TMS And Treatment-Resistant Depression

Medically reviewed by Laura Angers Maddox, NCC, LPC
Updated May 16, 2024by BetterHelp Editorial Team
Please be advised, the below article might mention trauma-related topics that include suicide, substance use, or abuse which could be triggering to the reader.
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The first options recommended to treat depression typically include some form of talk therapy, sometimes in combination with medication and lifestyle changes like regular exercise. However, for some individuals, these traditional treatments are not enough to reduce or resolve their symptoms. 

For those experiencing treatment-resistant depression, a healthcare provider might look to other options to help them find symptom relief. One of these is transcranial magnetic stimulation (TMS), a procedure approved by the US Food and Drug Administration (FDA) to treat symptoms of depression. Learn more about this option below. 

Learn about the effectiveness of TMS for depression

Treatment-resistant depression symptoms

Depression, also called unipolar depression or major depression, is a diagnosable mental illness that’s common but serious. Conditions that fall under this category of depressive mood disorders are thought to be caused by a combination of risk factors, including genetics, differences in levels of brain chemicals, exposure to trauma or stressful life events, and others. Symptoms of depression can range from mild to severe and typically include things like:

  • Persistent low mood
  • Trouble with emotional or mood control
  • Feelings of guilt or worthlessness
  • A feeling of emptiness
  • A lack of interest in activities previously enjoyed
  • Fatigue
  • Difficulty concentrating
  • Significant changes in appetite
  • Significant changes in sleeping patterns 

Treating depression typically involves some form of interpersonal psychotherapy, such as cognitive behavioral therapy sessions (CBT), acceptance and commitment therapy, behavioral activation techniques, and dialectical behavioral therapy. Medication may be recommended in conjunction with therapy in some cases. Your therapist or psychiatrist may also suggest some healthy lifestyle changes to help reduce symptoms, such as exercising, meditating, and eating nutritious foods.

Treatment resistance is defined as the “failure of a disease or disorder to respond positively or significantly to treatment.” Treatment-resistant depression is when traditional treatments such as therapy, medication, and lifestyle changes don’t improve depression symptoms, or only help minimally or for a short time. 

An individual with depression who is engaging in positive behaviors loses hope in many cases when they don’t see any results. So in cases like these, a doctor or psychiatrist may suggest alternative treatments such as TMS to help ease depression symptoms.

Transcranial Magnetic Stimulation (TMS)

Transcranial magnetic stimulation is a medical treatment that sends magnetic energy pulses to certain parts of the brain to encourage enhanced communication between brain cells—specifically in the brain areas responsible for managing mood. Research suggests that these pulses may help improve mood and reduce depression symptoms. 

A person may qualify for TMS rapid relief treatment based on their history with depression, how long their symptoms have persisted, and how they’ve responded to past treatments. This procedure is a clinical practice performed in a medical setting, often by a psychiatrist, neuropsychologist, or doctor. 

TMS process

Repetitive transcranial magnetic stimulation for depression involves placing a device that looks somewhat like a helmet on the patient's head in order to send electromagnetic currents to the brain through the skull. The patient may receive impulses to the head for several minutes in timed intervals to get certain parts of the brain involved in stimulation. 

An individual may be encouraged to attend sessions several days a week for four to six weeks as part of their treatment. TMS requires no sedation, surgery, or anesthesia. Side effects from treatment may include mild scalp discomfort or a headache after a session. 


How effective is TMS? 

The idea of using magnetic currents to stimulate parts of the brain comes from the theory that mental disorders like persistent depression result from certain parts of the brain being non-responsive to traditional treatments. Research suggests that TMS may be able to effectively stimulate these areas. 

Consider a recent meta-analysis of several clinical trials that has associated TMS with symptom remission. In one study cited in the analysis, 20.7% of patients had remission and 34.5% had partial remission after this treatment. So while these results for TMS as a standalone treatment show promise, many mental health experts believe that several factors—including social, biological, and psychological influences—may contribute to depression. That’s why a person might see greater symptom improvement by using TMS in combination with other forms of treatment. 

Possible challenges to seeking TMS

While TMS may be able to help individuals living with treatment-resistant depression, it’s not always readily available to them due to various barriers. For example, to qualify for TMS treatment, individuals must work with a professional to determine whether they meet the criteria, since certain health conditions or aspects of medical history may make some ineligible. In addition, qualified technicians must administer TMS with tools and equipment authorized by the FDA. Some locations may not have this option available due to a limited number of professionals providing the service. 

Finances can be another barrier to receiving TMS. TMS therapy costs can be expensive, with some options priced as high as $10,000. That’s why most people must ensure that their insurance will provide coverage for the procedure, which could require a complex process of referrals, approvals, and/or appeals. 

Is there hope for treating treatment-resistant depression? 

People experiencing depression for an extended period may have symptoms that are resistant to treatment. For some, making adjustments to traditional treatments helps temporarily or shows no results. These are the cases in which TMS may be considered as a way to provide some symptom relief to those who have been living with long-term depression. Even if TMS doesn’t help a given individual with persistent depression, there are other forms of experimental treatments available as well.

Since various studies indicate that it may be helpful for treatment-resistant depression, TMS is now also being used to treat other conditions that affect the brain, including forms of anxiety, post-traumatic stress disorder, bipolar disorder, chronic pain, substance use disorders, thyroid hormone issues, and diseases that affect mobility and cognitive behaviors. 

Why doesn’t TMS treat depression for everyone—and what then?

TMS may not be effective for everyone, and research is still being done to determine why this may be. So far, there are a few theories that primarily relate to variations in how the brain receives magnetic impulses. 

Some clinical neuroscience experts believe there could be a lack of understanding of exactly how the currents penetrate the skull and brain, creating varied results in how the brain is stimulated. In addition, some researchers believe that one side of the brain is responsible for the development of depression and, therefore, should be targeted by TMS, while others say there isn't yet enough research to support this claim.

Electroconvulsive therapy options

If TMS doesn't work for you, there may be other options available—such as electroconvulsive therapy, or ECT treatments, which are done under anesthesia. Talk to your doctor about the best option for you.

Getty/Vadym Pastukh
Learn about the effectiveness of TMS for depression

Other forms of support for those living with depression

Living with treatment-resistant depression symptoms can be challenging. It can be frustrating to try different treatments and not experience symptom relief, and the process of working with health insurance companies and various specialists to try new treatments and get the cost covered can be stressful and frustrating. Working with a therapist throughout the process can be helpful.

A therapist can offer you a safe space to express your feelings, get support, and build healthy coping mechanisms for symptoms as you navigate the process of finding the right alternative treatment for you. If you don’t want to add another in-person appointment to your schedule, you might consider meeting with a therapist virtually for your convenience. 

How online therapy can help

With a platform like BetterHelp, you can get matched with a licensed therapist and meet with them remotely via phone, video call, and/or in-app messaging. Research suggests that online therapy in general can offer similar effectiveness to in-person therapy for treating conditions like depression.

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TMS, or transcranial magnetic stimulation, is a medical procedure that may help individuals living with treatment-resistant depression find some symptom relief. If traditional depression treatments aren’t helping you improve, you might talk to your doctor or psychiatrist about TMS as one of the possible options for treatment-resistant depression. If you’re looking for support on your treatment journey, you may benefit from meeting with a therapist online or in person.
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