Transcranial Magnetic Stimulation (TMS)

Transcranial magnetic stimulation is a pain-free, noninvasive treatment that uses magnetic pulses to trigger nerve cells in your brain. It may help manage conditions like depression, obsessive-compulsive disorder and certain types of migraine. Some types of TMS can also help reduce smoking for a short period.

TMS works by using a small coil placed on your head. It sends magnetic pulses into your brain. These pulses pass through your skull and create tiny electrical signals in your nerve cells underneath. Depending on the pulse pattern, TMS can help wake up underactive areas or calm overactive areas.

If you’ve tried other treatments without much success, your provider may consider TMS as the next step.

Types of TMS treatment

There are a few different ways you can get TMS. The main differences are in how the pulses are delivered, how long each session lasts and how deep the stimulation reaches in your brain:

• Repetitive TMS (rTMS): It uses repeated magnetic pulses to the same spot on your head. Pulses can be slow or fast, depending on your treatment plan. Sessions often take 20 to 40 minutes.
• Theta-burst stimulation (TBS or iTBS): It uses very quick bursts of pulses. Because it’s faster, sessions can take about three to 10 minutes.
• Deep TMS (dTMS): It uses a special, helmet-like coil that can reach deeper brain circuits. It’s FDA-cleared for depression and OCD. One deep TMS approach is cleared to help with quitting smoking in the short term.
• Accelerated TMS (aTMS): One well-known example is Stanford Neuromodulation Therapy (sometimes called the SAINT-style approach), an accelerated form of theta-burst stimulation delivered in several brief sessions per day for about five days in specialized settings. In 2025, the FDA also cleared an accelerated deep TMS protocol for major depressive disorder.

Your provider may recommend different types based on your symptoms and how your brain responds.

What conditions does TMS manage?

TMS may help when other treatments haven’t worked well. In the United States, the FDA cleared different TMS devices and protocols for:

• Major depressive disorder (including treatment-resistant depression)
• Migraine with aura (for acute migraine pain, using a handheld single-pulse TMS device)
• Obsessive-compulsive disorder (OCD)
• Quitting smoking (supporting short-term quitting with a deep TMS protocol)

Researchers are also studying TMS to see if it can help with other conditions, like:

• Alzheimer’s disease
• Bipolar disorder
• Borderline personality disorder (BPD)
• Chronic pain
• Eating disorders
• Essential tremor
• Fibromyalgia
• Generalized anxiety disorder
• Parkinson’s disease
• Post-traumatic stress disorder (PTSD)
• Schizophrenia
• Stroke complications
• Substance use disorder
• Tinnitus and auditory hallucinations
• Traumatic brain injury

Who is a good candidate for TMS therapy?

TMS can be a helpful option if you haven’t had enough relief from other treatments, like medication or therapy. Many adults with depression or OCD benefit from it. It gives you another choice that doesn’t involve anesthesia or surgery.

Who isn’t a good candidate for TMS therapy?

TMS isn’t safe for everyone. It may not be a good fit if you have:

• Metal or electronic implants in your head or neck: This includes cochlear implants, metal plates or certain clips or wires. The magnet used in TMS can move these devices and cause harm. Most metal in the rest of your body, like hip or knee replacements or dental fillings, is safe.
• Non-removable metal near the area where the TMS coil is: This includes aneurysm clips or coils, implanted brain stimulators, cardiac pacemakers or defibrillators, stents or any metallic implants. It also includes shrapnel or foreign objects in your head or neck.
• A history of seizures or epilepsy: TMS very rarely causes seizures. But the risk is higher if you already have a seizure disorder or take medications that increase seizure risk. Your provider may recommend adjusting your medicines or choosing another treatment.

Your provider will review your medical history. They’ll talk through any risks to decide whether TMS is right for you.

What happens before transcranial magnetic stimulation?

Before treatment, you’ll meet with your healthcare provider for a screening and exam.

Your provider will explain how TMS works and what you can expect during each session. You can eat and drink normally beforehand. And it helps to wear comfortable clothing.

For safety, your provider may recommend that someone drives you to and from your first appointment. Make this plan ahead of time.

What happens during TMS treatment?

The steps might vary slightly depending on the type and clinic where you get treatment. Here’s what you could expect:

1. Getting ready: You’ll remove any metal items, like glasses with metal frames or jewelry. This keeps you safe around the magnet.
2. Setting up the machine: You’ll sit in a reclining chair. The TMS machine has a coil your provider will place on your head. It may be inside a helmet or attached to an arm that your provider positions near you.
3. Putting on hearing protection: Your provider will give you earplugs or headphones. The machine makes loud clicking sounds. This protects your ears.
4. Positioning the coil: Your provider will place the coil or helmet on the right spot on your head. This depends on the condition you’re being treated for.
5. Adjusting the settings: Before the session starts, your provider will send a few test pulses. You may feel tapping on your scalp or feel your hand or thumb twitch. This is normal and helps them set the correct strength.
6. Beginning treatment: The machine will deliver repeated magnetic pulses. You’ll hear clicking sounds and feel light head tapping.
7. Ending treatment: Your provider will turn off the machine and take the coil off your head. You can remove your hearing protection.

Depending on the type of TMS you’re getting, a session can last about three minutes up to around 40 minutes. Accelerated programs may include more than one session in a day.

TMS benefits

This treatment may help manage certain mental health conditions, especially when other therapies didn’t offer the right symptom relief.

Here are some possible benefits:

• It’s noninvasive. TMS doesn’t involve surgery, needles or anesthesia. You’re awake the whole time. And you can go back to your day after the session.
• It has a good safety record. Most side effects are mild and short-lasting, like scalp discomfort or a headache. Serious side effects, like seizures, are very rare.
• It may ease symptoms. Many people notice improvements in depression, OCD or other conditions.
• You can combine it with other treatments. TMS often works alongside medications and therapy. Using these together may improve overall results.
• It offers another option. TMS may be an option when other treatments, like medications or ECT, aren’t recommended or haven’t helped enough.

Your provider will help you understand the benefits for your situation.

TMS treatment side effects

Most people don’t have side effects. If they do happen, they’re usually mild and improve quickly after each session. TMS doesn’t cause memory loss or problems with thinking.

Common side effects include:

• Headache or scalp discomfort
• Mild facial twitching

Seizures are the most severe side effect, but they’re very rare. Your provider will check your medical history and watch you during treatment to make sure you’re safe.

What happens after a TMS session?

After your session, you can go back to your normal day. If you have mild side effects, like a headache, your provider may ask you to rest for a few minutes before leaving. These symptoms usually fade quickly. You might notice condition improvement within a couple of weeks.

How long do I need TMS?

TMS usually requires a series of treatments. A common schedule is five days a week for four to six weeks (often about 30 to 36 sessions for depression-related protocols, though this can vary by device and diagnosis). Some accelerated programs deliver multiple short sessions per day over about five days. This can shorten the overall treatment timeline in certain centers.

Your provider will explain the plan that’s right for you. They’ll tell you how many sessions you’ll need and how long your treatment should last. Some people benefit from “maintenance” sessions or an additional short course later if symptoms return.