “Dip” This is usually short-lived lived only lasting 5-7 days and typically self-resolving.
Yes, deep TMS has the FDA approval as a treatment for OCD. Currently, only deep TMS has FDA approval for its use in treating OCD, but there is currently no ‘cure” for OCD, but it can be minimized by treating the symptoms.
Yes, TMS has been used off-label to help treat PTSD, but it should always be used in conjunction with trauma therapy to prevent exacerbation of memories that can trigger symptoms.
83% of people experience improvements, and 62% achieve complete remission from their depression.
Training is provided by manufacturers of the device, as well as ongoing support. Many medical centers offer advanced courses on the treatment.
Patients who have failed to respond to antidepressants or psychotherapy are the ideal candidates for TMS. People who are not a good fit for TMS are those with metallic implants in ears or eyes, stents in the neck or brain, and other metal devices implanted in or near the head should refrain from undergoing TMS therapy.
It is very unlikely for TMS to ever cause anxiety; in fact, it is used to treat anxiety off-label. However, there is a remote possibility for TMS to unmask anxiety symptoms that were underlying a severe depression.
No, in fact, recent studies have shown TMS, when targeted at the Parietal lobe, can help with age-related memory loss as well as possible Alzheimer’s dementia-related memory loss.
TMS is currently under investigation for its use in treating Bipolar disorder. It is currently not FDA-approved for Bipolar Depression, but the ongoing studies are showing some positive results.
Yes, mild fatigue is not uncommon after the first few treatments of TMS, as it is like a “workout” for the brain. However, for many patients, this is a very welcomed effect and can be a benefit for many patients who experience insomnia due to their depression.
TMS can cause scalp tenderness during the treatment pulses, but typically does not cause a lasting headache. For patients who are prone to headaches, they can premedicate with ibuprofen or acetaminophen prior to treatments to prevent a headache.
TMS can be used to help enhance cognition, which can improve one’s ability to learn new information.
Depression is considered in terms of “remission” and” recurrence.” TMS can put depression into remission for an extended period of time, but there is a possibility that, depending on the nature of the patient’s depression, symptoms can recur down the road. If this does occur, then patients are even more likely to respond positively to repeated TMS treatments.
The basic answer to this question is that the time to respond to TMS therapy varies. Patients can see improvement in their depression symptoms at any time within the first third, middle third or end, and even as far out as 34 weeks. It is highly recommended that patients complete the TMS course to give them the best chance possible of achieving optimal results from the treatment.
How much do the benefits outweigh the disadvantages when it comes to TMS and depression medications?
Pros & Cons of Medications
- Covered by almost all insurance plans
- Taken every day without requiring a daily office visit
- Systemic side effects
- Severe withdrawal when stopped
Pros & Cons of TMS
- Covered by almost all insurance plans
- Daily treatment for 30 consecutive treatments (Followed by Taper)
- No systemic side effects
- No withdrawal when treatment ends
As you can see, both medications and TMS have their own set of pros and cons.
Both medications and TMS are covered by almost all insurance plans; however, currently, insurance companies require some type of attempt to try medication before TMS can be approved and covered.
Treatment-resistant depression (TRD) generally means depression has not improved enough after trying at least two antidepressant treatments at an appropriate dose and length of time. (nimh.nih.gov)
If this happens, it does not mean there are no options left. Treatments such as TMS, medication changes, psychotherapy, esketamine, or other approaches may be considered depending on your needs.
TMS does not usually work after just one treatment.
Some people begin noticing improvement during the first few weeks, while others improve later in the treatment course. The timing varies from person to person.
Your symptoms should be monitored throughout treatment so your clinician can evaluate your progress. (nimh.nih.gov)
There is no single answer.
Some people maintain improvement after completing treatment, while depression symptoms may return for others.
Ongoing medication, therapy, follow-up care, or additional TMS may be considered depending on your symptoms and individual treatment plan.
TMS is generally well tolerated. The most common side effects are usually mild and temporary and may include:
- Headache
- Scalp discomfort
- Tingling or muscle movement around the face or scalp
- Brief lightheadedness
These effects often become less noticeable as treatment continues. (nimh.nih.gov)
A seizure is a rare but serious risk depending on your medical history, medications, and other factors. If you are at risk, your clinician will recommend other treatment options.
Many insurance plans cover TMS for major depressive disorder when certain medical criteria are met.
Coverage depends on your insurance plan, diagnosis, and treatments you have already tried. Medicare coverage requirements can also vary by Medicare contractor and clinical circumstances. (cms.gov)
TRICARE covers outpatient TMS for adults with major depressive disorder. (tricare.mil)
Our team can help verify your benefits and complete authorization paperwork.
Antidepressants are medications that circulate throughout the body.
TMS works differently. It uses magnetic pulses to stimulate specific areas of the brain involved in depression. (nimh.nih.gov)
TMS may be considered when medication has not helped enough or has caused difficult side effects. Neither treatment is best for everyone.
Often, yes.
TMS may be used along with medication and psychotherapy. However, your clinician should review all medications before treatment because some medicines can affect TMS safety or seizure risk. (nimh.nih.gov)
Do not stop or change your medication unless your healthcare provider recommends it.
For most people, yes.
TMS does not require anesthesia or sedation. Patients are generally able to drive themselves and return to work and normal activities after treatment. (va.gov)
Your clinician may give you different instructions based on your individual medical situation.
Both may be options for certain people with depression, but they are very different treatments.
TMS uses magnetic pulses to stimulate areas of the brain. It does not involve medication or sedation.
Spravato (esketamine) is a prescription nasal spray given in a certified healthcare setting. Patients must be monitored after treatment because of risks including sedation, dissociation, and changes in blood pressure. Patients should not drive until the following day after a restful sleep. (fda.gov)
Which treatment is more appropriate depends on your symptoms, medical history, previous treatments, and personal needs.
TMS and electroconvulsive therapy (ECT) are both brain-stimulation treatments, but they are very different.
TMS uses magnetic pulses and does not require anesthesia or intentionally cause a seizure.
ECT is performed under anesthesia and uses an electrical current to produce a controlled seizure. ECT is an important and highly effective treatment for some severe psychiatric illnesses, but it can cause memory-related side effects. (nimh.nih.gov)
Your clinician can help determine which treatment is appropriate for your situation.
Most people describe TMS as a tapping or clicking sensation on the scalp.
Some people have scalp discomfort or a headache, particularly early in treatment. These effects are usually mild and temporary and often become easier to tolerate as treatment continues. (nimh.nih.gov)
If treatment is uncomfortable, tell your TMS team. Adjustments may sometimes help.
Traditional TMS treatment works through repeated stimulation over a series of sessions, rather than one treatment.
Many standard TMS protocols are given five days a week for several weeks. Other TMS protocols may use different schedules or shorter treatment sessions. (nimh.nih.gov)
Your treatment schedule depends on the type of TMS prescribed for you.
TMS does not work for everyone.
Your symptoms should be monitored throughout treatment. If you are not improving enough, your clinician can review your treatment and discuss other options.
These may include medication changes, psychotherapy, Spravato or other treatments, depending on your diagnosis and medical needs.
Not responding to one treatment does not mean you are out of treatment options.
Yes. Depression can return after any successful depression treatment, including TMS.
If symptoms return, your clinician can reassess you and discuss the next step. This may include medication, therapy, additional TMS, or another treatment.
Having a follow-up plan is an important part of depression care.
Yes. TMS is used within the Department of Veterans Affairs to treat depression, including depression that has not improved enough with previous treatments. (va.gov)
TRICARE also covers outpatient TMS for adults with major depressive disorder, subject to eligibility and coverage requirements. (tricare.mil)
If you are a Veteran, active-duty service member, retiree, or eligible family member, our team can help you review your treatment and insurance options.
It’s not you, it’s the brain.
Depression is often linked to reduced activity in a specific brain region known as the left dorsolateral prefrontal cortex, which is located in the front-left part of the brain. This area plays a key role in mood regulation, decision-making, and attention.
When the left dorsolateral prefrontal cortex functions properly, it helps activate other regions of the brain, leading to a more balanced mood, improved focus, and stronger working memory.
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