In the treatment of depression, today it is customary to use multiple therapeutic approaches in an integrated manner. Generally, we talk about drug therapy and psychotherapy. 

Transcranial Magnetic Stimulation aims to remodulate neuronal activity through the magnetic impulses emitted by a device and can be used both as an integration to traditional therapies, drugs and psychotherapy, to improve the effects of traditional treatments, and as an alternative to medical therapy. In particular, it can be indicated, together with psychotherapy, for those patients who have contraindications to taking drugs due to other pathologies (heart disease, liver disease, nephropathy) or in patients who refuse drug therapy due to experienced side effects or simple personal aversion. A very recent study from 2021, published by Publimed confirms the effectiveness of TMS in regressing the symptoms of drug-resistant depression.

In patients with Parkinson’s, transcranial magnetic stimulation is used to support traditional pharmacological therapy, and the maximum benefit is obtained when the patient also follows courses of physiotherapy or, better to say, neuromotor rehabilitation. In this case, in fact, the area of the brain that is stimulated through the magnetic waves is the motor cortex, which is one of the main areas of the brain responsible for movement control. TMS in combination with physiotherapy allows the patient to have improvements on the motor symptoms of the disease.

In patients with Alzheimer’s, TMS remodulates the plasticity of the precuneus, an area of the brain involved in memory functions. Recent scientific evidence has shown that this brain structure is one of the first to ‘suffer’ from Alzheimer’s disease and is already compromised in the prodromal stages of the disease. However, in typical forms of Alzheimer’s, the brain structures primarily involved in degenerative phenomena are those located in the medial temporal lobes. In fact, the early stages of the disease are dominated by memory disturbances. The neuromodulatory strategy using TMS consists in stimulating the precuneus, which, at least in part, suffers due to mechanisms of disconnection with the medial temporal structures. This neuromodulation has been shown to be effective in slowing the progressive accumulation of cognitive deficits, the aggravation of which leads individuals with initial Alzheimer’s disease to a state of dementia.

Timing is therefore very important in treatment: in fact, stimulation is more effective in early Alzheimer’s. This makes a precise diagnosis from the first symptoms and a careful evaluation by the neurologist essential to maximize the benefits of the treatment, which must be administered with anatomical accuracy on the basis of neuroimages obtained with Magnetic Resonance. The ultimate goal is to improve memory, slowing down the degenerative process of the brain cells (neurons) of the precuneus and the structures connected to it, which perform important cognitive functions.

Transcranial magnetic stimulation, TMS, together with cognitive behavioral therapy, CBT (Cognitive Behavioral Therapy), helps reduce the desire to smoke or to consume other psychostimulant substances, if used frequently.

The brain regulates emotions especially through the limbic system, composed of a series of nuclei and deep nerve fibers that connect, among others, with the orbito-frontal cerebral cortex, an area of the brain that plays a fundamental role in the emotional response and in the subsequent decision-making. The regulation function of this system, both for its activation and for its inhibition, is carried out by neurotransmitters, chemical substances naturally present in the nervous system, which have the ability to excite or inhibit the brain circuits responsible for the development of emotions and many other functions of the nervous system.

Nicotine, and psychostimulants in general, interfere with the action of various neurotransmitters. Simply put, these substances alter the messages that the brain processes in particular in the limbic system. The mechanisms through which these substances carry out this action are different but, in general, it can be said that they modify the quantity of some neurotransmitters present in our brain such as dopamine, a neurotransmitter useful for consolidating memory and a mediator of pleasant sensations, and glutamate, which favors the exchange of information between neurons and has a stimulating and natural activation function of the circuits of our nervous system.

Psychostimulant substances or an excess of psychoactive drugs introduced into the body from the outside, through the activation of the circuits of the limbic system, intensify the sensation of pleasure and sense of gratification. Hence a sensation of false well-being which, in the event of problematic and prolonged use, leads to addiction and a desire that is difficult to control, defined as craving, to take the psychostimulant substance to which the whole organism, and in particular the brain, is by now used to it.

TMS and cognitive-behavioral therapy, used in synergy, are effective for treating patients who make problematic use of nicotine or other psychostimulant substances. The aim of treatment is for the person to have the opportunity to choose to stop using nicotine or other psychoactive substances, without being dominated by craving. This is possible only by restoring decision control, which occurs above all in the orbito-frontal area of the brain, freeing this function from the conditioning of false emotions. The process, from the initial clinical assessment of the patient to the completion of the series of TMS treatment sessions, takes approximately one month. In some cases it is useful to continue with boosters with TMS sessions in the following months.

The comprehensive TMS treatment program begins with a pre-TMS outpatient consultation evaluation, where the specialists assess your suitability for the treatment and provide answers to any queries you may have. In your initial treatment session, they conduct a brain mapping procedure to determine your unique TMS “dose”, ensuring a tailored approach to your therapy. Throughout your therapy journey, a trained TMS technician will closely monitor your daily progress and administer the TMS therapy. The TMS therapy may be optimized with other services aiming to restore your wellbeing, such as rehabilitation, cognitive exercises, consultations with psychologists and/or neurologists.

Throughout a TMS treatment session, you are comfortably seated in a reclined chair. You remain completely conscious and attentive, with the option to engage in conversation, listen to music, watch videos, or simply relax using earplugs.

An average treatment session typically spans from 20 to 30 minutes, during which you will experience a sequence of gentle taps on your head beneath the TMS coil. It’s not uncommon for certain patients to encounter slight discomfort on their scalp beneath the coil or occasionally experience a lingering headache after the initial few sessions. These sensations are ordinary, can be addressed by modifying the stimulation parameters, and usually dissipate within the initial week of daily sessions.

The number of Transcranial Magnetic Stimulation (TMS) sessions required varies depending on the condition being treated, individual response to therapy, and the specific protocol used. However, for most patients undergoing TMS for major depressive disorder, a standard course consists of 20 to 30 sessions, typically administered five days per week over four to six weeks.

Each session usually lasts 20 to 40 minutes, depending on the type of stimulation (standard or deep TMS) and the treatment plan tailored by the clinician. Some patients begin to notice improvements as early as the second or third week, while others may need to complete the full course before experiencing meaningful symptom relief.

In some cases, clinicians may recommend additional or extended sessions—up to 36 or even 40 treatments—especially if the patient shows a delayed but promising response. For those who respond well to the initial course but experience a return of symptoms weeks or months later, a shorter series of “maintenance” or “booster” sessions can be scheduled to help sustain the benefits.

Patients being treated for other conditions, such as obsessive-compulsive disorder (OCD), anxiety, or substance use disorders, may follow slightly different protocols. These typically involve a similar number of sessions, though the specific brain regions targeted and pulse frequencies may vary.

It’s important to note that TMS is a cumulative therapy—meaning its effects build over time with consistent and repeated stimulation. Missing too many sessions or stopping early can reduce its overall effectiveness. For best results, it’s recommended to follow the treatment schedule as closely as possible and attend sessions regularly.

The duration of treatment will always be customized based on your clinical evaluation, response rate, and overall goals. Throughout the course, your provider will monitor your progress closely and may adjust the frequency or number of sessions based on how your symptoms evolve.

In summary, most patients will need around 30 sessions of TMS therapy, with some variation based on individual response and clinical need. Regular attendance and close communication with your care team are key to achieving the best outcomes.

Similar to medications, the response time to TMS therapy can differ among patients. For optimal results in treating depression with TMS, it is advisable to undergo TMS sessions on weekdays consistently, typically spanning four to six weeks. It’s worth noting that, frequently, there may not be any noticeable shift in mood during the initial weeks of treatment. Clinical trials have shown that the majority of patients observed substantial benefits as early as the conclusion of the second week of TMS treatments, while a minority of needed more than 30 sessions before experiencing relief from depressive symptoms.

A study published in 2018 in The Lancet, a prestigious international scientific journal, reports that 47% of patients treated with TMS for major depression responded to therapy and 27% achieved remission of symptoms. Further studies show that TMS is a promising technology to treat neurological pathologies such as Alzheimer’s and Parkinson’s disease on which it seems to have efficacy in the remission of motor and cognitive symptoms.

In general, the data confirm the efficacy of transcranial magnetic stimulation in neurophysiological pathologies and its safety as a minimally invasive technique with low risk for the patient.

TMS offers a distinct advantage over other depression treatments by precisely honing in on the intended brain region or “target.” This precision allows clinicians to focus solely on specific areas of the brain while leaving others unaffected. TMS does not result in memory issues or cognitive impairments, nor does it alter a person’s personality. When patients find relief from their depression symptoms through TMS, they often experience improved cognitive abilities and overall functioning.

In comparison to other depression treatments, TMS is associated with minimal side effects. Research indicates that approximately one out of every five individuals may experience a mild to moderate headache or tenderness in the scalp following TMS treatment. These discomforts, however, typically resolve within the initial week and can be effectively managed.

While Transcranial Magnetic Stimulation (TMS) therapy has shown significant efficacy in treating conditions like major depressive disorder, addiction, and anxiety, it’s important to recognize that, like all medical treatments, it may not work for everyone in the same way or within the same timeframe. A lack of response to the initial course of TMS does not necessarily indicate treatment failure—it may instead signal the need for adjustments, additional sessions, or complementary strategies.

For most patients undergoing TMS for depression, noticeable improvements typically begin to emerge between the second and fourth week of treatment. However, some individuals may require more extended therapy—30 to 40 sessions or more—to achieve a response. If a patient does not experience any improvement by the end of the standard course (usually 4 to 6 weeks), clinicians will usually perform a thorough evaluation to determine why.

Several factors could influence an individual’s response to TMS. These include:

• The specific location of stimulation on the brain,

• The intensity and frequency of the pulses,

• Co-existing neurological or psychiatric conditions,

• Medication use during the treatment course,

• Or even individual neurobiological variability.

In cases where no progress is observed, clinicians may revise the treatment plan. One approach is to adjust the stimulation parameters—this might include changing the targeted brain region, increasing the pulse intensity, or switching to bilateral stimulation (stimulating both hemispheres of the brain rather than one). Some patients also benefit from deep TMS, a variant that targets deeper brain structures associated with mood and behavior.

Another common next step is to combine TMS with other therapies, such as psychotherapy (e.g., cognitive behavioral therapy or trauma-informed approaches), pharmacological treatment, or lifestyle interventions. In some cases, patients who previously did not respond to medication may respond better when TMS is used in conjunction with it. The neuromodulatory effects of TMS can sometimes enhance the brain’s receptivity to other forms of treatment.

Importantly, non-response to an initial round of TMS does not rule out future success. Many patients who do not respond immediately can benefit from a second treatment course, sometimes several months later. Research has shown that some individuals classified as “non-responders” in their first course may still achieve remission or significant improvement during subsequent treatment cycles, particularly when the protocol is revised to better suit their individual needs.

It is also worth noting that in rare cases, TMS may not be the right intervention due to biological treatment resistance or other complicating medical or psychiatric conditions. In such instances, clinicians might discuss other neuromodulation options, such as electroconvulsive therapy (ECT) or vagus nerve stimulation (VNS), which have shown benefit in patients with severe, treatment-resistant depression.

In summary, if TMS does not initially work, it is not necessarily the end of the road. There are multiple paths forward, and TMS is part of a broader, evolving field of neuroscience-based mental health treatment. Continued communication between patient and provider, open reassessment, and willingness to modify or combine approaches are key to finding the most effective path toward recovery.

No, Transcranial Magnetic Stimulation (TMS) and Electroconvulsive Therapy (ECT) are not the same, though both are used to treat severe psychiatric conditions such as major depressive disorder, especially when other treatments have failed. While they are both forms of neuromodulation—therapies that influence brain activity—they differ significantly in their method, effects, risks, and patient experience.

TMS is a non-invasive, outpatient procedure that uses magnetic fields to stimulate specific areas of the brain. It targets regions like the dorsolateral prefrontal cortex, which is involved in mood regulation. During TMS, an electromagnetic coil is placed against the patient’s scalp, delivering rapid pulses that help activate underactive neural circuits. Each session typically lasts about 20 to 40 minutes, requires no anesthesia, and allows the patient to return to daily activities immediately afterward. TMS does not induce seizures, and the most common side effects—mild headaches or scalp discomfort—are usually temporary.

In contrast, ECT is a more intensive medical procedure that involves sending controlled electric currents through the brain to intentionally trigger a brief seizure. It is typically performed in a hospital setting under general anesthesia, and patients often require multiple sessions spaced over several weeks. ECT is considered highly effective, particularly for treatment-resistant depression or severe bipolar disorder, but it carries more significant side effects. The most well-known of these are short-term memory loss, confusion, and, in some cases, longer-term cognitive issues, especially with repeated treatments.

TMS and ECT also differ in public perception. ECT has historically carried stigma due to its portrayal in media and its earlier, less refined use. However, modern ECT is carefully controlled and can be life-saving in acute situations. TMS, being more recent and less invasive, has gained popularity as a gentler alternative for those who do not respond to medication but wish to avoid anesthesia or cognitive side effects.

In summary, TMS and ECT are distinct therapies with different mechanisms and risk profiles. TMS offers a non-invasive option with fewer side effects, while ECT remains a powerful but more intensive treatment reserved for the most severe or urgent cases.

The timeline for experiencing improvement with Transcranial Magnetic Stimulation (TMS) therapy can vary significantly from person to person. While some patients begin to notice changes in mood or energy as early as the second week of treatment, for many others, significant improvements may not appear until the fourth or even fifth week. This variation is entirely normal and does not mean the treatment isn’t working.

TMS is a gradual and cumulative process. It works by stimulating specific areas of the brain associated with mood regulation, particularly the dorsolateral prefrontal cortex. These regions typically become underactive in individuals suffering from depression or anxiety. Through repeated daily stimulation—usually five sessions per week—the therapy helps restore normal activity and connectivity in these circuits over time.

Most standard treatment plans include 20 to 30 sessions, with many patients showing noticeable improvement somewhere between session 10 and session 20. For others, especially those with long-standing or treatment-resistant depression, it may take longer to feel a meaningful shift. This delayed response does not mean the therapy won’t be effective—it may simply reflect the brain’s unique pace of adaptation.

When improvement begins, it often starts with subtle changes: better sleep, a decrease in negative thinking, increased motivation, or the ability to handle daily stress more easily. Over time, these small gains typically grow into more sustained and noticeable emotional relief.

It’s also common for patients to have good days and bad days throughout the course of treatment. TMS is not a linear experience, and fluctuations are expected as the brain adjusts to stimulation. Clinicians track your progress closely through standardized assessments and check-ins to ensure the therapy is working as expected.

In summary, you may start to feel better within the first few weeks, but the full benefit of TMS is often realized only after completing the full course. Patience, consistency, and regular communication with your care team are essential for achieving optimal results. If progress seems slow, your provider may adjust your treatment plan to better suit your needs.