TMS for Treatment-Resistant Depression: How It Works, Safety, Benefits, and Real-World Outcomes

If you’ve tried antidepressants and therapy without lasting relief, transcranial magnetic stimulation (TMS) is a non-drug, noninvasive option with a strong safety record and growing evidence for meaningful, durable improvement in depression.

What is TMS?

TMS uses a treatment coil placed against the scalp to deliver brief, focused magnetic pulses to the dorsolateral prefrontal cortex (DLPFC)—a brain region involved in mood regulation. Sessions are outpatient, you’re awake the whole time, and there’s no anesthesia or recovery period. Modern protocols include standard repetitive TMS (rTMS), theta-burst stimulation (iTBS) (a faster protocol), and Deep TMS, which can reach broader/deeper targets. The U.S. FDA first cleared TMS for major depression in 2008; additional clearances and protocol refinements have followed since then. 

Is TMS safe?

Yes—TMS has a well-characterized safety profile. The most common effects are mild scalp discomfort or headache, usually easing after the first week. Rare events like seizure are uncommon with modern safety guidelines and screening. Large surveys estimate the seizure rate around 0.8 per 10,000 sessions; clinical guidance considers overall risk <1% and very low when protocols are followed. Hearing protection is used to mitigate coil noise. 

Typical, short-lived side effects

Scalp discomfort/tapping sensation Headache Facial muscle twitching/tingling during pulses Lightheadedness (uncommon) These are generally mild to moderate and fade after sessions. 

Your clinician will screen for contraindications (e.g., certain implanted metallic/electronic devices, active seizures) and review medication/substance factors to reduce risk. (Coverage policies and clinical protocols reflect these safety considerations.) 

How effective is TMS in treatment-resistant depression (TRD)?

Randomized trials (gold-standard research). Meta-analyses show that, compared with sham, active rTMS produces significantly higher response and remission rates in TRD. A 2023 meta-analysis reported ~36% remission with active rTMS vs ~8% with sham across trials. 

Real-world outcomes (what clinics see day-to-day). In large registries of routine clinical practice, outcomes are often even stronger: clinician-rated response 58–83% and remission 28–62% across tens of thousands of patients. 

Protocol advances. Network meta-analysis suggests iTBS to the left DLPFC offers a favorable balance of efficacy, speed (3–10 minutes per session), and tolerability. 

Durability. In a 2025 analysis, ~85% of patients maintained wellness at 24 weeks after an acute TMS course (relapse-prevention success), highlighting meaningful durability for many. Maintenance/booster sessions can extend benefits. 

When to consider TMS. Contemporary guidelines endorse TMS after inadequate response/intolerance to antidepressants and psychotherapy, with growing integration into step-wise depression care. 

How does TMS compare with “another medication trial”?

Effectiveness of antidepressants tends to decline with each additional trial in TRD, while TMS maintains robust effect sizes and is non-systemic (no weight gain, sexual dysfunction, or sedation typical of many medications). Some comparative analyses suggest TMS can outperform switching to yet another medication after multiple failures. 

What about Deep TMS and other indications?

Anxious depression: FDA cleared the H1 coil labeling for anxiety symptoms comorbid with depression (2021).  Smoking cessation: Deep TMS with the H4 coil has FDA clearance as a short-term aid; ongoing phase IV data continue to emerge. 

(Your care plan will focus on the depression indication; these additional clearances reflect the maturing evidence base.)

Mini case snapshots (de-identified composites from the literature)

“After meds failed… relief in 6 weeks.” A 42-year-old with three failed antidepressants completed iTBS (left DLPFC). By week 6, PHQ-9 improved from 20→6 (response), sustaining remission with brief monthly boosters—consistent with RCT and durability data.  “Severe TRD in routine practice.” Registry patients across >100 clinics show 58–83% response and 28–62% remission in real-world settings, aligning with what many clinics see beyond narrowly selected trial samples. 

What to expect during treatment

Course length: Typically 4–6 weeks of weekday sessions; iTBS sessions are just a few minutes.  During a session: You’ll feel a tapping sensation under the coil; most people read, listen to music, or relax. Aftercare: You can drive yourself and return to normal activities immediately—no anesthesia or recovery period. 

Frequently asked safety questions

Will TMS affect my memory?

Unlike ECT, TMS does not impair memory; cognitive testing in trials typically shows no negative cognitive effects and in some cases improvements associated with mood recovery. 

What about seizures?

They’re very rare with modern protocols and screening—on the order of ~0.008% per session in large surveys. Your clinician will review medications/sleep, and you’ll wear hearing protection for comfort/safety. 

Does TMS work if I’ve failed multiple meds?

Yes—TMS is specifically studied in treatment-resistant populations and maintains meaningful response/remission rates even after multiple medication failures. 

Bottom line

For many people with treatment-resistant depression, TMS offers clinically significant improvement or remission—with minimal, transient side effects, no systemic medication burden, and growing evidence for durability. If you’re curious whether you’re a candidate, we can review your history and tailor a protocol (standard rTMS, iTBS, or Deep TMS) to your goals and schedule.

References

Vida RG, et al. BMC Psychiatry. 2023: rTMS vs sham in TRD—significant gains in response/remission. 

Sackeim HA, et al. J Affect Disord. 2020: Large outcomes registry—response 58–83%, remission 28–62% in routine care. 

Kishi T, et al. Mol Psychiatry. 2024: Network meta-analysis—iTBS (left DLPFC) shows favorable efficacy/acceptability. 

Stultz DJ, et al. Brain Stimul. 2020 & Taylor JJ, et al. 2021: TMS safety; seizure risk low (~0.8 per 10,000 sessions).  Mayo Clinic (2023): Side-effect overview (headache/scalp discomfort most common; generally mild). 

Trapp NT, et al. 2024: FDA milestones, anxious-depression labeling; overview since 2008.  CANMAT 2023/2024 updates: Guideline-based placement of TMS in depression care. 

Noda Y, et al. JAMA Netw Open. 2025: Relapse prevention success ~85% at 24 weeks after rTMS monotherapy.