How many TMS treatments will I need?

How the all-natural PTSD, depression and anxiety solution works

By Jason de Paul on March 25, 2021

Transcranial Magnetic Stimulation (TMS) is fast becoming a common treatment for patients suffering from depression and comorbid anxiety. This is due to its high efficacy rate and non-invasive nature. However, one thing that remains variable is the treatment frequency and how long lasting the benefits are. As an alternative, or addition to, medication and talk therapy, the treatment is considered noninvasive as well as very well tolerated. TMS Therapy is a six-week process, five days a week. Here, we consider the factors that may influence the number of TMS treatments a patient requires.

TMS treatments offer depressive patients an opportunity to receive optimal care while going through their usual daily activities. The side effects are minimal to none. Thus, your TMS treatment can be taken before work, on a lunch break, or any time convenient for the patient. With the recent advancements in TMS technology, TMS treatments may take as little as three minutes and a maximum of 20 minutes. This is due to clinical trials showing that the number and speed of pulses matter more than the amount of time someone is being treated. Clinical trials also support 36 sessions as the best current number of treatments for possible remission. Therefore, insurance companies that cover TMS authorize exactly 36 treatments. TMS has some advantages over medication since it may come with fewer side effects. While some patients have reported headaches after treatment sessions, they are usually fleeting and do not last long. Therefore, there are no fears of addiction, weight gain, drowsiness, fatigue, or the feelings of numbness that accompany many depression medications.

TMS is administered without anesthesia and does not require any specific instructions post-treatment. This eliminates any worries a patient may have about having a driver or going back to work. The device is not attached to the body, but simply rests on the treatment location on an adjustable arm. By stimulating the left dorsolateral prefrontal cortex (LDPFC), TMS helps enhance mood and feelings of excitement through magnetic pulses by simulating neuron activity. TMS treatment effects can be felt as early as the first five days into treatment. Most patients start feel changes between 15 to 20 treatments. Changes are noticed through Provider and Technician observation, weekly PHQ-9 scores, and both a patient's family and patient feedback.

Factors that determine the frequency of TMS treatments

"Perhaps the best evidence for efficacy comes from patients who have been treated successfully with antidepressants and are switched in a blinded fashion to placebo. In a meta-analysis of 31 withdrawal studies among more than 4,000 patients, Geddes and colleagues found that 41 percent of patients who were switched to placebo relapsed, compared to 18 percent who remained on an antidepressant. These studies provide compelling evidence that antidepressants are effective for some people" (NIH, 2011).

"An estimated 65% received combined care by a health professional and medication treatment. Treatment with medication alone was least common (6%). Approximately 35% of adults with major depressive episode did not receive treatment" (NIH, 2019).

"Current treatments for depression remain severely limited. Since the introduction of Prozac nearly 30 years ago, there have been no new categories of antidepressants, only variations of the existing SSRIs and SNRIs (targeting serotonin and norepinephrine, only two of hundreds of neurotransmitters).

Yet over 50% of depressed individuals do not respond to any type of existing medications, or various types of therapy, according to a recent major study (STAR*D, Rush et al, 2006.)  In fact, they become worse with repeated episodes of depression. Those that do respond to existing medications often experience troublesome side effects (Hope for Depression Research Foundation, 2021).

"If you don't notice any change in your mood after a few weeks, talk with your doctor. If the first antidepressant you take doesn't work, it's likely that another one will. About 60% of people who take antidepressants feel better with the first medicine they take, but others need to try more than one before noticing a change. A study funded by the National Institute of Mental Health in 2008 found that about 50% of patients who did not feel better after using one medication noticed an improvement when they took a new one or added a second medication to the first treatment. You and your doctor can work together to find the medication that's right for you" (WebMD, 2010).

Patients may have to undergo an exhausting cycle of frequent changes in medication with side effects and partial responses. TMS, on the other hand, is successful in treating many of those it is administered to. Various clinics have their own internal data, but the world average for remission from depression doing TMS Therapy is between 45% and 55%. Olympia TMS has a remission rate of 67.4% out of the 253 patients that completed a full round of TMS in 2020.

TMS Therapy as an option is determined only by licensed physician who looks at:

1) The severity of symptoms.

2) Past and current medication history

3) Past and current diagnoses

4) Possible contraindications

5) Other past and current treatments

TMS is not only effective in treating current depressive symptoms, but also has the potential of preventing the reoccurrence of those symptoms. Generally, a patient will get authorized for one TMS procedure, but in some cases may do more than one round of treatments if determined necessary by the provider. Depending on the severity and peculiarity of each case, a patient may need another treatment round later on or simply a few extra treatments to break into remission. This is a case-by-case basis, and not the typical form of treatment when doing TMS.

Olympia TMS offers qualitative treatment to patients battling mental health conditions that are resistant to medication. Dr. David Penner is a Harvard-trained psychiatrist with his own practice in downtown Olympia. He speaks on the frequency of TMS treatments in fighting depression and anxiety.

"We decided to start TMS services two years ago. I have been in practice in this community for almost a decade. I became all too familiar with treating people's depression with only partial responses and with sometimes significant side effects despite my best efforts. I went into psychiatry to help individuals suffering, and it broke my heart when people could only get limited benefit from medications, continuing to have depressive symptoms, or side effects to the medications that without TMS they needed. TMS has been an absolute revolutionary treatment for my patients, many of which have been able to carefully discontinue all of their medications."

For more information, call Dr. Penner at (360) 539-1736, or see