TMS. How electromagnetic brain stimulation went from experimental to FDA-cleared and might actually work better than your antidepressants
Imagine if you could treat depression by literally pointing a magnetic wand at someone’s head for 20 minutes a day. No pills. No side effects beyond mild scalp discomfort. No anesthesia. Just… magnets.
Sounds like pseudoscience, right? Like something you’d find on a late-night infomercial between copper bracelets and alkaline water. Except this time, it’s real, it’s FDA-cleared, it works, and Medicare will pay for it.
Welcome to Transcranial Magnetic Stimulation (TMS), the treatment that makes psychiatrists sound like they’re describing science fiction but is actually backed by decades of rigorous research and thousands of successful treatments.
Transcranial Magnetic Stimulation is a noninvasive treatment that uses a magnetic field to influence brain activity. It can treat depression, obsessive-compulsive disorder and other brain-related conditions when other treatment approaches aren’t effective.
Here’s how it works: An electromagnetic coil placed on varying areas of the scalp generates magnetic pulses and stimulates different brain areas to create the desired pathophysiologic and clinical outcome. The magnetic field passes painlessly through your skull and induces small electrical currents in your brain tissue, activating neurons in targeted regions—primarily the dorsolateral prefrontal cortex (DLPFC), which is underactive in people with depression.
Think of it as recharging your brain’s battery, except instead of plugging it in, you’re using electromagnets. It’s like jump-starting a car, but the car is your prefrontal cortex and the jumper cables are… actually pretty sophisticated medical equipment.
The procedure is completely noninvasive. No surgery. No holes drilled in your skull. No electrodes implanted. You sit in a chair, a magnetic coil gets positioned near your forehead, and for 20-40 minutes, you hear loud clicking sounds while magnetic pulses stimulate your brain. Then you go about your day. No recovery time. No cognitive fog. No memory loss.
It’s so noninvasive that the biggest inconvenience is remembering to bring earplugs.
TMS wasn’t always mainstream. The first study on the therapeutic use of rTMS in psychiatry was published in 1995, involving patients with medication-resistant depression. Back then, it was experimental. Controversial. The kind of thing that made people ask “wait, are we sure we’re not just giving people fancy placebo treatments?”
Then the evidence started piling up.
In 2008, the FDA cleared the first rTMS protocol to treat depression, which consisted of high-frequency (10 Hz) rTMS delivered over the left-dorsolateral prefrontal cortex (L-DLPFC) for just under 38 minutes per session, with a stimulation intensity of 120% of the resting motor threshold, across 30 sessions (5 days a week for 6 weeks). In the study leading to this decision, 301 medication-free patients diagnosed with treatment-resistant depression were randomized to sham or active TMS groups, with response rates significantly superior in the active group.
Since then, the FDA clearances have multiplied:
As of 2025, TMS is no longer experimental. It’s standard of care for treatment-resistant depression, covered by Medicare and most major insurance companies, with over 6.1 million treatments delivered.
Let’s cut through the marketing hype and look at the numbers.
For depression, the success rates vary by study but generally fall in the 50-60% response rate range (defined as at least 50% reduction in depression symptoms) and 30-40% remission rate (essentially symptom-free). Among the 1,169 adolescents treated with NeuroStar and tracked through their TrakStar platform, 78% achieved clinically meaningful improvement in their depression severity.
Compare that to antidepressants, which have response rates around 40-60% and remission rates around 30%, and TMS starts looking pretty competitive. Especially when you consider that TMS is typically used for treatment-resistant depression—people who’ve already failed multiple medication trials.
The accelerated SAINT protocol (Stanford Accelerated Intelligent Neuromodulation Therapy) showed particularly impressive results. In a randomized controlled trial, participants who received SAINT experienced on average a 62% reduction in their Montgomery-Åsberg Depression Rating Scale (MADRS) scores following just five days of stimulation, compared to minimal improvement in the sham group.
62% reduction in depression scores. In five days.
That’s not a typo. Traditional TMS takes 6 weeks. SAINT does it in less than a week using functional MRI to map out an individual’s brain connectivity to identify the optimal anatomic region for stimulation, then delivers multiple short TMS sessions every day for five days.
For OCD, the data is also promising, though perhaps less dramatic than for depression. TMS targets different brain regions for OCD (typically the supplementary motor area or orbitofrontal cortex) and shows meaningful symptom reduction in patients who haven’t responded to medications or therapy.
Here’s where TMS really shines compared to other psychiatric treatments: the side effects are minimal and the serious risks are extraordinarily rare.
The safety profile of TMS is excellent. There are common side effects, but they tend to be minor and easily managed. The most common side effects include:
These side effects are usually mild and only last a few minutes. Most people return to their usual activities immediately after a session.
The most serious known side effect of TMS is seizure. But let’s put this in perspective: your risk of having a seizure from TMS is less than 0.01% for each session—less than 1 in 10,000.
In a 2018 study, only 18 seizures occurred out of 586,656 TMS sessions, for a seizure rate of only 0.31% per 10,000 sessions. Seizures are extremely rare, typically involve a single isolated event lasting less than a minute, and have no adverse sequelae. Patients who have experienced TMS-induced seizures have all been discharged to outpatient care after emergency evaluation.
For context, your risk of seizure from TMS is significantly lower than your risk of seizure from certain antidepressant and antipsychotic medications. Bupropion (Wellbutrin), a commonly prescribed antidepressant, has a seizure risk of approximately 0.1-0.4%—roughly 10-40 times higher than TMS.
TMS is contraindicated if you have:
But for healthy patients or those with depression alone, TMS is remarkably safe. Safer than ECT (electroconvulsive therapy), which requires anesthesia and causes memory loss. Safer than most psychiatric medications when you account for metabolic effects, sexual dysfunction, weight gain, and discontinuation syndromes.
People often confuse TMS with electroconvulsive therapy (ECT), but they’re completely different animals.
ECT:
TMS:
ECT is more effective, but TMS is safer and more tolerable. TMS often functions as a middle-ground option: more effective than medications alone, less intensive than ECT, appropriate for patients who’ve failed medications but aren’t candidates for or don’t want ECT.
As one researcher put it: TMS may present a second option after pharmacotherapy, but before initiating ECT.
Traditional TMS protocols require commitment. You show up to a clinic 5 days a week for 6 weeks—that’s 30 sessions. Each session lasts 20-40 minutes (depending on the protocol). You can drive yourself there and back. No recovery time. But it’s still a significant time investment.
The typical FDA-cleared protocols include:
Standard High-Frequency Protocol:
Theta-Burst Stimulation (TBS):
Accelerated TMS (SAINT Protocol):
Low-Frequency Protocol:
The emergence of accelerated protocols is a game-changer. Instead of disrupting your life for 6 weeks, you take one week off and complete the entire treatment course. For people who are hospitalized, experiencing acute suicidal ideation, or simply can’t commit to 6 weeks of daily appointments, accelerated TMS expands access significantly.
Here’s the question everyone wants answered: how much does this cost, and will insurance pay for it?
Without Insurance:
That’s… not cheap. But before you panic:
With Insurance: Most major insurance companies now cover TMS for treatment-resistant depression, including:
Medicare Coverage Requirements: To qualify for Medicare coverage of TMS, you must:
Medicare covers 80% of approved TMS costs. You’re responsible for:
With secondary insurance, many patients pay little to nothing out-of-pocket.
Private Insurance Requirements (typically):
Some insurance companies are stricter than others, but most major carriers recognize TMS as medically necessary for treatment-resistant depression. Coverage is expanding to include OCD and other conditions as the FDA clearances grow.
TMS isn’t first-line treatment. You don’t walk into a psychiatrist’s office with mild depression and get prescribed TMS. It’s for people who’ve tried other options and haven’t gotten better.
Good candidates:
Poor candidates:
While depression remains TMS’s primary FDA-cleared indication, researchers are exploring numerous other applications:
Currently Being Studied:
The challenge with off-label TMS is that insurance won’t cover it. So while your psychiatrist might believe TMS could help your PTSD, unless you can pay $15,000 out-of-pocket, you’re probably not getting it approved.
As more studies demonstrate efficacy and FDA clearances expand, coverage will likely follow.
TMS is one of the most significant advances in psychiatric treatment in the past two decades. It’s safe, effective, and increasingly accessible. For people with treatment-resistant depression who’ve cycled through multiple medications without relief, TMS offers a legitimate alternative that doesn’t involve swallowing pills or risking significant side effects.
The evidence is solid:
The limitations are real:
If you’ve been on four different antidepressants, endured the weight gain, sexual dysfunction, emotional blunting, and still feel like shit—TMS might be worth investigating. If you’re pregnant and can’t take medications but your depression is severe—TMS could be an option. If you’re a teenager who’s failed two medication trials and your parents are desperate for alternatives—TMS is now FDA-cleared for you.
But TMS isn’t magic. It’s medicine. Evidence-based, FDA-cleared, Medicare-covered medicine that happens to use electromagnets instead of chemicals. Some people get dramatically better. Some people get moderately better. Some people don’t respond at all.
The good news is that if you’re a candidate, insurance will likely cover most of the cost, the side effects are minimal, and you can continue your regular life throughout treatment. Unlike ECT, you won’t lose your memories. Unlike antidepressants, you won’t lose your libido. Unlike electrodes implanted in your brain (an actual thing called deep brain stimulation), nobody’s drilling holes in your skull.
You’ll just sit in a chair for 20 minutes a day while a machine that sounds like a woodpecker hammers electromagnetic pulses into your prefrontal cortex, hopefully convincing your neurons to start functioning like they’re supposed to.
And honestly? For treatment-resistant depression, that’s not a bad deal.
Just remember to bring earplugs. Those magnetic pulses are loud.
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