What Is TMS Therapy? A Plain-Language Guide for Patients Considering It

TMS therapy was cleared by the FDA in 2008, and more than 6.4 million treatments have since been performed on over 175,000 patients across the United States. Despite that track record, many people researching it for the first time still have a basic question: what is it actually doing to the brain, and is it safe? This guide answers that plainly.

The Basic Explanation

Transcranial magnetic stimulation — TMS — is a non-invasive procedure that uses magnetic pulses to stimulate specific areas of the brain involved in mood regulation. It does not require surgery, anesthesia, or medication of any kind. The technology is similar in principle to MRI: a magnetic coil is positioned near the head, and precisely targeted electromagnetic pulses are delivered to brain regions that are underactive in patients with depression, prompting neurons to fire and neurotransmitters to release.

You sit in a reclining chair during treatment. You are fully awake. There is no sedation, no recovery room, and no restriction on driving yourself home afterward. For most patients, each session involves a mild tapping sensation near the treatment site. That sensation typically diminishes after the first week (National Institute of Mental Health).

Why Magnetic Pulses Affect Mood

The brain regions most closely associated with depression — particularly the prefrontal cortex — show reduced activity in patients with major depressive disorder (MDD). TMS targets those regions directly, stimulating neural activity in a way that medication reaches only indirectly, through the bloodstream and systemic neurotransmitter pathways.

One of the more significant findings in TMS research is that its effects extend beyond the treatment period. Studies show TMS promotes neuroplasticity — the brain’s capacity to form and strengthen neural connections — which helps explain why many patients maintain improvement after their treatment course ends, not just while sessions are ongoing (National Center for Biotechnology Information). This is not a mechanism unique to antidepressants, and for patients who cannot tolerate or have not responded to medication, it offers a genuinely different route to relief.

The evidence base supporting TMS is substantial and peer-reviewed. Its FDA clearance history and clinical evidence have been documented across multiple independent studies (National Center for Biotechnology Information).

What TMS Is FDA-Cleared to Treat

TMS carries FDA clearance for four specific indications. The first and most established is major depressive disorder in adult patients who have not achieved satisfactory improvement from prior antidepressant medication. The second is MDD with comorbid anxious depression — major depression accompanied by significant anxiety symptoms — which TMS can address simultaneously. The third is obsessive-compulsive disorder (OCD) in adults, where TMS is used as an adjunct treatment alongside other care. The fourth is major depressive disorder in adolescent patients between the ages of 15 and 21, also as an adjunct.

Outside these cleared indications, research has explored TMS applications for other conditions. We only offer TMS for its FDA-cleared indications at Cohen & Associates. If your situation involves a different condition or presentation, your evaluation will clarify what options are available and appropriate.

What Makes Precision TMS Different

Not all TMS is delivered the same way. At Cohen & Associates, we are the only practice in the Sarasota region offering neuronavigated, precision-based TMS using the NeuroStar Advanced Therapy System. We use visor2™ neuronavigation technology to more exactly target TMS pulse delivery — applied with or without MRI assistance — which increases treatment precision and consistency across sessions.

Our TMS program is coordinated and delivered by Samantha Hagan, our TMS coordinator, who brings several years of experience across multiple TMS devices and has served as a corporate trainer for two separate TMS organizations. Precision in coil placement matters clinically. The same magnetic pulse delivered to a slightly different location produces a different result, and neuronavigation reduces that variability.

Sessions at our practice run in as little as three minutes for some protocols, with a standard range of three to twenty minutes. The recommended treatment course is six weeks of daily sessions, five days a week. Many patients notice changes within two to three weeks of starting.

What to Expect from Side Effects

TMS has a well-documented side effect profile, and it compares favorably to most psychiatric medications. The most common experience is temporary discomfort or tapping at the treatment site, which occurs during sessions and generally resolves within the first week of treatment (National Institute of Mental Health). There is no weight gain, no sexual dysfunction, no systemic drug burden, and no cognitive impairment associated with TMS. There is a rare risk of seizure of less than 0.1% per patient — a figure comparable to the seizure risk associated with several antidepressant medications.

TMS is also free from the withdrawal considerations that apply when stopping certain psychiatric medications. Patients who complete a course of TMS and see improvement are not then managing a taper or discontinuation process.

Results vary by individual. Two in three patients who complete a TMS course report remission of depression symptoms — a meaningful figure, though not a guarantee. We do not promise specific outcomes, and we discuss what the evidence realistically supports for your presentation during evaluation.

Addressing the Practical Concerns

The time commitment for a TMS course is real: six weeks of sessions, typically five days per week. For working patients, this means planning around your schedule. Sessions at our practice are short — some protocols complete in three minutes — and because no sedation is involved, you can return to work, drive, and carry on your day immediately after each appointment.

On insurance and cost: coverage for TMS varies by plan and clinical presentation. Because we operate a direct-care practice, the insurance process works differently than in a standard in-network setting. Our team verifies your specific coverage and handles prior authorization before treatment begins, so you have a clear financial picture before committing. For patients without applicable coverage, self-pay options are discussed during the consultation. We do not publish session pricing on our website; those conversations happen directly and before any treatment begins.

FAQ

Is TMS the same as electroconvulsive therapy (ECT)?

No. ECT — electroconvulsive therapy — involves delivering an electrical current that intentionally induces a seizure, requires general anesthesia, and carries significant memory-related side effects. TMS uses magnetic pulses, does not induce a seizure, requires no anesthesia, and is performed while you are fully awake. The two treatments share a general category of brain stimulation, but the mechanisms, side effect profiles, and patient experiences are entirely different.

Can TMS be used alongside medication?

Yes, in many cases. TMS is not a replacement for medication management — it is often used alongside existing psychiatric medications. Whether to adjust your current medications during a TMS course is a clinical decision made by your provider. Discuss your full medication history during your evaluation.

How do I know if my depression qualifies?

The primary qualifying criterion for adult TMS is major depressive disorder with inadequate response to at least one prior antidepressant medication. Your evaluation will establish whether your history and presentation meet clinical criteria. If your situation is less clear-cut — partial medication response, multiple medication trials, or additional diagnoses — the evaluation process is designed to sort through exactly that. Learn more about TMS candidacy criteria at our practice.

What happens if TMS doesn’t work for me?

TMS does not produce sufficient improvement in every patient. If it is not working, we do not simply continue the same course — we reassess. Other options, including ketamine-assisted psychotherapy, SPRAVATO® (esketamine nasal spray), and medication management adjustments, remain on the table. The evaluation process at our practice is ongoing, not a single decision point.

Is the NeuroStar system different from other TMS devices?

NeuroStar is an FDA-cleared TMS system with a substantial body of clinical evidence behind it. Combined with the visor2™ neuronavigation technology we use, it allows for more precise targeting than standard TMS delivery. Not all TMS providers use neuronavigation; our practice does, and it is one of the features that distinguishes our program.

Key Takeaways

• TMS is a non-invasive, medication-free procedure using magnetic pulses to stimulate underactive brain regions — no surgery, no anesthesia, no sedation required.
• TMS is FDA-cleared for major depressive disorder, anxious depression, OCD, and adolescent depression (ages 15–21).
• Cohen & Associates is the only practice in the Sarasota region offering neuronavigated, precision-based TMS using the NeuroStar system and visor2™ technology.
• Side effects are typically mild and transient; there is no systemic medication burden and no withdrawal process.
• Results vary by individual; a new patient evaluation is the first step to determining whether TMS is appropriate for your specific presentation.

If you have been trying to get a clear picture of what TMS actually involves before deciding whether it is worth pursuing, that is the right instinct. At Cohen & Associates, we will give you the same honest assessment in person. Call us at 941-559-8500 or use our online contact form to schedule a new patient evaluation.

References

1. Mayo Clinic. Transcranial magnetic stimulation overview. https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625
2. National Center for Biotechnology Information. TMS FDA approval and evidence base. https://pmc.ncbi.nlm.nih.gov/articles/PMC8864803/
3. National Center for Biotechnology Information. TMS therapy and neuroplasticity. https://pmc.ncbi.nlm.nih.gov/articles/PMC9313265/
4. National Institute of Mental Health. TMS safety and side effects. https://www.nimh.nih.gov/news/media/2020/sarah-h-lisanby-transcranial-magnetic-stimulation-safety-and-risk
5. National Center for Biotechnology Information. Deep TMS evidence and FDA clearances. https://pmc.ncbi.nlm.nih.gov/articles/PMC10523198/

Medical Disclaimer
The information in this blog is for educational purposes only and does not constitute medical advice. Transcranial magnetic stimulation and other psychiatric treatments should only be pursued under the supervision of a licensed psychiatric provider familiar with your full medical and psychiatric history. Individual results vary. NeuroStar Advanced Therapy is only available by prescription. A doctor can help decide if TMS therapy is right for you. If you are experiencing a mental health crisis or thoughts of self-harm, please call or text 988 to reach the Suicide and Crisis Lifeline or go to your nearest emergency room.