Finishing a TMS course is a milestone, not a finish line. Depression is often a recurring illness, and the research on TMS shows that benefit lasts for many people but fades for some. A written relapse-prevention plan, made while you feel well, is the most practical thing you can do in the weeks after your last session.
This page covers what the studies say about how long results last, the early warning signs worth watching, how medication and therapy fit afterward, what happens if symptoms return, and a plan template you can fill in with your psychiatrist.
How long do TMS results last?
There is no single answer, and anyone who promises permanent results is overstating the evidence. Two lines of research give a reasonable range.
- A 2019 meta-analysis by Senova and colleagues pooled studies of people who responded to an initial TMS course. Response was still present in 66.5% at three months, 52.9% at six months and 46.3% at twelve months.
- A one-year naturalistic study by Dunner and colleagues (2014) followed 120 people who had responded or remitted; 75 of them (62.5%) continued to meet response criteria throughout follow-up. They stayed on antidepressants, and TMS could be reintroduced if symptoms returned. The study was sponsored by the device maker.
Put together, roughly half to about six in ten initial responders were still doing well at one year in these studies. In Senova's analysis, people who received some form of maintenance treatment tended to do better. For a closer look at the durability data, see the physician-level review of how long TMS results last.
Why depression can come back
Relapse after TMS is not a sign that you did something wrong. Depression often recurs regardless of which treatment brought relief. In the large STAR*D medication study, people who needed more treatment steps to get well had higher relapse rates afterward. Many people who reach TMS have already tried several medications, so planning for the possibility of recurrence is simply realistic.
Common triggers people describe include major stress, disrupted sleep, illness, alcohol, seasonal changes and stopping a medication too quickly. None of these guarantees a relapse, and your own pattern matters most. Look back at what preceded past episodes; that history is the best guide to what you should watch.
Early warning signs to watch
Relapse often builds gradually rather than arriving overnight. Small changes are easier to address than a full episode. Signs people often notice first:
- Sleep shifting: waking early, sleeping far more, or lying awake ruminating
- Pulling back from people, texts left unanswered, plans canceled
- Losing interest in things that recently felt good again
- Low energy or a heavy feeling that lasts most of the day
- More self-critical thoughts, irritability, or hopelessness
- A rising score on the questionnaire you used during treatment
The last one is the most objective. If you tracked a PHQ-9 during TMS, keep taking it every week or two for a few months. The guide to tracking progress with the PHQ-9 explains the score bands. Agree with your psychiatrist on a number that means "call now," so you are not deciding in the moment.
Some changes need same-day attention: thoughts of death or suicide, not being able to get out of bed for several days, or unusually elevated mood with little sleep. If you are thinking about suicide or are in crisis, call or text 988 (the 988 Suicide & Crisis Lifeline) or go to the nearest emergency room.
The first three months after your last session
The weeks right after a course are a transition. You go from daily appointments and steady contact with a clinical team to ordinary life, and that change alone can feel unsettling. A simple structure helps.
- Week 1 to 2: Book a follow-up with your psychiatrist before the course ends, so there is no gap. Use the time you used to spend traveling to sessions for something restorative, such as a walk or a standing call with a friend.
- Month 1: Keep taking your rating-scale questionnaire on a fixed day. Compare it with your final treatment score rather than with how you felt before TMS.
- Months 2 to 3: Review the plan below with your psychiatrist. Decide together whether anything about medication, therapy frequency, or monitoring should change.
Expect ordinary ups and downs. One hard week after a stressful event is not the same as a relapse. A pattern of several warning signs lasting more than a week or two, or a questionnaire score that keeps climbing, is the signal to call. If you are unsure, call anyway; a short check-in costs little and can prevent a longer setback.
It also helps to decide in advance who you will tell. Partners and close friends often notice withdrawal or irritability before you do. Giving one person permission to say "you seem off lately" turns them into an early-warning system rather than a worried bystander.
Medication and therapy after the course
There is no single best strategy for staying well after a course. A 2018 consensus statement says there is "no 1 recommended maintenance antidepressant strategy" after a successful TMS course and lists repeat TMS, medication and psychotherapy among the options.
Medication. In the Dunner study, participants stayed on antidepressants during follow-up. If you would like to reduce or stop a medication after TMS, plan it with your prescriber and do not change doses on your own. A slow, monitored taper with a clear plan for what to do if symptoms return is safer than an abrupt stop. This guide to getting off psychiatric medications safely covers the general principles.
Therapy. Therapy teaches skills you keep after sessions end: spotting thinking traps, scheduling rewarding activity, and handling stress before it snowballs. How therapy helps prevent relapse and behavioral activation are good starting points, and TMS and talk therapy together covers how the two fit during a course.
Maintenance TMS: what is known
Maintenance or "booster" sessions are scheduled TMS sessions after the main course, given before symptoms return. The research is promising but thin. The 2025 consensus review says maintenance is "promising although the frequency of maintenance treatments needed to sustain benefit is unclear," and that monthly single sessions may not be useful. CANMAT 2023 rates the evidence for TMS maintenance at Level 3, compared with Level 1 for the acute course.
Coverage is the practical barrier. Medicare's New York policy states that maintenance therapy is "not reasonable and necessary," and Cigna and Optum also exclude it. Because of this, many clinicians treat acutely, monitor closely, and retreat if needed. Schedules, costs and who might benefit are covered in detail in TMS maintenance and booster sessions.
If symptoms come back: retreatment
A return of symptoms does not mean starting from zero. The Clinical TMS Society recommends that if relapse occurs in someone who benefited from a course, TMS "should be reintroduced until remission is re-achieved." In a 2026 multisite study of people who had a second course, 82.5% of prior responders responded again, and response came earlier in the second course. That study was retrospective, so treat it as encouraging rather than definitive.
Insurers usually cover a repeat course only if the first one clearly worked. Medicare in New York looks for more than 50% improvement on a standard rating scale in the earlier course. Aetna looks for at least a 50% reduction in symptoms that lasted at least two months, and does not consider a repeat course within 60 days of the last one medically necessary. Keeping your final scores and dates makes this much easier later.
If a course did not help in the first place, the options are different; what if TMS does not work? covers them.
Daily habits that support staying well
No lifestyle habit has been shown to make TMS results last longer, and it would be misleading to claim one does. Habits matter because they support mood generally and because changes in them are often early signals. Regular sleep and wake times, physical activity you can sustain, limited alcohol, and steady social contact are reasonable foundations. The site's guide to insomnia and depression is worth reading if sleep is your weak spot, and supporting TMS with sleep, movement and nutrition sorts the evidence honestly.
Your written relapse-prevention plan
Fill this in with your psychiatrist near the end of your course and give a copy to someone you trust. Supporting a loved one through TMS has suggestions for the people around you.
| Section | What to write |
|---|---|
| My final scores | Starting and ending PHQ-9 (or other scale), with dates |
| My early warning signs | Three to five personal signs, such as sleep changes or withdrawing from friends |
| My triggers | Situations that preceded past episodes |
| Check-in rhythm | How often I take the questionnaire and see my psychiatrist |
| Action threshold | The score or sign that means I call within a week |
| Ongoing treatment | Medications, therapy, and any maintenance plan agreed on |
| Retreatment notes | Device and protocol used, number of sessions, and how I responded |
| Contacts | Psychiatrist, therapist, a trusted person, and 988 |
Review the plan at each follow-up and update it if anything changes. For more on every stage of treatment, return to the TMS guide, or see the TMS therapy page for how to reach the team about follow-up care.
Sources
- Durability of antidepressant response to repetitive transcranial magnetic stimulation: Systematic review and meta-analysis. Brain Stimulation, 2019. pubmed.ncbi.nlm.nih.gov
- A multisite, naturalistic, observational study of transcranial magnetic stimulation for patients with pharmacoresistant major depressive disorder: durability of benefit over a 1-year follow-up period. Journal of Clinical Psychiatry, 2014. pubmed.ncbi.nlm.nih.gov
- Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. American Journal of Psychiatry, 2006. pubmed.ncbi.nlm.nih.gov
- Consensus Recommendations for the Clinical Application of Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Depression. Journal of Clinical Psychiatry, 2018. pmc.ncbi.nlm.nih.gov
- Consensus review and considerations on TMS to treat depression: A comprehensive update endorsed by the National Network of Depression Centers, the Clinical TMS Society, and the International Federation of Clinical Neurophysiology. Clinical Neurophysiology, 2025. tmslab.org
- Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults. Canadian Journal of Psychiatry, 2024. pmc.ncbi.nlm.nih.gov
- The Clinical TMS Society Consensus Review and Treatment Recommendations for TMS Therapy for Major Depressive Disorder. Brain Stimulation, 2016. pmc.ncbi.nlm.nih.gov
- Transcranial Magnetic Stimulation Retreatment for Recurrent Depression: A Large Real-World Multisite Cohort Study. Acta Psychiatrica Scandinavica, 2026. pubmed.ncbi.nlm.nih.gov
- LCD L33398 Transcranial Magnetic Stimulation (version 40). Wellpoint Federal via CMS Medicare Coverage Database, 2026. cms.gov
- Transcranial Magnetic Stimulation (Coverage Policy EN0383). Evernorth Health Services (Cigna), 2026. a.static.cigna.com
- Behavioral Clinical Policy: Transcranial Magnetic Stimulation (BH803TMS112025). Optum Behavioral Health Solutions, 2026. providerexpress.com
- Transcranial Magnetic Stimulation and Cranial Electrical Stimulation (Clinical Policy Bulletin 0469). Aetna, 2026. aetna.com
FAQs
Is TMS a permanent fix for depression?
No treatment for depression can promise that. In studies, roughly half to about six in ten people who responded to TMS were still doing well a year later, and many who relapsed improved again with another course.
How soon after TMS can depression come back?
It varies. Some people stay well for a long time; others notice signs within months. Regular check-ins with a rating scale help catch changes early.
Should I stop my antidepressant after TMS works?
Only with your prescriber. In the one-year follow-up study by Dunner and colleagues, participants stayed on antidepressants. Any change should be gradual and planned, with a clear step to take if symptoms return.
Will insurance pay for a second course of TMS?
Often, if the first course clearly helped and enough time has passed, but rules differ by plan. See does insurance cover TMS?
What records should I keep after finishing TMS?
Your starting and final scale scores, dates of the course, the number of sessions, and the device and protocol used. These help both your care and any future insurance request.
