TMS therapy for depression

TMS (transcranial magnetic stimulation) is a non-invasive treatment for depression. A device placed against your head sends short magnetic pulses to the part of the brain that helps regulate mood, which tends to be underactive in depression. It's mostly used when antidepressants haven't helped enough. You're awake the whole time, there's no anesthesia, and you can drive yourself home and get on with your day.

How does TMS work?

During TMS, a coil placed against your scalp creates magnetic pulses, similar in strength to an MRI scan but aimed at one small area. The pulses pass through the skull and stimulate nerve cells in the prefrontal cortex, a region involved in mood. Repeated over several weeks, this stimulation appears to strengthen activity in the brain networks linked to depression.

The most common form is called repetitive TMS (rTMS). Some clinics use deep TMS, which reaches a little further into the brain, or theta burst stimulation, which delivers the pulses in a few minutes instead of 20 to 40.

Who is TMS for?

TMS is FDA-cleared for adults with major depression who haven't improved enough with at least one antidepressant. It has since been cleared for obsessive-compulsive disorder (OCD), and in 2024 for teens aged 15 and up with depression.

It may be a good fit if:

• You've tried one or more antidepressants without enough relief
• Side effects made it hard to stay on medication
• You'd like an option that doesn't add another daily pill

TMS usually isn't used if you have metal in or near your head (such as aneurysm clips, cochlear implants or certain stimulators; braces and dental fillings are fine), and it needs extra care if you've had seizures. Your clinician will go through a safety checklist with you.

If depression is what you're dealing with, the free depression self-check is a quick way to see how much it's affecting you before you talk to a clinician.

What happens during a TMS session?

You sit in a reclining chair, fully awake. The technician places the coil against your head and starts the pulses, which make a clicking sound (you'll wear earplugs) and feel like a light, repeated tapping on your scalp. A session lasts anywhere from about 3 to 40 minutes depending on the type. You can talk, watch TV or listen to music, and go back to work or drive right after.

At the first visit, the clinician measures the right spot and strength for you. A typical course is five sessions a week for four to six weeks, often around 36 sessions in all, sometimes with a few tapering sessions at the end.

How well does TMS work?

Many people improve. In studies of TMS in regular clinical practice, about half of people with hard-to-treat depression had a strong response, and about a third had their depression lift fully (remission). Improvement usually builds over the course, often becoming noticeable after two to four weeks.

Benefits often last months or longer. If symptoms come back, many people respond to another round of TMS.

What are the side effects of TMS?

Side effects are usually mild and fade during the first week or two:

• Scalp discomfort or tapping sensations where the coil sits
• Headaches, usually eased with an over-the-counter pain reliever
• Brief lightheadedness or facial twitching during the session

Seizures are a rare but serious risk; large reviews have found the risk to be low. Unlike electroconvulsive therapy (ECT), TMS doesn't require anesthesia and doesn't cause memory problems.

TMS vs medication and ECT

TMS is often the next step after antidepressants haven't worked, and many people stay on their medication during TMS. Electroconvulsive therapy (ECT) remains the most effective treatment for severe or very treatment-resistant depression, but it requires anesthesia and can affect memory for a time. TMS sits between the two: more involved than a pill, much less involved than ECT. Spravato (esketamine nasal spray) is another option at the same stage, and some clinics offer both.

How much does TMS cost?

Without insurance, TMS commonly costs about $200 to $400 per session, or about $6,000 to $12,000 for a full course of 30 to 36 sessions, according to 2026 price guides. Prices vary with your city, the clinic and the type of TMS. With insurance, most people pay their plan's copay or coinsurance for each session, after any deductible, which usually brings the cost down a lot.

Does insurance cover TMS?

Most major insurers and Medicare cover TMS for depression when you meet their criteria. These usually include a diagnosis of major depression and having tried a certain number of antidepressants (often two to four), and sometimes therapy. Insurers almost always require prior authorization, which the TMS clinic typically handles for you. Our insurance guides explain coverage with Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, Medicare and Medicaid.

Before you start, ask the clinic:

• Do you take my insurance, and will you handle the prior authorization?
• What will I pay per session, or for the full course?
• What happens if I miss a session?

See how much does therapy cost for how copays, deductibles and coinsurance work.

How do I get TMS?

TMS is prescribed and overseen by a psychiatrist and delivered at a TMS clinic, usually by a trained technician. Your current psychiatrist or primary care doctor can refer you, or you can contact a TMS clinic directly; many will do a free consultation and check your insurance. Our guide on how to find a psychiatrist can help if you don't have one yet.