Transcranial Magnetic Stimulation

Sometimes depression and anxiety persist even with thoughtful treatment. That can feel exhausting and discouraging, especially when you’re doing the work and still not getting relief. TMS is one option that supports the brain directly in a way that is noninvasive, evidence-based, and often well tolerated.

Transcranial Magnetic Stimulation, or TMS, uses focused magnetic pulses to stimulate specific brain networks involved in mood, motivation, attention, and emotional regulation. It does not require anesthesia or sedation. Most people drive themselves to and from sessions and return to their day afterward.

In my practice, TMS is provided using a Magstim system, which has FDA-cleared indications for depression, OCD, and decreasing anxiety symptoms in patients with depression (“anxious depression”). (Magstim)

What treatment looks like

TMS is a course of treatment, similar in spirit to physical therapy for the brain. Most protocols involve 9-20 minute sessions three-five days per week for about four to six weeks, and many plans include a taper afterward. (PMC)

There are different evidence-based protocol styles.

• Standard rTMS commonly targets the left prefrontal region and builds change gradually over a series of sessions.

• Theta burst stimulation (iTBS) is a shorter session format and has been shown in a major non-inferiority trial to be comparable in benefit to standard rTMS for treatment-resistant depression, with similar tolerability. (PubMed)

Before treatment begins, we do a careful setup visit to determine precise placement and individualized intensity. The goal is to make treatment both effective and as comfortable as possible.

Success rates

TMS is one of the strongest evidence-supported non-medication treatments for depression. Across research studies and real-world clinical use, many people experience meaningful improvement.

• Response (50% improvement): 45–60%

• Remission (symptoms improve to below a clinical threshold): 30–40% (PMC)

If symptoms return later, some people benefit from booster sessions or a repeat course. We would decide this thoughtfully based on your history and your goals.

Beyond mood: emerging areas of benefit

TMS is primarily offered for depression, OCD and anxious depression. At the same time, the brain networks involved in mood overlap with circuits for self-regulation, cognitive control, and food cravings, which is why there is growing research interest in additional benefits.

Focus, motivation, energy, sleep and functioning

Many people describe the change not as a sudden “flip,” but as a gradual return of capacity. When depression lifts, it is common for focus, energy, sleep and motivation to improve along with it.

Cravings and “food noise”

There is growing research exploring whether stimulating prefrontal control networks can reduce cravings and binge-type patterns in some individuals. This is still an active area of study and is not an FDA-cleared indication for standard outpatient TMS for depression, but the early signal is promising.

For example, recent peer-reviewed work has evaluated TMS approaches for binge eating symptoms and found meaningful reductions in validated binge-eating measures in some participants. (PMC)

How TMS feels

During TMS you stay awake and alert. The coil makes a clicking sound, and most people feel a tapping or pulsing sensation on the scalp where the treatment is delivered. You may also notice mild twitching in nearby muscles (forehead, jaw, or around the eye) during certain pulses.

The first few sessions are often the most unfamiliar. Most people acclimate quickly, and we can fine-tune positioning and comfort measures so the experience becomes routine and manageable.

Side effects and how we address them

TMS is generally well tolerated. The most common side effects are mild to moderate and tend to improve as the course continues. Serious side effects are rare when people are appropriately screened and protocols are followed.

Common side effects

• Scalp discomfort or tenderness during treatment

• Headache (often tension-like)

• Facial muscle twitching during pulses

• Lightheadedness

Rare but important risks

• Seizure is the most serious potential risk of TMS, but it is very rare. Large real-world datasets estimate the risk at about 0.003% per session (roughly 1 in 30,000 sessions) and about 0.07% per patient over a treatment course. We reduce risk through careful screening and by following established safety protocols.

Ways we reduce and manage side effects

• Adjust coil position and angle: small changes can reduce scalp pain or jaw/face twitching without compromising treatment integrity.

• Gradual intensity ramp-up: for sensitive patients, we can build intensity more slowly so your system adapts comfortably.

• Comfort supports: a brief pause, repositioning, or cushioning approaches can help.

• Headache plan: hydration, sleep support, and (when medically appropriate) an OTC pain reliever before or after sessions can reduce headaches, which usually lessen over time.

• Hearing protection: for those sensitive to sound, ear protection can be used during treatment because the coil makes a clicking sound that may be unsettling for some.

If you ever feel worse, unusually activated, or emotionally raw during treatment, tell us. Sometimes symptom shifts are part of healthy change, and sometimes they’re a sign we should adjust the plan. We track how you’re doing throughout the course so we can keep treatment both effective and tolerable.

How TMS works in the brain

TMS uses magnetic pulses through a coil placed on the scalp to create gentle electrical currents in a specific brain region. Repeated sessions help the brain “retrain” the networks responsible for regulation: attention, planning, impulse control, and the ability to shift perspective and emotion. The goal isn’t to change who you are. It’s to support the circuitry that helps you steer your mind, respond with more flexibility, and re-engage with life.

What does that electrical current “do” to neurons?

Neurons communicate by sending tiny electrical signals. The induced current from TMS can briefly depolarize neurons (helping them fire) and influence how active a local brain region is during and after stimulation. When pulses are repeated over many sessions (repetitive TMS), the brain begins to adapt. Researchers describe this as changes in synaptic plasticity (the brain’s “learning” machinery), similar in concept to long-term potentiation, how the brain strengthens or reshapes connections with repeated input.

How does that help mood, motivation, and cognitive control?

Most depression protocols target the dorsolateral prefrontal cortex (DLPFC), a hub involved in regulation: attention, planning, impulse control, and the ability to shift perspective and emotion. In many people with depression, this region and its connected networks can function less effectively.

TMS doesn’t just affect one “spot.” When you repeatedly stimulate a node like the DLPFC, you influence the wider network it’s connected to, circuits involved in mood regulation and stress response. Over time, this can help the network communicate more effectively, which is one reason people often describe a gradual return of capacity: less rigidity, more resilience, and more access to motivation and clarity.

Insurance coverage

TMS is often covered by insurance when medical criteria are met. Most plans require prior authorization, and coverage varies based on your specific policy. If you are interested, my office can help you understand benefits and the typical approval process.

MBLDN Psychiatry and Wellness is in network with select plans, specifically Aetna, Anthem, Cigna, Optum, and Blue Shield of California plans only. If you have one of these plans, TMS sessions are often covered, but coverage still depends on your specific benefits and medical necessity criteria, and almost always requires prior authorization.

A grounded way to think about TMS

TMS is not about forcing the brain to perform. It is about supporting the circuits that help you feel more steady, more resilient, and more able to engage with your life. If you are looking for a non-medication option with strong evidence behind it, or if you want another path when traditional approaches haven’t been enough, TMS may be worth exploring.

Contact us to schedule an intake and find out if this path is right for you.