A standard TMS course for depression runs about nine weeks from first session to last. The most common cleared schedule is one session a day, five days a week, for six weeks (30 sessions), then a three-week taper of three, two and one sessions, for 36 sessions in total. Most of the work, and most of the change people notice, happens in weeks 2 through 6.
Below is what each phase usually involves, what is known about how mood tends to shift along the way, how shorter "accelerated" schedules differ, and what to do if you miss a day. Treat it as a map, not a promise: people move through a course at different speeds, and the TMS team treating you sets the actual plan.
The standard course at a glance
| Phase | Sessions | What usually happens |
|---|---|---|
| Before week 1 | Consultation | Screening, medical and medication history, consent, often insurance authorization |
| Week 1 | 5 | First session includes mapping and motor threshold; scalp discomfort is most noticeable now |
| Weeks 2–3 | 10 | Routine sets in; first formal mood ratings; early change in some people |
| Weeks 4–6 | 15 | The bulk of treatment; many people who will respond show it by now |
| Weeks 7–9 (taper) | 3, then 2, then 1 | Fewer visits; end-of-course ratings; plan for afterward |
The 36-session shape above comes from the NeuroStar label. Other devices and protocols use similar six-week blocks, and some clinics stop at 30 sessions or skip the taper. Several commercial insurers write the same pattern into their policies: up to 30 sessions plus 6 tapering sessions.
Before week 1: consultation and screening
A psychiatrist confirms the diagnosis, reviews which treatments you have tried, and screens for things that affect safety, such as metal in or near the head, implanted devices, a seizure history and some medications. Bring a full medication list; our guide to taking medications during TMS explains why. If insurance is involved, authorization usually has to come through before session one, which can add days or weeks.
For the full walk-through, see what happens at a TMS consultation.
Week 1: mapping, getting used to the feeling
The first session is the longest
At the first visit the team finds your motor threshold, the stimulation strength at which a pulse over the motor area of the brain makes your fingers move. It is judged by watching for finger movement, sometimes with a sensor on the hand. Your treatment dose is then set as a percentage of that number, and the coil is moved forward to the treatment spot over the left front of the head. Our article on the first session and mapping covers this step by step.
How long each session takes
Standard 10 Hz sessions deliver 3,000 pulses; depending on the gap between pulse trains, that takes between about 19 and 37.5 minutes. Theta-burst (iTBS) sessions deliver 600 pulses in a little over 3 minutes. Add time for check-in and positioning.
What it feels like this week
Tapping on the scalp, a clicking sound (you wear earplugs) and some facial twitching are normal. Scalp pain or discomfort near the coil is the most common side effect; NeuroStar's safety information says these events are temporary and do not occur for most patients after the first week. Headache is also common; in the deep TMS pivotal trial it was reported by 26.7% of people on active treatment and 18.9% on sham. See what TMS feels like and TMS side effects for detail.
Week 1 is also when the rare risk of a seizure is highest. In a large survey of labs and clinics, seizures were most likely within the first few TMS exposures. When TMS followed published guidelines in people without known risk factors, the rate was fewer than 1 seizure per 60,000 sessions.
Mood in week 1
Most people do not feel a clear mood change in the first five sessions, and that is expected. A minority do improve early: in a secondary analysis of the THREE-D trial, 19% of participants followed a "rapid response" pattern, and the differences between response patterns were detectable by week 1.
Weeks 2 and 3: routine and the first check-in
By now sessions feel routine. Your team will ask you to fill out a depression scale, often the PHQ-9, at set points. Medicare's billing rules, for example, require the treating physician to track response with a validated scale such as the PHQ-9, HAM-D or MADRS. Our guide to tracking progress during TMS explains the scores.
Around session 10, your psychiatrist may look closely at how much you have changed. In one clinical series of 101 patients treated at a different (dorsomedial) brain target, people with less than 20% improvement at session 10 were correctly predicted to be non-responders 88.2% of the time. That is useful information, not a verdict: a 2026 analysis of two theta-burst trials found that early improvement correctly predicted response only 67–75% of the time and called that accuracy insufficient to justify stopping treatment. If you are not better yet at the two-week mark, the usual next step is a conversation, not quitting. Read more in when TMS starts working.
Weeks 4 to 6: the core of the course
This is where most of the antidepressant effect builds. A 2018 expert consensus advised telling patients that a standard acute course of 20 to 30 sessions over six weeks will very likely be needed to match the results of the regulatory trials. In a registry of 7,215 patients treated in real-world practice, courses of fewer than 30 sessions had worse outcomes than all longer courses.
People describe improvement in different ways. The THREE-D analysis found four patterns: no response (11%), rapid response (19%), and two groups that improved steadily, in a straight line, across the course (30% and 40%). So a slow, steady climb is the most common picture, not a sudden switch.
Things that help during these weeks:
- Keep sleep regular and alcohol low. Sleep deprivation, alcohol withdrawal and heavy drinking are all listed as factors that can lower seizure threshold. Our page on caffeine, alcohol and sleep during TMS has practical tips.
- Keep therapy appointments if you have them; see TMS and talk therapy together.
- Report any new or worsening symptoms the same day, including agitation, racing thoughts or worse mood.
Weeks 7 to 9: the taper
On the NeuroStar label, the taper is three sessions in week 7, two in week 8 and one in week 9. The idea is to step down gradually rather than stop abruptly. Honestly, the evidence for tapering is thin: the 2025 international consensus update says tapering at the end of a course "has little empirical support". Some clinics taper, some do not, and some insurers cover only the label pattern.
Your end-of-course rating usually happens here. Response typically means at least a 50% drop on the scale, and remission means the score falls below a set cutoff, as in the deep TMS trial's definitions. This is also the time to plan what happens next: who monitors you, what keeps you well, and when to call. See maintenance and booster sessions and building a relapse-prevention plan.
Accelerated schedules: a different timeline
Accelerated TMS packs several sessions into each treatment day. Three FDA-cleared examples show how different the calendars can be:
| Protocol | Sessions per day | Calendar |
|---|---|---|
| SAINT (Magnus) | 10, about 10 minutes each | 5 days; 50 sessions in total |
| BrainsWay accelerated Deep TMS | 5 on treatment days | 6 treatment days within 2 weeks, then 2 sessions a day once a week for 4 weeks |
| MagVenture accelerated TMS | 2 to 10 | Varies by protocol |
SAINT sessions in the original study were spaced 50 minutes apart, so a treatment day fills most of a working day. Note that the BrainsWay schedule is not a one-week course; it still spans six weeks. Many insurers, including Aetna, Cigna and UnitedHealthcare, currently classify accelerated protocols as experimental or unproven. For coverage details see whether accelerated TMS is covered, and for the evidence behind each protocol, Dr. Lewis's physician guide to accelerated TMS.
If you miss a session
No published rule says exactly how many missed days are too many, so this is a judgment call for your team. Some practical points:
- Call ahead. Clinics can often move you to a different time the same week.
- A missed day is usually added at the end rather than doubled up, but ask; some devices are cleared for more than one session a day and some are not.
- A long gap, illness, a new medication or a large change in sleep may prompt the team to recheck your motor threshold. There is a billing code specifically for motor threshold re-determination during a course.
- Finishing matters more than perfect attendance. Registry data link courses of fewer than 30 sessions with less benefit.
What a week of TMS looks like in real life
For most people the practical cost is time: a short visit every weekday for six weeks, then fewer visits during the taper. There is no anesthesia, so you can usually go straight back to work or class. Our guide to working, studying and driving during TMS covers scheduling and leave, and fitting daily sessions into a Brooklyn week covers getting there.
For an overview of the treatment itself, start at the TMS guide, or see the TMS therapy page for how to ask about it.
Sources
- K231926 510(k) Summary - NeuroStar Advanced Therapy System. U.S. FDA, 2024. accessdata.fda.gov
- K173620 510(k) Summary - MagVita TMS Therapy System w/Theta Burst Stimulation. U.S. FDA, 2018. accessdata.fda.gov
- K220177 510(k) Summary - Magnus Neuromodulation System with SAINT Technology. U.S. FDA, 2022. accessdata.fda.gov
- Stanford Accelerated Intelligent Neuromodulation Therapy for Treatment-Resistant Depression. American Journal of Psychiatry, 2020. pubmed.ncbi.nlm.nih.gov
- 510(k) Premarket Notification K251449 (BrainsWay accelerated Deep TMS) and 510(k) summary. U.S. FDA, 2025. accessdata.fda.gov
- 510(k) Premarket Notification K260189 (MagVenture Accelerated TMS) and 510(k) summary. U.S. FDA, 2026. accessdata.fda.gov
- Safety Information. NeuroStar (Neuronetics), 2026. neurostar.com
- Efficacy and safety of deep transcranial magnetic stimulation for major depression: a prospective multicenter randomized controlled trial. World Psychiatry, 2015. pmc.ncbi.nlm.nih.gov
- Seizures from transcranial magnetic stimulation 2012-2016: Results of a survey of active laboratories and clinics. Clinical Neurophysiology, 2019. europepmc.org
- Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: Expert Guidelines. Clinical Neurophysiology, 2021. europepmc.org
- 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. doi.org
- Billing and Coding: Transcranial Magnetic Stimulation (A57528). CMS Medicare Coverage Database, 2026. cms.gov
- Transcranial Magnetic Stimulation and Cranial Electrical Stimulation (Clinical Policy Bulletin 0469). Aetna, 2026. aetna.com
- Behavioral Clinical Policy: Transcranial Magnetic Stimulation (BH803TMS112025). Optum Behavioral Health Solutions, 2025. providerexpress.com
- Transcranial Magnetic Stimulation (Coverage Policy EN0383). Evernorth Health Services (Cigna), 2026. a.static.cigna.com
- Transcranial Magnetic Stimulation for Treating Physical Health Conditions (2026T0536W). UnitedHealthcare, 2026. uhcprovider.com
- Trajectories of Response to Dorsolateral Prefrontal rTMS in Major Depression: A THREE-D Study. American Journal of Psychiatry, 2019. pubmed.ncbi.nlm.nih.gov
- Early symptom improvement at 10 sessions as a predictor of rTMS treatment outcome in major depression. Brain Stimulation, 2018. pubmed.ncbi.nlm.nih.gov
- Dose or time? Comparing early prediction of intermittent theta-burst stimulation response across accelerated and daily protocols for depression. European Archives of Psychiatry and Clinical Neuroscience, 2026. pubmed.ncbi.nlm.nih.gov
- Dosing transcranial magnetic stimulation in major depressive disorder: Relations between number of treatment sessions and effectiveness in a large patient registry. Brain Stimulation, 2023. pubmed.ncbi.nlm.nih.gov
FAQs
How many weeks does a standard TMS course take?
About nine weeks on the most common cleared schedule: six weeks of daily weekday sessions, then a three-week taper. Some clinics stop after six weeks or about 30 sessions.
Will I feel better after the first week?
Usually not yet. Most people improve gradually across weeks 2 to 6. A minority improve early, and some respond late in the course.
Does the scalp discomfort last the whole course?
For most people it is worst in the first week and then fades. Tell the technician if it does not; the coil position or dose ramp can sometimes be adjusted.
Can I take a week off for vacation in the middle?
Talk to the TMS team before booking. There is no fixed published rule, and a long gap may mean rechecking your motor threshold or extending the course.
Is accelerated TMS just a shorter version of the same thing?
It uses several sessions a day, so the calendar is shorter, but the protocols differ and many insurers still classify them as experimental. See our coverage guide.
