What Is Transcranial Magnetic Stimulation (TMS), and What Can It Treat?

If you have a mental health condition like depression and medication isn’t helping, you are not alone. Up to 30% of people with major depression struggle with refractory major depression. This is an ongoing and severe form of the disorder that does not get much better with therapy or medication.

The good news is that there is a treatment available called transcranial magnetic stimulation (TMS). It is safe, effective, and easy to go through. And it’s not just for depression. TMS is an FDA-approved treatment for:

• Obsessive-compulsive disorder (OCD)

• Major depressive disorder (MDD)

• Migraine headaches

• Smoking cessation (to help you stop smoking)

In this post, we will cover what TMS is, how it works, and what it can treat. We will also cover its benefits, risks, and success rates. Lastly, we will share what you can expect during treatment and how you can find a TMS provider.

How does TMS compare to electroconvulsive therapy (ECT)?

TMS is a type of brain stimulation therapy. You might be familiar with one other such therapy: electroconvulsive therapy (ECT). ECT can also treat refractory major depression, but it’s different from TMS. 

With ECT, healthcare providers use equipment to send an electrical current throughout your entire brain. This happens while you are under anesthesia and asleep. The electrical current causes a seizure and chemical changes in the brain to help improve mental health disorders. 

TMS is similar, but it uses magnets to target specific areas in your brain. The idea is that repeated, gentler electrical currents may be helpful for some people without creating a seizure throughout the entire brain.

TMS is easier than ECT because you can do it right in your provider’s office, and you do not have to be under anesthesia. TMS also has fewer side effects than ECT. 

How does TMS work?

Just like we don’t know entirely how antidepressant medication works, we don’t know exactly how TMS works. What scientists do know is that it helps brain cells communicate better with each other. 

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During a TMS treatment session, medical providers place a magnetic coil against your head, over a part of the brain involved in your symptoms. The magnet is a coil in the shape of a figure eight and is about 5 inches long. 

Your provider then turns on a machine that produces short electrical pulses. The pulses go from the coil magnet, through your skull, and into your brain. These electrical pulses activate, or excite, your brain cells. Experts believe that this makes it easier for cells to pass messages to each other.

What can TMS treat?

TMS can treat a number of mental and physical health conditions. There are two main types of TMS: deep TMS and repetitive TMS (rTMS). 

Deep TMS involves sending an electrical current in a few different parts of the brain at once. It has been shown to improve symptoms in some people with substance use disorders. 

rTMS targets a specific part of the brain that is involved in your symptoms. rTMS can treat:

• Major depressive disorder (MDD)

• OCD

• Schizophrenia

• Depressive symptoms associated with bipolar disorder

• Parkinson’s disease

• Stroke

• Migraine headaches

Often, your provider will discuss TMS with you if you’ve tried several medications and your symptoms aren’t getting better. In some cases, your provider may offer TMS earlier in your treatment process.

Dr. Umer Najib, a neurologist at Rockefeller Neuroscience Institute at West Virginia University, says that TMS can be used if you haven’t tried medication. However, most insurance companies only cover TMS if you have tried two to four medications and your symptoms did not improve. 

What are the risks and benefits of TMS for mental health conditions?

Overall, TMS is considered a safe procedure. The treatment is also quick and simple. You don’t need time to recover after each treatment, and you can go right back to your day.

One of the benefits of TMS is that it has a lower risk of short-term side effects. Common short-term side effects can include:

• Headache

• Discomfort on your head where the magnet is placed

• Brief lightheadedness

• Tingling or contractions in your scalp, jaw, or face muscles during the procedure

There are some possible severe side effects of TMS. However, these are very uncommon. These side effects include: 

• Seizures: Because of the very small possibility of seizures, TMS is not recommended if you have epilepsy or a history of seizures.

• Hearing impairment: TMS can lead to hearing issues, including hearing loss or ringing in your ears. Your provider may offer you ear plugs to wear during each TMS session.

• Mania: Mania is a symptom of bipolar disorder where you experience unusually high energy, mood, or agitation. TMS may trigger mania in people with bipolar disorder who were in a depressive episode before treatment. 

Let your provider know if you have metal or electrical implants in or near your head and neck. TMS uses magnets that may interact with these devices or implants. Your provider will also likely ask if you have any head or neck tattoos. Some types of tattoo ink can be magnetic. 

How successful is TMS?

Since TMS is a new treatment, research is ongoing to test how well it works for various conditions. What we do know is that it works really well for some people and certain health conditions.

TMS can help with major depression. More than half of people who get TMS have fewer depression symptoms after treatment. Depression may go into remission — where you have no symptoms — for more than one-third of those who have TMS.

TMS is also an effective treatment for OCD. Almost 75% of people who received TMS treatment for OCD had improvement in symptoms. One month later, more than half of that group still experienced improvement.

TMS also works well for treating migraine headaches. TMS treatment may cut the number of migraines in half. TMS may also reduce the severity of the headaches. 

What can you expect if you undergo TMS?

TMS is an outpatient procedure, meaning it happens in your provider’s office. You can drive yourself to and from your appointments. You can also go about your day like usual after treatment. A TMS treatment session typically lasts about 30 minutes. 

TMS treatment typically occurs every weekday, Monday through Friday. The length of time you will get TMS depends on your condition. For depression, Najib says that treatment typically lasts 6 weeks, for a total of 30 treatment sessions. 

Your provider may recommend ongoing maintenance TMS sessions based on your symptoms. Najib says maintanence TMS may require up to three treatments per week for depression. 

Your first TMS appointment

Here’s what you can expect at your first TMS appointment: 

• Prepare for treatment. Your first TMS appointment will include time for your provider to set up the equipment for you. This includes measuring your skull, determining what strength magnet to use, and where the magnet will be positioned on your head. 

• Get fitted for your cap. You’ll wear a light cap on your head for treatment, similar to a swimming cap. Your provider marks on the cap where they will place the magnet. 

• Find your motor threshold. Your provider will place a pulse — it feels like a quick tap — on your head to see when your thumb or toes twitch. This may sound weird, but it’s called your motor threshold. Your provider can’t see into your brain. So they look for these twitching clues to get the strength right. 

What to expect during TMS appointments

There are a few different types of machines that your provider may use for TMS. However, the general process will be similar. Often, a trained TMS tech will do your daily treatment with regular check-ins from your psychiatrist. 

Najib describes the process of daily TMS treatment in his clinic as:

1. Check in. Each day, your provider will ask if there were any changes to your sleep, medication, or substance use. All of these can affect your treatment.

2. Prepare for treatment. Once you sit down in the chair for TMS, your provider will place the cap on your head. They will also adjust the magnetic coil on your head so the pressure is firm but comfortable. The treatment chair may have a back or side headrest. This helps keep your head aligned with the coil while also keeping you relaxed and comfortable.

3. Protect your ears. The TMS machine pulses can be loud, especially since you will be close to the machine. To help prevent ringing in your ears or potential hearing issues, your provider may offer you earplugs each day. 

4. Receive the pulses. When treatment starts, you will feel a rapid tapping on your head under the magnetic coil, like a woodpecker pecking on your head. There are short breaks between tapping. For example, you may feel a series of taps for 4 seconds. Then, you have a 10-second pause, another series of taps over 4 seconds, and so on. 

If you are doing TMS for OCD, your provider will ask you to do a provocation right as treatment starts. A provocation is a thought or action that triggers anxiety and your OCD symptoms. For example, you might think about touching a public door handle or harming a loved one. Provocations help activate the brain pathways that TMS targets to treat OCD. 

Wear comfortable clothing to your appointments. You might want to bring a book with you, as you may be able to read or watch TV during treatment. 

Why trust our experts?

Written by:

Mona Bapat, PhD, HSPP

Mona Bapat, PhD, HSPP, has 15 years of clinical experience providing therapy. She is a licensed clinical psychologist in Indiana and Illinois with treatment experience in individual, couples, family, and group therapy modalities.

Edited by:

Renée Fabian, MA

Renée Fabian is the senior pet health editor at GoodRx. She’s worked for nearly 10 years as a journalist and editor across a wide range of health and well-being topics.

Reviewed by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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