How long do TMS results last? Long-term benefits for depression

Transcranial magnetic stimulation (TMS) is a non-invasive treatment for depression that uses magnetic pulses to stimulate the brain.

For many people, the benefits of a TMS course last at least a year with continued follow-up care. In a large real-world US study, 62.5% of those who responded kept that response for the full 12 months, and 70.5% of those who reached remission did not relapse. If symptoms come back, another round of TMS often restores the benefit.

How long do the long-term benefits of TMS last?

How long the benefits last varies from person to person. The numbers above come from a large study of adults treated in regular clinical practices across the US. All of them had depression that had not improved enough with antidepressants; on average, they had tried 2.6 antidepressants in the current episode before TMS. After the TMS course, they continued their antidepressants and could return for more TMS if symptoms started to come back. About a third did so at some point during the year.

In that study, response meant the symptoms of depression dropped by at least half, and remission meant few or no symptoms were left. Of those who had responded by the end of the course, including those in remission, 62.5% still met the standard for response at every follow-up check over the next 12 months. Of those in remission, 70.5% did not relapse during the year. When symptoms did return, it was more often in the first six months. People who reached remission were more likely to stay well than those who only responded, which is one reason remission is the goal of treatment.

What affects how long TMS results last?

One of the most important factors is how complete the improvement was by the end of the course. Here are some of the factors that affect whether depression returns after any treatment, several of which can be addressed:

Symptoms that remain after treatment: Leftover symptoms at the end of treatment are one of the strongest predictors that depression will return. In the 12-month TMS study, people who stayed well had fewer leftover symptoms at the end of their course than those who relapsed.

Previous episodes: Having had episodes of depression in the past raises the chance of another one.

Co-occurring anxiety: Anxiety alongside depression may also raise the risk, although the evidence is weaker.

Severity and stress: A more severe episode and ongoing stress may also raise the risk, although the evidence for both is less consistent.

What if you improved but are not fully well?

If you improved with TMS but are not fully back to yourself, the course itself can sometimes be extended. In my experience, adding more sessions sometimes helps, particularly when the improvement came late in the course and was still on an upward trajectory when the course was ending.

Research points the same way. Across many trials, more TMS sessions were linked to better outcomes, and the authors suggest a course of at least 30 sessions. In one large clinic study, only those who were still improving steadily at the end of a standard course, about 1 in 5, improved considerably with additional sessions.

In my practice, we also look at other factors that may be holding someone back from full recovery, such as sleep problems, dietary or metabolic issues, an inactive lifestyle, and other psychiatric or medical conditions. Addressing them is part of reaching remission, which in turn helps the improvement last.

How will I know if depression is coming back?

Depression tends to return gradually, and the early signs tend to look like the symptoms that were slowest to improve or never fully went away. In one small study, most people with recurrent depression noticed early symptoms before a relapse, typically for a few weeks beforehand.

Changes to watch for include sleep, energy, appetite or concentration slipping. People close to you may notice these changes too, and in the same study, relatives recognized the early signs about as well as patients did.

If you notice early signs, don't wait until they have become severe. If you are having thoughts of suicide, call or text 988 to reach the Suicide & Crisis Lifeline, or go to the nearest emergency room.

What happens if my symptoms come back after TMS?

It is not uncommon for some people to have their depression come back after a period of doing well. However, addressing it early usually prevents a full episode. It is therefore important to continue with regular follow-ups and to let your treatment team know right away if you notice any symptoms creeping back.

If you responded to TMS before, it is likely to help again. In a large real-world study of people who had responded to a first TMS course, 82.5% responded again to a second course, and 54% reached remission. In my practice, a full course may not be needed, depending on how severe the symptoms are. In my experience, most patients who get help early do well and return to functioning well.

Do I need maintenance TMS sessions?

There is no consensus on the best way to keep the benefit after a TMS course, and expert recommendations name no single strategy. Two approaches are used, and each has some evidence behind it.

Returning at the first signs: You continue regular follow-ups after the course, and TMS is restarted as soon as worsening begins, without waiting until it has become severe. In a small trial of people who had responded to TMS and stayed off medication, a scheduled monthly session did no better over a year than this approach. When symptoms returned and TMS was restarted, 63% of people in the first-signs group and 78% in the monthly-session group responded again.

Scheduled maintenance sessions: After the course, sessions are tapered over several weeks and then continued on a schedule, often about once a month. Pooled studies suggest that maintenance sessions given monthly or more often may help keep mood stable for up to six to twelve months. In a separate trial, people who had reached remission on antidepressants and added monthly sessions of TMS had a lower chance of relapse over the next year (about 16%) than those who continued medication alone (about 44%).

The evidence on both approaches comes mostly from small or uncontrolled studies, so neither has been shown to be better. Other strategies after a successful course include medication, psychotherapy, exercise, or a combination of these.

What should you do after a TMS course?

Note which symptoms were the last to improve, since those are often the first to return, and share the list with someone close to you.

In my practice, we also encourage patients to take care of themselves after the course, with good sleep habits, a healthy diet, regular exercise, avoiding alcohol and drugs, and managing stress.

Do not stop or change your medicine on your own; if you have side effects or concerns, contact your prescriber right away.

If you have had TMS and notice early signs, contact your treatment team to arrange a follow-up visit.

If you have not had TMS and are considering it, standard and accelerated TMS are offered at our Tomball office. See whether TMS is right for you.

Everhealth is not a crisis service. If you are in crisis, call 911, go to the nearest emergency room, or call or text 988.

This content is educational and not a substitute for a professional evaluation.

Frequently asked questions

Is TMS a permanent fix for depression? TMS is not a permanent fix, although in my experience some patients have a lasting remission. Depression can return after any treatment that works, including antidepressants. Follow-up data beyond about a year are limited, so no one can say in advance how long the benefit will last for a particular person.

Is it safe to repeat TMS? Repeat courses appear to be as well tolerated as the first. In a six-month study in which TMS was given again when symptoms began to return, side effects were similar to those of the first course. Side effects of TMS are usually mild, such as temporary scalp discomfort, and TMS doesn't require anesthesia.

Can I continue my current medications with TMS? Usually, yes. TMS is often given alongside antidepressants. In the largest trial comparing two standard TMS methods, participants stayed on stable doses of their medicines throughout treatment. Your clinician reviews everything you take before a course begins, and any changes are made with your prescriber.

Can I stop my antidepressant after TMS works? You should not stop it on your own. In my practice, the general recommendation is to continue all the medicines you were taking at the start of TMS for now, work with your prescriber on any adjustments, and reassess if there has been no relapse in 6 to 12 months.