Depression is a leading cause of disability in the US, and for many, first-line approaches such as antidepressants and Cognitive Behavioral Therapy (CBT) don’t offer relief.
Patients with treatment-resistant depression (TRD) have only a 20% chance of achieving remission and have increased rates of hospitalization, self-harm, and suicide attempts, underscoring the need for innovative therapeutic approaches such as Transcranial Magnetic Stimulation (TMS) [1].
TMS is a leading treatment for TRD, with studies showing over 60% of patients are responsive to treatment, offering new hope for those who struggle with chronic depression [2].
Read on to learn more about TMS for treatment-resistant depression, what to expect during a session, and how it could help improve your quality of life.
What Is Transcranial Magnetic Stimulation (TMS)?
Transcranial Magnetic Stimulation (TMS) is a noninvasive form of brain stimulation designed to target regions in the brain that regulate emotions and cognitive functioning. By delivering small magnetic pulses and vibrations via a coil placed over the head, it is thought to strengthen pathways in the brain and stimulate nerve cell activity that impacts mental health conditions and chronic pain.
TMS was FDA-approved in 2008 for Major Depressive Disorder and has since grown as an effective therapy for treatment-resistant cases of not only depression but also other mental health problems, including anxiety, mood disorders, and substance abuse.
Is TMS Electroshock Therapy?
Some patients see the coils used in TMS and get intimidated, often wondering, “Is TMS like electroshock therapy”? No, it is not. ECT uses controlled electrical current to induce seizures under anesthesia and can cause temporary memory loss.
It is still used today, but only for rare, life-threatening depression, especially when other TRD treatments have failed. TMS is considered a safer, less invasive option with little to no side effects.
What Is Treatment-Resistant Depression (TRD)?
Treatment-resistant depression (TRD) is a type of major depressive disorder (MDD) that occurs when at least two first-line antidepressants have failed to improve symptoms.
The antidepressants must be at the correct dose, and the duration should be at least 6 to 8 weeks before a mental health provider can diagnose TRD. TRD affects around 30% of adults with MDD in the US (approximately 2.8 million individuals) [3].
What Causes Treatment Resistance in Mental Health?
Treatment-resistant depression is caused by a combination of several factors, including medication, misdiagnosis, lack of awareness around co-occurring conditions and trauma, and incomplete therapy [1] [4].
- Medications: Incorrect regimens, only taking one antidepressant, being on the wrong kinds of meds, or the wrong dose.
- Misdiagnosis: Incorrect or incomplete diagnosis, especially if the condition shares similar symptoms with other mental health conditions or substance use disorders.
- Incomplete Treatment: Lack of regular therapy or follow-up sessions. Individuals with treatment-resistant mental health conditions often require long-term treatment.
- Lack of Specialized Care: Certain mental health conditions, such as eating disorders or personality disorders, often require integrated care and specialized services that typical treatment programs or regimens don’t offer.
Is TMS Effective for TRD?
TMS is one of the leading therapies for treatment-resistant depression, with strong evidence that it is an effective option for symptom relief [5] [6].
- A 2022 study found that 63% of patients with TRD respond to TMS, with 42% achieving remission.
- A randomized 2025 clinical trial found that TMS was as effective as lithium in preventing the recurrence of depression and other mood disorders, with fewer adverse side effects.
- Patients with severe treatment resistance (failed 4+ antidepressants) had a 37% response rate to TMS therapy and a 19% remission rate.
Can TMS Help With Other Mental Health Conditions?
Currently, TMS is only FDA-approved for the treatment of Major Depressive Disorder; however, there are currently large trials looking at the effectiveness of TMS for conditions such as obsessive-compulsive disorder (OCD), pediatric depression, bipolar disorder, and smoking cessation.
Although TMS for these conditions is not yet approved, they may be used “off-label” to provide adequate relief.
What Can I Expect in My TMS Session?
TMS sessions typically begin with the technician placing a magnetic coil over your scalp, targeting the brain region. This delivers gentle, magnetic pulses that stimulate regions such as the prefrontal cortex involved in emotional regulation, mood, and impulsivity.
During the session, you remain fully awake and can listen to music, relax, or talk with your technician. Most patients do not fall asleep during their sessions as the TMS machine can get loud, similar to an MRI.
TMS sessions typically last 20 to 40 minutes. You will likely hear clicking sounds, vibrations, or tapping on your head. Sessions typically occur daily, 4 to 5 times a week, over 4 to 6 weeks. Your provider will monitor progress and can make adjustments as needed to improve the outcome of your results.
TMS Mapping in Your First Session
Your first TMS session may include “mapping”. The clinician will measure your motor threshold (the minimal level of stimulation needed to trigger a muscle twitch) by delivering single pulses and observing muscle responses to ensure the coil is correctly placed and the pulse intensity is tailored to your specific needs.
Side Effects of TMS
TMS is non-invasive, requires no anesthesia, and typically has few side effects reported. The most common side effect is a headache, although this usually resolves shortly after treatment.
Individuals who are considered high-risk, such as those with epilepsy, traumatic brain injury, or other neurological issues, are typically not good candidates for TMS, as it can increase the risk of seizures.
What Is The Typical Cost of TMS Therapy?
The out-of-pocket cost of TMS can range from $6,000 to $15,000 for a full course of treatment, consisting of 20 to 36 sessions at $200 to $500 per session. However, most insurance plans cover TMS, reducing the out-of-pocket costs to $10 to $50 per session.
Affordable, FDA-Approved TMS Therapy for Treatment-Resistant Depression
Harper Clinic is a state-of-the-art functional medicine clinic in Utah, providing evidence-based TMS therapy for treatment-resistant depression. Our consultation team is happy to evaluate you to see if you meet the criteria for TMS therapy and help you move forward on your healing journey.
If you have already tried 2+ conventional treatments for depression, such as antidepressants and CBT, and have not found relief, you may be a good candidate for TMS. We also offer TMS for off-label use in treatment-resistant cases of OCD, PTSD, and chronic pain.
Speak with a clinician to review candidacy, verify insurance, and schedule your treatment today at Harper Clinic.
Sources
[1] Maj, M. (2023). Et al. Treatment-resistant depression: definition, prevalence, detection, management, and investigational interventions. World psychiatry: official journal of the World Psychiatric Association (WPA), 22(3), 394–412.
[2] Uğurlu, T. et al. (2022). Efficacy of transcranial magnetic stimulation in treatment-resistant depression. Turkish journal of medical sciences, 52(4), 1344–1354.
[3] Sheehan, J. J. (2021). The Prevalence and National Burden of Treatment-Resistant Depression and Major Depressive Disorder in the United States. The Journal of Clinical Psychiatry, 82(2), 20m13699.
[4] Pillinger, T. (2022). Treatment resistance in psychiatry: state of the art and new directions. Molecular psychiatry, 27(1), 58–72.
[5] Nakajima, S. et al. (2025). Repetitive Transcranial Magnetic Stimulation as Maintenance Treatment of Depression: The MAINT-R Randomized Clinical Trial. JAMA Network Open, 8(6), e2515881.
[6] Marton, F. et al. (2024). Utilization and outcomes of transcranial magnetic stimulation and usual care for MDD in a large group psychiatric practice. BMC psychiatry, 24(1), 497.