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Everything You Need to Know About TMS Therapy and Depression

You’ve tried everything to recover from depression. You’ve taken medications. You’ve been to therapy. You’ve made lifestyle changes. But it doesn’t seem to ever be enough; you’re still suffering, and maybe you’re even starting to feel hopeless.

Transcranial magnetic stimulation (TMS) is an FDA-approved innovative treatment that’s been proven to relieve depression symptoms, even when nothing else works.

This blog post walks you through everything there is to know about TMS therapy, including how it affects your brain, its pros and cons, its effectiveness, and how to get started. 

How Does Depression Impact our Brains?

We know that depression is a common mental illness, but we don’t often think of it as a brain disease. When we think of neurological disorders, we think of things like epilepsy and Parkinson’s. But depression is a real illness, too, with severe effects on the brain organ. This serious disorder is a lot more complicated than the feeling of being “down in the dumps” and causes the brain to stop working as it’s supposed to and change chemically.


Neurotransmitters are brain chemicals that are responsible for sending messages between neurons. There is significant research that indicates that depression causes a chemical imbalance in our brains – meaning that people with depression don’t have enough of certain neurotransmitters that are thought to be responsible for regulating our mood.

The neurotransmitters that are affected by depression include:

  • Serotonin: This is often referred to as the “feel good” chemical; it’s responsible for regulating mood, sexual functioning, and blood clotting, among other things.
  • Dopamine: This chemical is linked to the brain’s reward circuit, and is responsible for feelings of reward and motivation.
  • Norepinephrine: Scientists still don’t have solid evidence that norepinephrine is associated with mood, but there has been some evidence that indicates that people with depression may have too little norepinephrine in certain brain circuits.

Brain Shrinkage

Scientists say that depression also causes certain areas of our brains to shrink in size and lose brain cell tissue, scientifically known as gray matter volume (GMV). Some specific areas of the brain that lose GMV when we’re sick with depression are:

  • Hippocampus: This part of the brain is highly reactive to stress hormones like cortisol, and is responsible for things like memory and mood.
  • Prefrontal cortex: This is a very important part of the brain, responsible for executive functioning – things like judgment, impulse control, and emotion regulation. The dorsolateral prefrontal cortex in particular has been shown to be affected by depression.
  • Thalamus: Almost all sensory information goes through the thalamus; it controls things like alertness, sleep, and consciousness.
  • Amygdala: The research about how depression affects the amygdala isn’t conclusive; some studies have found that the amygdala, which is responsible for fear, might actually grow when someone has depression.

There’s also evidence that people with depression have more inflammation in the brain, although it’s not clear whether the depression or the inflammation comes first. Additionally, the disease has been linked to less oxygen in the body, including the brain. When our brains get less oxygen, they can suffer other consequences like brain cell death and inflammation.

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Comprehensive Mental Health Care: Treating Your “Whole Self”

What Does TMS Therapy Do to our Brains?

Since we’ve established that depression is a brain disease, it would make sense that a treatment targeting specific areas of the brain would be effective.

TMS therapy, or transcranial magnetic stimulation, uses an electromagnetic field to stimulate the areas of the brain that are thought to be affected by depression. Magnetic coils (similar to MRI magnets) are placed on certain areas of the scalp. These magnets deliver electromagnetic pulses directly to the brain and stimulate certain nerve cells.

Although there’s a significant evidence base that says that TMS therapy does, indeed, relieve depression symptoms, scientists still aren’t sure exactly how this treatment interacts with the brain – and why it’s so effective.

The current hypothesis is that the micro-pulses delivered during a TMS session affect the dorsolateral prefrontal cortex and “rewire” the communication between networks of the brain. The stimulation activates important parts of the brain that aren’t functioning as they should because of depression; remember, the dorsolateral prefrontal cortex is one part of the brain that’s highly affected by depression. This is thought to especially improve symptoms of depression associated with these parts of the brain, like fatigue and low appetite.

Although we don’t know for sure why TMS therapy works so well, what we do know is that it delivers necessary stimulation to important brain cells that are affected by depression.

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Weighing the Pros and Cons of TMS Therapy

It’s normal to be nervous when considering a new treatment, especially when it’s something like TMS therapy which is so different from anything you’ve tried before. TMS therapy is a non-invasive procedure that’s generally safe and well-tolerated by most people. However, that doesn’t mean it’s the right choice for everyone.

When deciding whether to start a new treatment, it’s important to weigh both its advantages and its disadvantages. Here, we’ll go through the pros and cons of TMS therapy to help you decide whether it might be the right treatment for you.

Pros of TMS Therapy

  • TMS therapy is safe: TMS is considered a safe treatment, and doesn’t carry the same risk for seizure as electroconvulsive therapy (another treatment for depression). It’s a non-invasive procedure, which means that no skin needs to be broken in order to receive the treatment.
  • TMS therapy is effective: We’ll talk more about this in the next chapter, but TMS therapy has been found to be very effective for treatment-resistant depression.
  • Little to no side effects: There are some side effects that people report after receiving TMS therapy, but they are mild and temporary (such as mild scalp pain or fatigue).
  • Non-addictive: Unlike some medications, there is no withdrawal period if you decide to stop receiving TMS treatment.
  • No anesthesia: You don’t need to receive any type of sedative or anesthesia to receive TMS, which means that you can drive yourself home immediately after receiving treatment.
  • Covered by insurance: TMS treatment is very often covered by commercial health insurance plans, making it affordable.

Cons of TMS Therapy

  • Time commitment: TMS requires patients to come in 5 days a week for anywhere between 4 to 6 weeks. Although sessions typically last around 40 minutes, this still is a time commitment to be aware of when considering TMS therapy. 
  • Availability in remote areas: Most TMS clinics are located in large metropolitan areas. If you live in a remote or rural area, you may have to travel a significant distance to reach your nearest TMS therapy provider. If you live in or around San Antonio, Texas, be sure to reach out to Genesis Behavioral Health to learn more about TMS therapy and how we can assist you with your mental health journey. 
  • Some mild side effects and risks: Although TMS therapy is generally safe and well-tolerated by most people, there are some mild side effects that people have reported, including scalp pain, fatigue, and tremors. There is also a 0.1 percent risk of developing seizures from TMS.
  • Strict insurance criteria: Some insurance companies make you jump through some hoops before approving you for TMS therapy. For example, you might be required to try at least four different antidepressants before your insurance plan approves you as a TMS candidate. If insurance doesn’t cover the cost, then TMS therapy can be expensive. At Genesis, we assist you in the insurance process as much as possible. You won’t have to tackle this task alone. 
  • Disqualification: If you have any metal implanted in or around your head, including metallic ink tattoos, then you may not be eligible to receive TMS therapy because of the magnetic coils’ contraindication with metal.

Ultimately, whether or not you’re a good candidate for TMS therapy is up to you and your medical provider. Talk to us about any concerns or questions you might have to figure out if TMS therapy is right for you.

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The Pros and Cons of TMS Therapy

Is TMS Therapy Effective?

Although, like we said earlier, researchers haven’t yet figured out the exact science behind how TMS therapy interacts with the brain, what they do know is that it works. Even people who’ve tried other treatment methods for depression symptoms and haven’t experienced improvement have found relief from their symptoms with TMS therapy.

Up to 60 percent of people with treatment-resistant depression experience some alleviation of symptoms after completing a full course of TMS therapy. Around one-third of those people find that their symptoms go away completely.

That’s no small feat, considering that people with treatment-resistant depression have tried every first-line depression treatment out there, including various medications and talk therapy. The more traditional first-line treatments didn’t work (or caused too many side effects), but TMS therapy did work.

There’s enough evidence for the effectiveness of TMS therapy, in fact, that even the Food and Drug Administration (FDA) approved TMS for the treatment of depression in 2008.

The FDA has also approved TMS for the treatment of Obsessive-Compulsive Disorder (OCD) and chronic migraines. There is a fairly large evidence base that supports its effectiveness for treating a whole myriad of other mental health disorders including PTSD, Generalized Anxiety Disorder, and Alzheimer’s.

With that being said, try not to walk into your first TMS appointment expecting it to be a miracle cure. Many people do describe feeling a sudden and dramatic improvement in their mood, but it’s not like that for everybody. Others say that it feels more like a fog clearing little by little, until their depression symptoms no longer keep them from doing the things that they used to enjoy. 

Over half of all TMS recipients do experience a clinically significant improvement in symptoms, so it’s smart to have hope – and it’s also important to keep attending your TMS appointments even if you don’t experience a drastic improvement after the very first session.

Someday, we’ll have more scientific research that’s able to explain why TMS therapy works. But for the question of whether or not TMS therapy is effective, the answer is simple: for many people, it’s a resounding yes.

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How to Get Started with TMS Therapy

If you’re interested in receiving TMS therapy from our mental health center, your first step is to contact our intake specialist through phone (210-404-9696) or email. We’ll ask you some basic questions just to make sure that you’re eligible for TMS treatment. we can also help you check your insurance benefits, give you the appropriate paperwork, and answer any questions you have. If you’re eligible for treatment, we will help you schedule your first appointment.

On the day of your first appointment, Dr. Williams will conduct an hour-long assessment, including information about your symptoms and mental health history. This will help us make sure that TMS therapy is the right treatment for you at this time in your life.

The insurance process usually takes one to two weeks to complete. Once your insurance company has approved you for TMS therapy, we’ll schedule the first treatment!

During your first treatment appointment, you’ll be fitted for your TMS cap, so that it’s perfectly adjusted to your scalp and brain. Our TMS staff will calibrate the TMS machine. It’s important that the electromagnetic pulses that are being sent to your brain are just the right strength; not so strong that it causes any pain, but not so weak that you don’t feel it at all.

After everything’s adjusted, you’re all set to begin treatment. Once you’ve started treatment, you’ll need to come back 5 continuous days every week to receive TMS.

Ready to Get Started?

If you’ve had multiple depressive episodes and treatments like psychotherapy or medication haven’t worked for you, then it might be time to consider a new method. Just because these traditional first-line treatments haven’t worked for you doesn’t mean that you need or deserve to live with the shackles of depression around your wrists forever.

Depression can be stubborn – but with TMS therapy, a life without it could be within reach. Our comprehensive mental health center has TMS providers on-site to deliver this innovative treatment and help you recover from depression. Take our TMS Quiz to see if you qualify.

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