Written by Aisha Saleem, Pharmacist & Health Writer at PharmaHealths.com
Last Updated: July 2026
If you’ve been told that TMS therapy might be an option for your depression, the first thing most people do is search for what it actually involves. The clinical description, transcranial magnetic stimulation, tells you very little about what walking into that first appointment feels like, how long the process takes, or what you should realistically expect week by week.
This guide is written to fill that gap. As someone who writes extensively about treatment-resistant depression from a pharmacist’s perspective, I want to give you a clear, honest, step by step picture of TMS therapy, from the initial assessment through to what happens after the course ends.
TMS Therapy at a Glance
• Type: Non-invasive brain stimulation
• Duration: 20 to 40 minutes per session, or around 3 minutes with TBS
• Frequency: 5 days per week
• Total course: 4 to 6 weeks
• Anesthesia: Not required
• Downtime: None
• Response rate: Around 50 to 60 percent
• Remission: Around one third of patients
What Is TMS Therapy and Who Is It For?
TMS therapy is a non-invasive outpatient treatment that uses focused magnetic pulses to stimulate underactive areas of the brain involved in mood regulation, primarily the left dorsolateral prefrontal cortex.
It is designed for people with major depressive disorder who have not achieved adequate relief from at least one antidepressant medication. The FDA cleared TMS for depression in 2008, and it has since accumulated a substantial evidence base. George et al. (2010), in a large multicenter trial published in Brain Stimulation, reported response rates of 50 to 60% in patients with treatment-resistant depression, with approximately one third achieving full remission. NICE recognizes TMS as an option for treatment-resistant depression through specialist referral pathways in the UK.
TMS is not suitable for everyone. Patients with implanted metallic or electronic devices in or near the head, including cochlear implants, metal skull plates, or deep brain stimulators, cannot have TMS due to the magnetic field involved. A history of epilepsy or seizure disorder requires careful assessment before proceeding. These contraindications are reviewed in detail during the initial assessment.
Importantly, TMS does not involve electrical currents passing through the brain like electroconvulsive therapy and it is not associated with memory loss.
Step One: The Initial Assessment
The TMS process begins with a clinical assessment, not a treatment session.
At this appointment, the treating team, typically a psychiatrist or trained TMS clinician, will review your full psychiatric and medical history, your medication list, and your previous treatment responses. They will ask about any contraindications, assess your current symptom severity using a validated scale such as the Patient Health Questionnaire (PHQ-9) or Hamilton Depression Rating Scale, and explain the full course of treatment including realistic expectations for response.
This is also the point at which your motor threshold is determined. This is an individualized calibration step unique to TMS. The clinician maps the area of your scalp corresponding to the motor cortex and applies test pulses to identify the minimum magnetic intensity that produces a visible twitch in your hand. This threshold is used to calculate the stimulation intensity for your treatment sessions, ensuring the dose is calibrated specifically to your neurology rather than a standard setting.
Questions to ask at this stage include how many sessions are planned, whether you should continue your current antidepressant during treatment, what the clinic’s response rate data looks like, and what the follow up plan is after the course ends.
Step Two: What Happens During a TMS Session
A standard TMS session is straightforward and requires no preparation beyond arriving without metal hairpins or jewelry near the scalp.
You sit in a reclined chair, fully awake and alert, and the TMS coil, a figure-of-eight shaped device, is positioned against your scalp at the pre mapped treatment site. The session begins and you will hear a rapid clicking or tapping sound and feel a corresponding tapping sensation on your scalp with each pulse. The sensation has been described by most patients as similar to having someone tap a pen firmly against the side of your head in a rapid rhythm.
A standard repetitive TMS (rTMS) session lasts between 20 and 40 minutes. Newer accelerated protocols, including Theta Burst Stimulation (TBS), a pattern of TMS pulses that delivers a full session’s worth of stimulation in as little as three minutes, have received FDA clearance and are increasingly offered at specialist centers. A systematic review published in the Journal of Affective Disorders found that TBS produced comparable antidepressant effects to standard rTMS with significantly shorter session times.
After the session ends, you can leave immediately. No recovery time is needed. The vast majority of patients drive themselves home and return to normal activities, including work, straight away. There are no dietary restrictions, no medication interactions with the treatment itself, and no anesthetic or sedation involved at any stage.
Step Three: The Full Treatment Course
A standard TMS course for depression involves five sessions per week, typically Monday through Friday, for four to six weeks, giving a total of 20 to 30 sessions.
The first week is usually the hardest in terms of tolerability. Scalp discomfort and mild headaches during or shortly after sessions are common and expected. These effects are localized, they occur at the point of stimulation, and typically resolve within the first week as your scalp adapts to the sensation. Over the counter pain relief taken before sessions can help during this adjustment period.
Most patients do not notice any mood change in the first one to two weeks. This is entirely normal and does not indicate that treatment is not working. The brain changes behind TMS response, including improved nerve communication and increased levels of supportive proteins like BDNF, take time to build gradually. Research from the National Institute of Mental Health has established that meaningful improvement in most responders becomes apparent between weeks two and four of treatment.
Week three is often described by patients as the point where something begins to shift. Sleep may improve before mood lifts directly. Motivation or appetite may return before emotional tone changes. The pattern of response varies between individuals, and the treating team will use symptom rating scales at regular intervals throughout the course to track progress objectively.
Some patients complete the full course with only modest improvement, and a smaller proportion may not respond at all. This does not mean further treatment options are exhausted, but it is important to have realistic expectations from the start.
Step Four: Monitoring Progress During Treatment
Your treating team should be assessing your response at regular intervals throughout the course, not just at the beginning and end.
Standardized symptom scores should be recorded at least every two weeks. If you are showing no response at all by the halfway point of the course, the treating team may adjust stimulation parameters, reconsider the coil positioning, or discuss whether an alternative approach is more appropriate. A partial response is clinically meaningful and should not be dismissed, it may indicate that a longer course or different protocol could produce fuller benefit.
Keep a brief daily mood log during your TMS course. This does not need to be elaborate, a simple 1 to 10 mood rating takes seconds and gives you and your clinical team far more useful data than relying on recall alone at review appointments.
Step Five: After the Course Ends
What happens after a TMS course finish is one of the most important and least discussed aspects of the treatment.
Response to TMS is not permanent by default. For patients who respond, the therapeutic benefit typically lasts between six months and a year without maintenance treatment. A review published in the Journal of Clinical Psychiatry found that patients who continued antidepressants after a successful TMS course had significantly lower relapse rates than those who stopped medication, reinforcing the value of TMS as a complement to rather than replacement for pharmacological treatment.
Maintenance TMS, single sessions delivered weekly or monthly after the initial course, is increasingly used to extend and preserve the therapeutic response. The optimal maintenance schedule has not been definitively established in the literature, but clinical practice typically involves tapering from weekly to monthly sessions based on individual response.
If depression returns after a successful TMS course, a repeat course is entirely appropriate and is clinically supported. Response to a second course in patients who responded to the first is generally comparable to the initial response.
What Is the Difference Between a TMS Responder and a Non-Responder?
Approximately 50 to 60% of patients with treatment-resistant depression respond meaningfully to TMS, and around one third achieve full remission. That leaves a proportion who complete a full course without adequate benefit.
Factors associated with better TMS response include shorter duration of the current depressive episode, lower number of previous treatment failures, and absence of significant anxiety comorbidity. However, these are population level associations, they do not reliably predict individual response, and patients outside these categories do respond. Non response to one TMS protocol does not necessarily mean non-response to a modified approach, different stimulation parameters, or a different brain stimulation modality entirely.
FAQs
Q1. What does TMS therapy feel like during a session?
TMS feels like a firm, rapid tapping on your scalp at the point of stimulation. Most patients describe it as unusual rather than painful. Some find the first few sessions uncomfortable, particularly around the temple area, but the majority adapt quickly and find sessions tolerable by the end of the first week. There is no sedation, no electrical sensation, and no pain inside the head.
Q2. How many TMS sessions do you need for depression?
A standard TMS course involves 20 to 30 sessions delivered five days per week over four to six weeks. Some patients receive extended courses of up to 36 sessions depending on their response trajectory. Maintenance sessions after the course are typically spaced weekly then monthly to preserve the therapeutic benefit.
Q3. How quickly does TMS therapy work?
Most patients begin noticing changes between weeks two and four of treatment. Sleep and energy often improve before mood lifts directly. A minority of patients notice earlier changes, and some take the full course before benefit becomes apparent. Not noticing anything in the first two weeks is entirely normal and not a sign the treatment is failing.
Q4. Do you need to stop antidepressants for TMS therapy?
No. Continuing antidepressants during TMS is standard practice and is how TMS was studied in the majority of clinical trials. Stopping medication before starting TMS is not recommended without a specific clinical reason. Evidence suggests that maintaining antidepressants after a successful TMS course significantly reduces the risk of relapse.
Q5. Can TMS therapy make depression worse?
A small number of patients report feeling temporarily more anxious or unsettled in the first week, which is likely related to the novelty of the experience and the scalp discomfort rather than a direct worsening of depression. Clinically significant worsening of depression as a direct result of TMS is not an established risk. If mood deteriorates significantly during a course, this should be raised with the treating team promptly.
Q6. Can TMS be repeated if depression comes back?
Yes. Repeat TMS courses are clinically appropriate and widely used. Patients who responded to an initial course generally show comparable response to a second course if depression returns. There is no established maximum number of TMS courses, and repeat treatment is a routine part of long-term TMS management for recurrent depression.
Q7. What maintenance schedule is recommended after TMS therapy?
There is no single universally agreed maintenance protocol, but clinical practice typically involves tapering from weekly to monthly sessions after the initial course for patients who have responded. Some patients manage well with quarterly booster sessions. The optimal approach is individualized based on how durable the initial response is and how quickly symptoms return when sessions are spaced further apart.
Call to Action
If this guide has helped you understand what TMS therapy actually involves, the mental health section at PharmaHealths.com has everything you need to build on it. I’ve written a detailed comparison of TMS and ketamine therapy for treatment-resistant depression, a full overview of all brain stimulation therapies including ECT and VNS, a complete guide to treatment resistant depression covering every evidence-based pathway, and a breakdown of how to safely combine depression treatments including TMS alongside medication. All written from a pharmacist’s perspective, evidence-based, clearly explained, and designed to help you make more informed decisions about your own care.
Disclaimer
This article is for general informational and educational purposes only and does not constitute medical advice or a treatment recommendation. TMS therapy is a specialist medical procedure that must be assessed, recommended, and supervised by a qualified healthcare professional. Individual eligibility, response, and safety considerations vary. Always consult your doctor, psychiatrist, or specialist TMS team before making any decisions about your treatment.
References
• George MS et al. Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder. Brain Stimulation. 2010. https://www.brainstimjrnl.com/
