Skip to main content
Dartmouth-Hitchcock logo
Summer Flowers In This Section

Transcranial Magnetic Stimulation (TMS)

Transcranial Magnetic Stimulation (TMS) is a treatment for depression that uses an electromagnet. We place the magnet next to your head to generate controlled electric currents within the brain.

TMS therapy:

  • Is a FDA-cleared for treatment of Major Depressive Disorder (MDD)
  • Is gentle with less side effects compared to most medications
  • Causes activation of brain cells, and of pathways in the brain, that play a role in depression
  • Is non-invasive, so there is no need for anesthesia and you can drive yourself to and from treatments

Transcranial Magnetic Stimulation (TMS) graphic

TMS treatment schedule

We schedule TMS treatments daily, five days per week, for six weeks. We then follow with a "taper" period, consisting of:

  • Three treatments in week seven
  • Two in week eight
  • Final treatment in week nine

There are 36 treatments in total.

We schedule the first treatment session for 45 minutes to tailor the treatment for you. All following treatments are typically less than 5 minutes in duration.

You can drive yourself to and from TMS appointments. You can also engage in all normal activities on days when you have TMS.

Risks and side-effects of TMS

Common side effects include:

  • Mild to moderate pain at the stimulation site
  • Headaches
  • Twitching of facial muscles
  • In rare cases, TMS can cause an unintentional seizure < 0.1%

Medical conditions that are not safe with TMS

In general, TMS is not safe for patients who have magnetically-sensitive implants in their head. TMS also isn't safe for patients who have implants within 12 inches (30 cm) of the treatment coil, such as:

  • Aneurism clips or coils
  • Bullet fragments
  • Cardiac pacemakers or defibrillators
  • Cerebral shunts
  • Cochlear implants
  • Stents in the brain

TMS may also not be safe if you have a history of seizures, or other medical conditions. Before starting TMS, we will review your medical history with you.

TMS medical insurance coverage

For appropriately-qualified patients, TMS is usually covered by insurance.

TMS insurance coverage guidelines

TMS is necessary for adults who have a confirmed diagnosis of MDD or have a single or recurrent episode.

You must submit medical records to your insurance that shows that TMS is necessary.

Insurance coverage criteria

  • Your depression has been resistant to treatment:
    • At least four unsuccessful trials of antidepressant medications during the current depressive episode.
    • A trial of adequate duration (4-6 weeks) and adequate dose of medication was unsuccessful.
    • The four unsuccessful trials included at least two different medication classes. Also, at least two trials of evidence-based antidepressant augmentation therapies.
  • You must also have had at least one trial of psychotherapy that did not treat your depression.

Insurance may also cover TMS, if you have had a significant, positive response to:

  • TMS during a previous depressive episode
  • Electroconvulsive therapy (ECT)
Contact Us