These are short, sourced answers to the questions people ask most about transcranial magnetic stimulation (TMS), grouped by topic. Each answer links to a page that goes deeper. TMS is FDA-cleared for major depression and a few other uses; anything outside those uses is off-label or research-stage, and the answers below say so where it applies.
Nothing here replaces an evaluation by a psychiatrist who knows your history. For a structured overview, start with the TMS guide.
TMS at a glance
| Question | Short answer |
|---|---|
| Main cleared use | Major depression in adults that has not improved with antidepressant medication |
| Typical standard course | 36 sessions: daily on weekdays for six weeks, then a three-week taper |
| Time per session | About 3 minutes (theta burst) to about 19 to 37.5 minutes (standard 10 Hz) |
| Anesthesia | None; you are awake throughout |
| Most common side effects | Scalp discomfort and headache, usually transient |
| Most serious risk | Seizure, which is rare |
The basics
What is TMS?
TMS uses a magnetic coil held against the scalp to deliver brief pulses that stimulate brain cells in a targeted area. For depression, the standard target is the left dorsolateral prefrontal cortex, a region involved in mood regulation. It is non-invasive and needs no medication or anesthesia. What is TMS therapy? explains it in plain language.
Is TMS FDA-approved?
TMS devices are FDA-cleared, not FDA-approved. That is a regulatory distinction: no TMS device went through the premarket approval pathway, and each is cleared or authorized as a Class II device. The first depression device was authorized in October 2008. See is TMS FDA-approved? for every cleared use.
What conditions is TMS cleared to treat?
Cleared uses include adult major depression, depression with anxiety symptoms, an add-on treatment for adult obsessive-compulsive disorder, an aid to short-term smoking cessation, add-on treatment of depression in ages 15 to 21, and, since 2026, an add-on treatment for adult PTSD with one specific system. A separate type of device is cleared for migraine.
How is TMS different from ECT?
ECT induces a seizure under general anesthesia; TMS does neither. In head-to-head studies ECT was more effective overall, with the clearest advantage in psychotic depression. The physician-level comparison of TMS vs ECT covers memory, effectiveness and who each suits.
How is TMS different from an antidepressant?
TMS works locally on the brain rather than circulating through the body, so its common side effects are local ones such as scalp discomfort and headache. It takes daily visits instead of a daily pill. TMS or another antidepressant? helps you weigh the next step.
What is deep TMS?
Deep TMS uses a differently shaped coil, often called an H-coil, that is designed to stimulate a broader and deeper area than the standard figure-8 coil. It was cleared for adult major depression in 2013. What TMS feels like compares the sensations.
What is theta burst stimulation?
Theta burst (iTBS) delivers pulses in rapid bursts, so a session takes about three minutes. In the 2018 THREE-D trial of 414 adults, it was non-inferior to standard 10 Hz TMS. Terms like this are defined in the TMS glossary.
What is accelerated TMS, and what is SAINT?
Accelerated TMS packs several sessions into one day. SAINT, cleared in 2022, gives 10 short sessions a day for five days using an MRI-guided target. SAINT is no longer the only cleared accelerated protocol. Coverage is limited; see is accelerated TMS covered by insurance?
Is TMS experimental?
Not for depression. European expert guidelines rate high-frequency TMS of the left prefrontal cortex for depression at Level A, their highest grade. The American Psychiatric Association calls it a safe and effective evidence-based treatment for appropriately selected patients. Some other uses are research-stage. TMS myths and facts sorts the claims.
What is treatment-resistant depression?
It usually means depression that has not responded to at least two adequate medication trials, though definitions vary. Some depression only looks resistant because of dose, duration or another medical issue. What is treatment-resistant depression? explains the definitions and options.
Safety and side effects
Is TMS safe?
For most people, yes, with proper screening. Transient headache and scalp discomfort were the most common side effects in the NeuroStar development program, and 4.5% of people stopped acute treatment because of side effects. TMS side effects covers the full picture.
Does TMS hurt?
Most people describe tapping or knocking on the scalp, and scalp discomfort is among the most common side effects. In the THREE-D trial, people rated theta burst slightly more painful than 10 Hz, 3.8 versus 3.4 out of 10. See what TMS feels like.
What is the seizure risk?
It is very low. In one large survey, seizures occurred in fewer than 1 per 60,000 sessions when TMS was given within guidelines to people without known risk factors. Risk is higher with factors such as epilepsy or brain lesions, which is why screening matters.
Does TMS affect memory?
A systematic review of 31 randomized studies found no reliable evidence of cognitive side effects from this kind of TMS. ECT, by contrast, was linked to more memory impairment in some head-to-head studies. Does TMS affect memory or thinking? goes further.
Can TMS damage hearing?
The coil makes a loud click, so hearing protection is required. FDA guidance calls for earplugs rated for 30 dB of noise reduction during treatment. When protection is used, studies have found no change in hearing. Report any ringing or muffled hearing.
Can I have TMS with fillings, braces or implants?
Dental amalgam fillings are acceptable under New York Medicare's policy. TMS is contraindicated with conductive or magnetic-sensitive metal implanted in the head or within 30 cm of the coil, and with implants such as cochlear implants, deep brain stimulators and vagus nerve stimulators. See TMS with metal, implants and tattoos.
Can TMS trigger mania?
A 2021 meta-analysis of 25 blinded trials found the risk of switching into hypomania or mania was not significantly different between active and sham TMS. People with bipolar disorder still need careful assessment and monitoring.
Can I keep taking my medications?
Usually, yes. FDA guidance asks for monitoring with drugs known to lower seizure threshold, while the 2021 international safety guidelines say current data no longer support extra caution for medications alone. Never change a dose without your prescriber. See medications during TMS.
Do alcohol and sleep matter during TMS?
Yes. Sleep deprivation, increased alcohol use and alcohol withdrawal are listed among factors that can lower seizure threshold. Caffeine, alcohol and sleep during TMS has practical guidance.
Can TMS help if I am having suicidal thoughts right now?
TMS takes weeks and is not a crisis treatment. Consensus guidance says people with acute suicidal thoughts should be considered for other treatments with established efficacy. 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.
Conditions
Does TMS treat anxiety?
TMS is cleared to reduce anxiety symptoms in people whose major depression comes with anxiety. For generalized anxiety disorder alone it is off-label, and a 2026 review found only low-strength evidence. See TMS for anxiety.
Does TMS work for OCD?
Deep TMS was authorized in 2018 as an add-on treatment for adult OCD. In the pivotal trial, response was 38.1% with active treatment versus 11.1% with sham after six weeks. TMS for OCD explains who it suits.
Is TMS used for PTSD?
One system was cleared in June 2026 as an add-on treatment for adult PTSD. A 2026 review of sham-controlled trials found low-strength evidence for reduced symptom severity and no evidence of benefit for remission. Other TMS approaches for PTSD are off-label.
Can TMS treat bipolar depression?
It is not FDA-cleared for bipolar depression, and use there is off-label. A 2026 meta-analysis found a small effect that did not hold up in sensitivity analyses. FDA guidance lists bipolar disorder among groups lacking evidence for safety or efficacy. Am I a candidate? covers this.
Can teenagers have TMS?
Several devices are cleared as an add-on treatment for depression in ages 15 to 21. The only large sham-controlled trial in adolescents was negative, so the evidence is mixed. TMS for teens and young adults is written for parents.
Is TMS used during pregnancy or after birth?
Off-label. FDA guidance lists pregnancy as a precaution, not a contraindication. The only sham-controlled trial in pregnancy had 22 participants, and a 2026 review calls this use experimental. See TMS during pregnancy and after birth.
Does TMS work for older adults?
A 2025 meta-analysis of 10 randomized trials in late-life depression found benefit over control. Age can affect dosing and screening; TMS for older adults explains how.
Can TMS help me quit smoking?
One deep TMS system is cleared as an aid to short-term smoking cessation in adults. In its pivotal trial, the four-week continuous quit rate was 19.4% versus 8.7% with sham. See TMS to quit smoking.
Does TMS help seasonal depression?
If winter depression meets criteria for major depression, TMS can be considered, but evidence specific to seasonal pattern is limited and established treatments for seasonal depression are usually tried first. Can TMS help seasonal depression? explains the order.
What about ADHD, autism or tinnitus?
All are off-label and research-stage. Studies of ADHD conflict, autism trials are mostly low certainty, and tinnitus benefit has not lasted at six months. Be cautious with clinics marketing these uses.
Can TMS help if I am still functioning at work?
Possibly, if you meet criteria for major depression and medication has not helped enough. Feeling able to work does not rule TMS out, though insurers look for documented severity. TMS and high-functioning depression covers this.
The treatment course
How many sessions will I need?
A standard course is 36 sessions: 30 daily weekday sessions followed by a six-session taper. Consensus guidance says 20 to 30 sessions over six weeks are very likely needed to match trial results. See a typical TMS course, week by week.
How long does each session take?
Standard 10 Hz sessions take about 19 to 37.5 minutes depending on settings, and theta burst takes about three minutes. Allow extra time for check-in.
What happens at the first session?
The team finds your motor threshold, the lowest strength that moves your fingers or thumb, then locates the treatment spot. One cleared system describes doing this by watching finger movement plus EMG. See the first TMS session.
What happens at the consultation?
A psychiatrist reviews your history, medications, therapy and safety screening, and you discuss protocols and insurance. What to expect at a TMS consultation includes a what-to-bring list.
Am I awake, and can I go back to work afterward?
Yes. TMS involves no anesthesia, you are awake throughout, and you can generally return to your day afterward. Some providers suggest a ride to the first appointment. See working, studying and driving during TMS.
What should I wear?
Comfortable clothes, and hair free of metal clips or pins. Remove objects that could interact with the magnetic field, such as hearing devices, piercings, jewelry and some glasses. The preparing for TMS checklist has a day-one list.
What if I miss a session?
Tell the team as early as you can. Policies differ: some teams add the missed session at the end, and some adjust the schedule. A single missed day is rarely a problem, but repeated gaps can make it harder to judge whether treatment is working and may affect what an insurer approved. Plan holidays and travel before you start. The week-by-week guide covers missed sessions.
Should I keep seeing my therapist?
Many people do. New York Medicare requires a prior trial of evidence-based psychotherapy before covering TMS, which shows how payers view therapy's role. TMS and talk therapy together explains how they fit.
How is progress measured?
With validated scales such as the PHQ-9, HAM-D or MADRS, which New York Medicare requires for monitoring. See tracking progress during TMS.
Can diet, exercise or supplements make TMS work better?
No specific habit or supplement is established as boosting TMS response. Exercise and sleep help depression in their own right. Supporting a TMS course with lifestyle sorts the evidence.
How does TMS fit with integrative care?
It is usually one part of a broader plan: diagnosis review, medication decisions, therapy, sleep and physical health. TMS within integrative psychiatry explains the approach and its limits.
How can family members help?
By helping with logistics such as rides or childcare, noticing changes you might miss, and knowing the warning signs that need a call, including new thoughts of suicide or unusually elevated mood with little sleep. Supporting a loved one through TMS is written for them.
Results
Does TMS work?
For many people, yes, though not for everyone. In a sham-controlled NIMH-funded trial, remission was 14.1% with active TMS versus 5.1% with sham. In randomized trials, remission gaps between active and sham TMS are typically about 9 to 18 percentage points.
Why do some clinics quote 80% or 90% success?
Those figures usually come from open-label registries or company-affiliated data that are mostly self-reported and partly limited to people who finished treatment. They are not comparable with controlled trials. See TMS myths and facts.
When will I notice a difference?
Most people who benefit improve gradually over several weeks, but timing varies. Some notice better sleep or energy before mood lifts, and some respond late in the course, which is one reason finishing the full course matters. When does TMS start working? covers what early changes mean.
What is the difference between response and remission?
Response usually means at least a 50% drop in symptom scores, remission means scores fall into the normal range. In one deep TMS trial, remission was defined as an HDRS-21 score under 10. Tracking progress explains the scales.
How long do results last?
In studies, roughly half to about six in ten people who responded were still doing well a year later. The physician-level review of how long TMS results last covers the data, and life after TMS explains how to plan for staying well.
Do I need maintenance sessions?
Not necessarily. Expert consensus calls maintenance promising but says the right frequency is unclear. TMS maintenance and booster sessions covers the options.
Can I repeat TMS if depression comes back?
Yes. The Clinical TMS Society recommends reintroducing TMS after relapse in people who benefited. In a 2026 retrospective study, 82.5% of prior responders responded again to a second course.
Can TMS be combined with ketamine or Spravato?
Sometimes they are used in sequence, but combining them in one package is not standard. Aetna classifies adjunctive ketamine given with TMS as experimental. Esketamine (Spravato) is FDA-approved for treatment-resistant depression and requires at least two hours of monitoring at each session. TMS vs ketamine therapy compares them.
What if TMS does not work for me?
It is not a dead end. Options include adjusting the protocol, rechecking the diagnosis, medication changes, esketamine, ketamine and ECT. What if TMS does not work? walks through them.
Is TMS a cure?
No treatment can promise a cure for depression. Claims that TMS results are permanent are overstated. Many people do stay well for long periods, especially with a relapse-prevention plan.
Cost and insurance
Does insurance cover TMS in New York?
Usually, for depression that meets criteria. Medicare and major commercial plans cover it with conditions, and New York Medicaid has covered it since October 2025 for fee-for-service members and since November 2025 in Medicaid managed care plans. See does insurance cover TMS?
How many antidepressants do I need to try first?
It depends on the plan. New York Medicaid defines treatment resistance as two trials of two different antidepressants. Aetna asks adults for two antidepressants from two classes plus an augmentation trial. The payer-by-payer guide has details.
Do I need prior authorization?
Often, and the rules vary by plan. State-regulated New York plans must decide within three business days of receiving the necessary information. Cigna's behavioral health arm removed prior authorization for contracted providers in March 2026. See TMS prior authorization
Is accelerated TMS covered?
Usually not. Aetna, Cigna and Optum classify accelerated protocols as experimental or unproven. Is accelerated TMS covered? has the details.
Is maintenance TMS covered?
Generally no. New York Medicare and Cigna both exclude maintenance therapy.
Is TMS for OCD covered?
It varies. New York Medicare does not cover deep TMS for OCD, while Cigna covers it for adults who meet its criteria. TMS for OCD covers coverage reality.
How much does TMS cost without insurance?
Reliable neutral price data are scarce. One clinic blog lists $6,000 to $15,000 for a standard course but gives no method or data source. Ask for a written Good Faith Estimate. See TMS cost without insurance.
Can I use an HSA or FSA?
IRS rules count psychiatric care as a medical expense, and HSA and FSA eligibility follows that definition. Confirm with your plan administrator.
What if my claim is denied?
Appeal. In New York you have four months from the final internal denial to request an external appeal, and the fee is capped at $25 per appeal. See how to appeal a TMS denial in New York.
Can I see an out-of-network TMS provider?
Often, if your plan has out-of-network benefits, but you may pay more, and prior authorization or a medical-necessity review can still apply. Ask the clinic for a superbill listing diagnosis and procedure codes, and check your deductible first. Out-of-network TMS explains superbills and reimbursement.
Do insurers cover TMS for teenagers?
Some do. Aetna, Cigna and Optum each set a minimum age of 15 for depression coverage. TMS for teens covers the details for families.
Getting started in Brooklyn
How do I choose a TMS provider?
Look for real psychiatrist oversight, an FDA-cleared device, clear measurement, honest talk about results and transparent insurance handling. How to choose a TMS provider in Brooklyn has a checklist.
How do I plan travel for daily sessions?
Daily visits make travel time a real factor, so check the route to wherever your TMS team is located before you commit. The practice office at 200 Prospect Park West is near the 15 St–Prospect Park stop on the F and G lines; ask the TMS team where sessions themselves are held. See getting to daily TMS sessions in Brooklyn.
Do I need a referral?
Not always, but your records from current prescribers will be needed. How to bring up TMS with your psychiatrist covers referrals and second opinions.
Am I a candidate?
You may be if you have major depression that has not improved enough with medication, have no metal or implants that rule it out, and can attend daily sessions. Am I a candidate for TMS? is a checklist.
What should I ask at a consultation?
Ask who supervises treatment, which device and protocol they recommend and why, how progress is measured, and what happens if it does not work. The practice also keeps a list of questions to ask about TMS therapy.
Where do I start?
The TMS guide walks through each stage, and the TMS therapy page explains how to ask about a consultation.
Sources
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- 510(k) Summary K220177: Magnus Neuromodulation System with SAINT Technology. U.S. Food and Drug Administration, 2022. accessdata.fda.gov
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FAQs
Is TMS covered by Medicare in Brooklyn?
Yes, for adults with major depression who meet the local policy criteria, including medication and psychotherapy trials. See does insurance cover TMS?
Is TMS the same as shock therapy?
No. ECT uses electrical current to induce a seizure under anesthesia. TMS uses magnetic pulses, does not aim to cause a seizure, and needs no anesthesia.
How soon can I start after a consultation?
It depends mainly on insurance approval and scheduling. State-regulated New York plans must decide on prior authorization within three business days of receiving complete information.
Can I do TMS on weekends?
Standard courses are usually scheduled on weekdays. Ask the TMS team about their hours and how holidays are handled.
Is there an age limit for TMS?
Depression clearances cover adults and, as an add-on treatment, ages 15 to 21. The adult labels say "adult patients" without naming an upper age, though some insurer forms use age bands; see TMS for older adults.
