Transcranial Magnetic Stimulation (TMS) Therapy: How It Works, Who It Helps, and What to Do If It Doesn’t

Transcranial Magnetic Stimulation (TMS) therapy has moved from niche research labs into everyday psychiatry clinics over the past 15 years. If you’ve tried multiple antidepressants, can’t tolerate side effects, or you’re looking for a noninvasive option that doesn’t involve anesthesia or systemic medications, TMS is probably already on your radar. But marketing copy often glosses over the hard questions people actually have: how long does TMS therapy last, is TMS permanent, is TMS right for me, what if TMS doesn’t work, can TMS make you tired, and more. You’ll find every one of those questions addressed directly in this article—along with dtms vs rtms, tms vs mert, tms for anxiety, tms cap, best TMS machines, and even the oddly phrased can TMS be short term for grieft (yes, we’ll address that head‑on and explain what people really mean by it).

Let’s get straight to it.

1) TMS in Plain English: What It Is and Why It Exists

TMS therapy uses rapidly alternating magnetic fields generated by a coil placed on your scalp to stimulate specific brain regions tied to mood, motivation, and cognitive control—most commonly the left dorsolateral prefrontal cortex (DLPFC) for depression. Those magnetic pulses induce small electrical currents that nudge underactive neural circuits toward healthier firing patterns. Unlike ECT, TMS does not require anesthesia, does not cause seizures (when done within safety guidelines), and does not produce memory loss. You sit in a chair, you’re awake the entire time, and after the session you drive yourself home or back to work.

Common practice: A standard course is five sessions per week for 4–6 weeks, followed by a taper (e.g., 1–2 sessions per week for several weeks) or planned maintenance. Individual parameters (frequency, intensity, train duration, inter-train intervals) are adjusted by your clinician based on mapping (motor threshold determination) and clinical response.

2) A (Very) Short Background

TMS was first demonstrated in the mid‑1980s as a safe way to stimulate the cortex. In 2008, the FDA cleared TMS for treatment‑resistant major depressive disorder. Since then, deeper coils (for deep TMS, or dTMS) and accelerated protocols have increased access, broadened indications (e.g., OCD, smoking cessation, migraine), and—more importantly—created pathways for coverage by insurers.

3) rTMS vs dTMS (dtms vs rtms): What’s the Practical Difference?

You’ll see dtms vs rtms discussed a lot. Here’s what matters:

• rTMS (repetitive TMS) typically uses a figure‑8 coil, which offers precise but relatively shallow stimulation (roughly 1–2 cm below the skull).

• dTMS (deep TMS) uses an H‑coil, which sits inside a helmet or TMS cap‑like device (more on that term shortly), designed to reach deeper cortical and subcortical structures. Some studies report higher response and remission rates with dTMS in depression and OCD, but not every head‑to‑head trial agrees. Cost, availability, and how your insurance contract is written often determine which one you’ll end up with.

Bottom line: The best choice between dtms vs rtms is the one you can access, afford, and complete—administered by a team that knows exactly what they’re doing and will pivot if you aren’t improving on schedule.

4) How a Typical Course Actually Feels

You’ll do an initial mapping session. The clinician finds your motor threshold (the lowest power that can make your thumb twitch), then calibrates treatment intensity as a percentage of that number—often around 100–120% of motor threshold. From there:

• Session length: 3 to 40 minutes, depending on protocol. Traditional rTMS can be 20–40 minutes. Intermittent theta burst stimulation (iTBS) protocols can cut that to around 3 minutes. dTMS sessions typically land around 20 minutes.

• Sensations: Tapping or knocking on the scalp, sometimes unpleasant at first. Headache and scalp discomfort are the most common side effects, and they often fade in the first week or two.

• Aftercare: You can return to your routine immediately. No sedation, no recovery room.

5) “How Long Does TMS Therapy Last?” — Two Meanings, Two Answers

This phrase gets misinterpreted, so let’s separate it:

A) How long does a course of TMS therapy last?

About 4–6 weeks of daily weekday sessions, followed by a taper or maintenance schedule. If you’re using accelerated protocols (e.g., SAINT or multi‑sessions per day research protocols), the calendar duration drops, but your total number of pulses is still substantial.

B) How long do the benefits last?

Durability varies. Many patients hold benefit for months to a year (or longer) after a full course. Is TMS permanent? No—TMS is not permanent for most people. Think of it like resetting and strengthening neural networks. Life stress, biological predisposition, and co‑occurring conditions can erode the gains over time. Booster or maintenance sessions are common and can re‑establish symptom control.

6) “Is TMS Right for Me?” — The Hard Criteria and the Real‑World Judgment Calls

Clinically, is TMS right for me usually gets answered by a combination of:

Treatment resistance: You’ve failed (or can’t tolerate) at least one or two antidepressant trials.

Diagnosis: Major depressive disorder is the most common. There is also TMS for anxiety, especially when it’s tied to depression or OCD. TMS is FDA-cleared for OCD and smoking cessation, and used off-label for PTSD, pain, and others.

Safety: No ferromagnetic metal in the head (outside the mouth), no active seizure disorder, not pregnant (varies by clinic), and no unstable medical issues.

Commitment: TMS only works if you show up, consistently, for weeks. If logistics are a nightmare, your chances of completing the protocol drop—and so do your odds of response.

If you check the boxes and you can commit to the time, TMS is a reasonable, evidence-supported option. Clinics like MidCity TMS, which specialize exclusively in transcranial magnetic stimulation, can provide a thorough evaluation to determine if you’re a strong candidate.

Most patients start noticing subtle shifts around week 2–3—sleep improves, suicidal ideation softens, energy stabilizes, irritability drops. The big gains often consolidate by week 4–6. Some people are “late responders” and explode with progress during taper or in the few weeks after finishing the protocol. If nothing moves by week 3, a good clinic reassesses coil placement, intensity, protocol, or diagnosis.

8) Side Effects You Actually See in Practice (Including “Can TMS Make You Tired?”)

Can TMS make you tired? Yes. Fatigue is a real and common side effect, usually mild and temporary. Other typical effects:

• Headaches (early weeks, usually responsive to OTC analgesics)

• Scalp discomfort or facial muscle twitching during pulses

• Temporary anxiety bump (seen in a minority; often settles after a few sessions)

• Rare: Seizure (extremely uncommon when safety rules are followed)

One more unsexy truth: boredom. Daily sessions for 4–6 weeks can feel like a grind. Be ready for that, mentally and logistically.

9) The Equipment Arms Race: “Best TMS Machines”

You’ll see clinics brag about having the best TMS machines. The truth:

• NeuroStar, MagVenture, Magstim → common for rTMS

• BrainsWay → known for dTMS (deep TMS) with the H‑coil system

• CloudTMS, Nexstim → niche or specialized use cases (e.g., neuronavigation)

“Best” depends on: indication, coil type, clinician’s familiarity, insurance recognition, and sometimes the speed of the protocol (e.g., iTBS support). A mediocre protocol on the fanciest machine won’t beat a well‑run clinic using a “boring” system.

10) The “TMS Cap” Explained

You asked for tms cap, so let’s demystify it. In some contexts, “TMS cap” refers to:

1. A tight fitting cap used to mark and maintain coil placement across sessions (especially in rTMS), or

2. The helmet‑style headgear used in dTMS systems like BrainsWay that house the H‑coil.

Either way, it’s about consistency and depth: consistent targeting for rTMS, deeper coverage for dTMS.

11) “What If TMS Doesn’t Work?”

It happens. The industry loves to quote response/remission rates, but a huge minority of patients don’t respond. If that’s you, don’t waste time pretending it’s working:

• Reassess targeting (are we really over the left DLPFC? neuronavigation can help)

• Increase intensity (if tolerated and still below safety limits)

• Switch from rTMS to dTMS (or vice versa)

• Try accelerated or theta burst protocols

• Layer psychotherapy during or right after TMS to lock in gains

• Move to ECT, ketamine/esketamine, VNS, DBS, or other neuromodulation routes if severity and history justify it

If a clinic can’t explain a plan for what if TMS doesn’t work, find one that can.

12) TMS for Anxiety: Where Things Stand

TMS for anxiety isn’t FDA‑cleared as a standalone indication, but anxiety symptoms commonly improve when depression improves, and OCD is FDA‑cleared for dTMS. There’s also mounting interest in targeting right DLPFC or medial prefrontal regions for anxiety and PTSD. Bottom line: yes, TMS can help anxiety, especially when it’s entangled with depression, but don’t expect uniform protocols or guaranteed reimbursement.

13) Maintenance, Boosters, and “Is TMS Permanent?”

We’ve touched this, but it’s worth isolating. Is TMS permanent? No—neurobiology isn’t static. Think of TMS as reopening a window of neuroplasticity. What you do during and after that window—therapy, sleep, exercise, stress management, substance use reduction—matters. Many patients get booster sessions: a few treatments every couple of months, or an abbreviated series when symptoms flicker back. This is normal and clinically sensible.

14) TMS vs MERT: What You Need to Know

You asked for tms vs mert. MERT (often branded as MeRT, “Magnetic e‑Resonance Therapy”) is a proprietary, EEG‑guided, customized rTMS protocol marketed for a wide range of conditions (depression, TBI, autism, PTSD). The sell is personalization—EEG plus rTMS tuned to your unique brain rhythms. The problem is a lack of high‑quality, independent, peer‑reviewed evidence to claim superiority over standard rTMS/dTMS. Clinics may charge a premium. Some patients swear by it. If you’re considering it, demand clarity on outcomes, protocol specifics, and why they believe it will outperform a standard, insured TMS protocol in your case.

Short version: TMS vs MERT often boils down to insurance‑covered, standardized evidence‑based TMS vs cash‑pay, proprietary, promising but under‑validated EEG‑guided TMS. Your risk tolerance, budget, and how desperate you are after multiple failures will drive this decision.

16) Can You Do TMS While on Meds? With Therapy? With Ketamine?

Yes, yes, and yes. TMS is commonly run alongside medications (though many patients cut back during or after if symptoms remit). Pairing TMS with psychotherapy can lock in cognitive and behavioral gains that your brain plasticity window makes more possible. Some clinics combine TMS + ketamine/esketamine—data is emerging, practice is growing, and the logic is sound (different mechanisms, potential synergy), but cost and logistics can be heavy.

17) Who Should Not Do TMS?

• Metal implants in the head/neck (aneurysm clips, cochlear implants, deep brain stimulators) that are ferromagnetic or otherwise not TMS‑safe

• Uncontrolled epilepsy/seizure disorders

• Severe cardiac arrhythmias with sensitive implanted devices

• Inability to sit still or cooperate for sessions (e.g., severe agitation)

• Pregnancy is a gray zone—some centers will treat with caution, others won’t

18) The Business Reality: Access, Cost, and Insurance

If you’re in the U.S., insurance often covers TMS for treatment‑resistant major depression (and OCD with certain devices), but requirements vary. Expect to document:

• Number of med trials

• Adequate dose/duration

• Trial of psychotherapy

• PHQ‑9 or MADRS scores showing severity

Cash pay costs vary wildly: $6,000–$15,000+ for a full course. Accelerated or boutique protocols can be more.

19) Red Flags When You’re Shopping for a Clinic

• Guarantees (“We guarantee remission”) — run.

• No reassessment plan if you’re not improving by week 3.

• No mention of mapping, motor threshold, or protocol flexibility.

• Vague about device, parameters, or indications.

• Aggressive upsell of unproven add-ons without clear rationale.

20) The Future: Faster, Smarter, More Individualized

• iTBS (theta burst) — 3‑minute sessions, similar efficacy to 37‑minute rTMS in many studies.

• Accelerated TMS (e.g., SAINT) — multiple iTBS sessions per day over 5 days with striking results in some trials. Not standard of care yet, but expanding.

• Closed‑loop / EEG‑guided TMS — real‑time biomarker targeting; promising but early.

• New targets (e.g., medial prefrontal cortex for compulsivity, trauma circuits for PTSD) — watch this space.

21) Quick Recap

• how long does tms therapy last → The course is 4–6 weeks; benefits can last months to a year, but is TMS permanent? No—maintenance may be needed.

• is tms right for me → If you have treatment‑resistant depression or OCD, can commit to daily sessions, and meet safety criteria, probably yes.

• is tms permanent → No. Durable, not permanent. Maintenance is common.

• tms cap → Either the fitted mapping cap for rTMS or the helmet used in dTMS.

• what if tms doesn't work → Reassess, adjust, switch to dTMS, consider iTBS/accelerated, combine with therapy/meds, or move to ECT/esketamine.

• best tms machines → NeuroStar, MagVenture, Magstim (rTMS); BrainsWay (dTMS). Best = what’s clinically appropriate, well delivered, and accessible.

• can tms be short term for grieft → Not typically; grief alone isn’t the target. If it converts to major depression, TMS can help.

• can tms make you tired → Yes, fatigue is common but usually mild and transient.

• dtms vs rtms → dTMS = deeper, broader stimulation (H‑coil). rTMS = focused, shallower (figure‑8). Efficacy differences vary; access and clinician skill matter.

• how long does it take for tms to work → Often weeks 2–4, with full response by week 4–6 for many.

• tms for anxiety → Indirectly helpful, especially when anxiety is tied to depression or OCD; ongoing research.

• tms vs mert → MERT (MeRT) is proprietary, EEG‑guided, cash‑pay, and under‑validated versus standard insured TMS. Buyer beware.

Bottom Line

TMS is not magic and not permanent, but it is real, evidence‑supported, and often life‑changing for people who’ve been stuck in the revolving door of meds and side effects. If you’re considering it, ask hard questions, choose a clinic that treats you like a data point and a person, and make sure they have a Plan B if you’re not improving by the midway point. And if you’re chasing the best TMS machines, don’t forget: the best outcomes come from the best execution, not just the shiniest hardware.

Solace Health Group conducts thorough research, includes trusted citations, and ensures all content is reviewed for accuracy. However, this article is not medical advice and should not replace professional evaluation or treatment. Always consult a licensed healthcare provider before making any medical or treatment decisions.

References:
https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625

https://www.healthline.com/health/tms-therapy

https://www.verywellhealth.com/tms-therapy-5219807

https://en.wikipedia.org/wiki/Transcranial_magnetic_stimulation

https://www.brainsway.com/knowledge-center/what-is-deep-tms/

https://www.neurostar.com/tms-treatment/

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https://www.cognitivefxusa.com/blog/repetitive-tms-vs-deep-tms

https://www.psychologytoday.com/us/blog/urban-survival/202302/tms-therapy-for-anxiety-and-depression

https://www.psychiatry.org/patients-families/tms

https://www.fda.gov/news-events/press-announcements/fda-clears-deep-transcranial-magnetic-stimulation-system-obsessive-compulsive-disorder

https://www.nimh.nih.gov/health/publications/brain-stimulation-therapies

https://www.tmsclinic.com/tms-vs-mert/

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https://www.neuromodulation.com/tms