TMS is an outpatient depression treatment for people whose medicine has not worked. Here are five things to settle before the first session.
Transcranial magnetic stimulation treats depression with magnetic pulses on the scalp. There is no surgery and no anesthesia. A standard course runs five days a week for four to six weeks.
A coil held against your head sends magnetic pulses through the skull. They create small electrical currents in the nerve cells underneath, in the part of the brain involved in mood.
Below are the five things to settle before the first appointment. You will also see what the screening asks about and which side effects are common. None of it means stopping the treatment you are already on.
Five things to settle before your first TMS session
TMS is not so much a last resort as a next step, and the order matters.
The FDA has approved it. Mayo Clinic says it is usually used only when other depression treatments have not worked (Mayo Clinic, 2023). Here are the five points that decide whether it fits.
- It is for depression that has not responded to medicine. Mayo Clinic says TMS is usually used only when other depression treatments have not worked. Most policies cover it but require a minimum number of antidepressants to have been tried already.
- The schedule is five days a week for four to six weeks. The National Institute of Mental Health says a typical course of repetitive TMS is daily sessions five days per week for four to six weeks. Cleveland Clinic puts a common depression course at about 30 to 36 sessions.
- A session lasts three to forty minutes, and you stay awake. Cleveland Clinic says a session can run from about three minutes up to around 40 depending on the type. Mayo Clinic says the newest pattern, intermittent theta burst stimulation, needs only 3.5 minutes.
- Metal in your head or neck can rule you out. Cleveland Clinic says TMS may not be safe with cochlear implants, aneurysm clips or coils, implanted brain stimulators, pacemakers or defibrillators. Most metal elsewhere, such as a hip replacement or a filling, is safe.
- A seizure history raises the risk and changes the plan. Cleveland Clinic says TMS very rarely causes seizures, but the risk is higher with a seizure disorder or with medicines that increase seizure risk. Your provider may adjust medicines or choose another treatment.
That schedule is the part people underestimate. It is a daily commitment.
What the first appointment does that the rest do not
The first visit runs longer than the rest, because it is a measuring session.
Cleveland Clinic says your provider sends a few test pulses first (Cleveland Clinic, 2026). You may feel tapping on your scalp. Your hand or thumb may twitch. That is how the strength is set.
Mayo Clinic says that mapping appointment usually lasts about an hour. The coil placement and dose are normally set only once.
Every session after that uses the measurements from the first. You sit in a reclining chair, wear earplugs, and hear a rapid tapping while the machine runs.
Unlike electroconvulsive therapy, repetitive TMS does not cause seizures or memory loss.
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⬇ Download your plan (PDF)Which side effects are common and which are rare
Most people get through a course with nothing worse than a sore scalp.
The National Institute of Mental Health says repetitive TMS is safe and well tolerated (National Institute of Mental Health, 2024). The side effects it lists are discomfort where the magnet sits, tingling of the scalp, jaw or face, mild headaches and brief dizziness.
Cleveland Clinic says seizures are the most severe side effect and are very rare. TMS does not cause memory loss or problems with thinking.
Mayo Clinic names two uncommon ones worth knowing. Emotional highs called mania, mostly in people with bipolar disorder. Hearing loss if the ears are not well protected.
Three things people get wrong about TMS
Three beliefs about TMS travel further than the evidence behind them.
TMS is the same as shock therapy. It is not. Electroconvulsive therapy applies electricity directly to the head. The National Institute of Mental Health says repetitive TMS instead uses low intensity magnetic pulses aimed at one brain site, without anesthesia.
It wipes out your memory. It does not. Mayo Clinic says that unlike electroconvulsive therapy, repetitive TMS does not cause seizures or memory loss. Cleveland Clinic says the same.
You have to stop your antidepressant. You do not. Cleveland Clinic says TMS often works alongside medications and therapy, and that using them together may improve results. NIMH says a treatment plan usually also includes psychotherapy, medication, or both.
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This article is education, not medical advice. The National Institute of Mental Health says brain stimulation therapies should be prescribed and monitored by a provider with specific training. If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide and Crisis Lifeline at 988. Ageless Coach is an affiliate partner and may earn a commission on purchases made through links on this page.