Pros and Cons of TMS Therapy: What to Weigh Before You Start

Labyrinth Psychiatry Group · Published October 22, 2026 · Clinical review by Dr. Salvatore G. Savatta pending

The short answer

The main pros of TMS: it can help depression that medication has not fixed, it needs no anesthesia, you can drive yourself home, and its common side effects are mild. The main cons: it takes five visits a week for several weeks, most plans must approve it first, early sessions can cause scalp discomfort or headaches, a seizure is possible but rare, and it does not work for everyone.

In a study of 42 US practices, 58% of 307 people whose depression had not lifted on an average of 2.5 antidepressants responded to TMS, and 37% reached remission. In the original sham-controlled trial, only 4.5% of patients stopped for side effects.

Pros and cons of TMS at a glance

Each row sets one advantage against its matching drawback. The sections below explain every line.

The pros of TMS therapy

1. It can work when medication has not. In everyday practice, clinicians rated 58% of people as responding and 37% as in remission at the end of a TMS course, after an average of 2.5 antidepressants had failed (Carpenter 2012). In a sham-controlled trial of medication-free patients, remission was 14.1% with TMS against 5.1% with a fake treatment, and almost 30% remitted in the open-label follow-up (George 2010).
2. No anesthesia, no sedation. You sit awake in a chair while the coil taps on your head. Unlike ECT, TMS can be done in an office and needs no anesthesia (NIMH), so you can drive yourself to and from each visit.
3. Side effects stay mostly at the scalp. The common ones are discomfort where the coil sits, tingling or twitching of the scalp, jaw or face, mild headaches and brief lightheadedness (NIMH). In the original trials, systemic side effects were minimal and headache reports fell after the first week (NIMH lecture, 2020).
4. No effect on memory or thinking in the trials. Across more than 10,000 sessions in the industry safety program, memory and thinking tests and hearing thresholds did not change, and there were no seizures (Janicak 2008). Dr. Savatta notes that there are no known long-term side effects and that TMS is not associated with problems with memory or thinking.
5. You can usually keep your antidepressant. Many people stay on their medication during TMS; your psychiatrist decides what to continue or change. In the one-year follow-up study, patients continued antidepressants after TMS (Dunner 2014).
6. The benefit often lasts. Of 120 people who responded, 75 (62.5%) still met response criteria through a year of follow-up (Dunner 2014).
7. FDA-cleared, with a long track record. The FDA cleared the first rTMS device in 2008 for depression that did not respond to at least one antidepressant in the current episode. TMS is now cleared for treatment-resistant depression, OCD, migraines, anxiety with depression and smoking dependence, and since March 2024 as an add-on treatment for depression in adolescents 15 and older (NIMH).
8. Covered by many plans. Medicare and many commercial plans cover TMS for depression when their criteria are met. The practice lists Aetna, Blue Cross Blue Shield, Cigna, Medicare, TRICARE and UnitedHealthcare / Oxford; confirm your own benefits with the office and your plan.

The cons of TMS therapy

1. It does not work for everyone. In the 42-practice study, about 4 in 10 people did not respond (Carpenter 2012). NIMH also notes that rTMS does not match the effect of ECT, which is still considered the “gold standard” for treatment-resistant depression (NIMH).
2. It takes a lot of visits. A typical course is daily sessions, five days a week, for 4 to 6 weeks (NIMH). At Labyrinth the standard course is 36 sessions for depression and 30 for OCD, about six to eight weeks.
3. Early sessions can be uncomfortable. In the original device trial, 36% of patients had pain where the coil sat and 21% had muscle twitching (NIMH lecture). In a large theta burst trial, headache was the most common treatment-related side effect, in about two-thirds of patients (THREE-D, 2018). The technician can adjust the coil if it hurts.
4. A seizure is possible, though rare. A survey of 174 TMS providers counted 24 seizures in 318,560 sessions from 2012 to 2016, about 0.08 per 1,000 sessions with standard figure-8 coils. Most happened in the first few sessions (Stultz 2020 review). This is why screening comes first.
5. Plans make you qualify first. Most plans ask for proof of the diagnosis and of earlier treatment, and approve the course before the first session. A denial or a long wait for approval is a real drawback.
6. The cost without coverage is high. A course is dozens of billed sessions. Our TMS cost in New Jersey article lists 2026 Medicare amounts per session and what each insurer requires.
7. Long-term effects are still being studied. NIMH says long-term side effects have not been determined and more research is needed (NIMH). Some people also need more TMS later: 36.2% of the one-year study group had TMS again during that year (Dunner 2014).
8. Not everyone can have it. Metal or electronic devices in or near the head, or a seizure history, usually rule TMS out. See who is and is not a candidate below.

Side effects and safety, in brief

Most TMS side effects are felt during or just after a session and ease as the course goes on. In an NIMH-sponsored trial, headache was reported by 32% of people on real TMS and 23% on a fake treatment, and discomfort at the coil by 18% and 10% (NIMH lecture). The coil makes a loud click, so earplugs protect your hearing at every session. For OCD, headache was reported by 37.5% of patients on the deep TMS device and 35.3% on the sham device, with no serious device-related reactions (FDA, 2018).

Our article Is TMS safe? covers screening and what to tell the care team before your first session.

The time it takes, in real numbers

• Visits: five a week at Labyrinth.
• Course: 36 sessions for depression and 30 for OCD, about six to eight weeks.
• Each session: 19 to 45 minutes, depending on the diagnosis. Across TMS types, NIMH puts a session at 3 to 40 minutes; a theta burst session takes about 3 minutes against 37.5 for standard 10 Hz TMS, with the same results in the THREE-D trial (Blumberger 2018).
• Accelerated TMS: some protocols give several sessions a day and work much faster, often within a week (NIMH). Ask at your evaluation which protocol the practice would use for you.
• After each visit: no recovery time. You drive yourself and go back to your day.

Labyrinth gives TMS at two offices: 11 Commerce Drive, Lobby Floor, Cranford, NJ 07016, and 1 Ethel Road, Suite 103B, Edison, NJ 08817. With 36 visits, the drive matters. The practice’s TMS page lists the nearby towns it serves, including Westfield, Garwood, Clark, Union, Linden, Springfield, Summit, Woodbridge and Metuchen.

Cost and insurance

Whether TMS is affordable usually comes down to plan approval. Plans usually ask for proof of the diagnosis and of earlier treatment, and most require approval before the first session. Bring your insurance card and a list of past medications to the evaluation, including ones you stopped because of side effects.

• How much TMS costs in New Jersey: 2026 Medicare amounts and each insurer’s rules.
• Is TMS covered by health insurance?: what plans look for before they approve a course.
• Insurance and access: the plans the practice lists.

Who is a good candidate for TMS, and who is not

The pros only count if TMS is safe and suitable for you. In general, TMS is considered for:

• Major depression that has not improved enough with at least one antidepressant in the current episode (the FDA’s 2008 clearance) — many people who come to TMS have tried several
• People who could not keep taking antidepressants because of side effects
• Obsessive-compulsive disorder that has not responded to usual treatment (FDA, 2018)
• Anyone who can come in five days a week for several weeks

It is generally not used for people with:

• A seizure disorder or a history of seizures
• Metal or electronic devices in or near the head, such as deep brain stimulators, electrodes, cochlear implants, aneurysm clips or stents
• Implanted heart devices close to the coil, such as a pacemaker or defibrillator
• Head tattoos made with metallic ink
• Certain neurological conditions, such as epilepsy, a brain tumor or a history of severe head injury

Sources: NIMH and FDA for the cleared uses; the safety list is the practice’s own screening list from its TMS page.

TMS compared with the alternatives

Our TMS vs. SPRAVATO page compares those two in detail, and treatment-resistant depression explains when each is considered. For a look at common beliefs about TMS, read Myth vs. reality about TMS therapy.

How to weigh the pros and cons for yourself

Three things tend to decide it:

1. How much medication has already been tried. TMS was cleared for people whose depression did not respond to at least one antidepressant, and many who come to TMS have tried several.
2. Whether five weekday visits fit your life for six to eight weeks, and which office is closer.
3. What your plan requires before it approves a course.

Questions worth asking at your evaluation:

• Am I a candidate, given my history and anything metal or electronic in my body?
• Which TMS protocol would you use for me, and how long would each session take?
• What does my plan need from me before it approves the course?
• Can I keep my current medication during TMS?
• How will we track whether it is working, and what happens if it is not?

Call 908-336-1187 or use the evaluation request form. The TMS therapy page walks through a course at Labyrinth from the first evaluation to the last session.

Questions about the pros and cons of TMS