Questions about TMS

What does TMS treatment feel like?

Patients are seated comfortably in a chair and will feel a tapping sensation on their scalp during the treatment. Patients also hear a “clicking” noise. To prevent discomfort from the clicking noise, earplugs should be worn (and are provided). However, the risk of any permanent hearing loss is extremely low.

What happens after a TMS treatment?

The TMS technician will note any side effects the patient experienced during the treatment. Because there is no sedation or anesthesia, patients can leave immediately after their treatment and resume normal activities including driving.

How soon does TMS improve symptoms?

Most trials indicate that patients experience improvement by the 4th week of treatment. However, some patients may experience improvement before or after the 4th week.

Is TMS the same as ECT (electroconvulsive therapy)?

No, these treatments work on very different principles. The main difference is that ECT causes a generalized seizure and this is repeated usually on alternating days for several weeks. While ECT is overall more effective in treating depression, it is also associated with significant side effects including memory loss (which is usually short-term but can be longer-lasting). ECT also requires the patient to be under anesthesia which carries its own risks. Because of the confusion that usually occurs after ECT, patients undergoing ECT must have someone to care for them after their treatment. TMS patients can receive their treatment and return to their usual activities, including driving, immediately after their treatment.

How long does the effect last?

While the overall efficacy of TMS is still being investigated, clinical studies seem to indicate that 67% of patients have a good response to TMS (i.e. get 50% better) and that 45% of patients with a good response (get 70% better). Typically these rates are maintained a year later. About 7% of our patients come back for re-treatment.

Can TMS patients also take antidepressants?

The largest TMS trials have regularly included patients taking antidepressants concurrently with TMS therapy. There are no apparent safety risks to patients who take antidepressants before, during or after treatment with TMS.

Does TMS cause memory loss?

No. Multiple clinical trials have not shown any increase in memory loss with TMS treatment. This is an important difference from ECT where there is a risk of memory loss.

What is the history of TMS development?

TMS therapy has been used since the mid-1980s in research settings to investigate the functioning of different parts of the brain. The first TMS device was developed in 1985 by Dr. Anthony Barker of Sheffield, England. It began to be investigated for use as an antidepressant therapy in the 1990s. Neuronetics, the makers of the Neurostar TMS device, sponsored a study in 2007 (O’Reardon, et al 2007) that showed the efficacy of TMS in treating Major Depressive Disorder. The device was eventually FDA cleared in 2008. A subsequent NIH study (George, et al 2010) largely replicated the industry-sponsored study (O’Reardon, et al 2007).


Since then multiple studies have shown TMS treatment is effective in treating Major Depressive Disorder. Other studies have also shown promising results in other psychiatric and neurologic disorders. In 2013, Levkovitz, et al published a clinical trial that led to FDA approval of the deep TMS (dTMS) device made by Brainsway. Since then multiple studies have confirmed the efficacy of dTMS. Other indications have been FDA cleared recently, including anxious depression and OCD.

What TMS devices do you use?

At Active Path, we use devices from the leading manufacturers in the industry, including NeuroStar TMS Therapy and Brainsway. For more information click here.

What about other medications?

Most other medications can also be taken before, during and after a course of TMS. There are some medications that can increase the seizure risk with TMS and these should be discussed with your TMS provider.

Do patients ever come back for a re-treatment?

About 7% of our patients come back for re-treatment.