Maintenance TMS



How Long Does TMS Last? Does Maintenance TMS Help?



It has been about 15 years since the FDA cleared Transcranial Magnetic Stimulation therapy (TMS) for treating depression, and the success rate has been very good. A frequently asked question that we often hear is, “is TMS therapy a permanent solution, and how long can patients expect the results to last?” Continue reading to find out. In this article, we will answer the following questions.

• Is TMS Permanent? 

• Does Depression Come Back After TMS?

• How Long Do TMS Benefits Last? 

• What To Do When Depression Relapses After TMS Therapy?

• What Is Taper-Off TMS Therapy?

• Does Taper TMS Help Prevent Or Delay Relapse?

• What Is Maintenance TMS Therapy?

• Does Maintenance TMS Therapy Prevent Relapse?

• Is Maintenance TMS Therapy Covered By Insurance?

The benefits of TMS therapy can last for a long time. Durability is the terminology we use for how long a certain treatment effect lasts. A couple of durability papers showed that two-thirds of patients kept the effect of TMS therapy for 6-12 months after the treatment. We don’t have good published data on the long-term durability of TMS beyond 12 months. But from anecdotal observation of our patients, those who make it beyond a year without recurrence of depression symptoms remain well for years and may never need TMS retreatment. Those who relapse early may need retreatment and a plan of maintenance and prevention of relapse. Please note that each case is unique, and our general answers might not apply to you and your specific circumstance. With that disclosure being said, let's be specific with the answer now. 

Is TMS Permanent?

For many, it is not permanent. If we track patients over a long period of time, about one third will have depressive symptoms again.



Does Depression Come Back After TMS?

Yes. Depression can come back again after TMS therapy.



How Long Do TMS Benefits Last?

About two-thirds of patients will continue to enjoy the benefits of TMS therapy 6 to 12 months after the end of TMS therapy.



What To Do When Depression Relapses After TMS Therapy?

At Florida TMS Clinic, if depression relapses soon after TMS therapy is over (less than 2 months), then we move on to another treatment option (Esktamine, ECT). If depression relapse later after TMS therapy (more than 2 months), then we recommend retreatment with a full course of TMS therapy again.

What Is Taper-Off TMS Therapy?

Taper-off TMS therapy is a sequence of 6 TMS therapy sessions tapered down in frequency over 3 weeks. Typically, 3 TMS sessions in the first week, then 2 in the second week, and then 1 in the last of the three weeks. Typically, it is performed after a successful course of daily TMS therapy for 30 sessions.

Does Taper TMS Help Prevent Or Delay Relapse?

Yes. Taper-off TMS can help push out relapse of depressive symptoms after a successful course of TMS therapy. Taper-off TMS is recommended only if the patient had positive results with the 30 sessions daily TMS course. There is no point in tapering off TMS if one didn’t respond to the acute course of TMS.



What Is Maintenance TMS Therapy?

Maintenance TMS is when we continue to do TMS on a regular basis beyond the acute phase and taper-off. Typically, maintenance TMS is done once a week TMS for a few months up to a year. Other names used to describe maintenance TMS are; preservation TMS, preventive TMS, and continuation TMS.



Does Maintenance TMS Therapy Prevent Relapse?

Maintenance TMS may prevent relapse of depressive symptoms after TMS. Or it may delay the onset of such a relapse. That being said, the clinical evidence is not conclusive.



Is Maintenance TMS Therapy Covered By Insurance?

No. Insurance doesn’t cover maintenance TMS.



• Based on the fact that taper-off TMS may delay the onset of relapse. We always recommend taper-off TMS to patients showing response or remission in depression symptoms.

• Based on the fact that TMS responders have a good chance of keeping the response after the first course of TMS, we don’t routinely recommend maintenance TMS after the first course of TMS therapy. 

• Based on the high likelihood of response again with TMS retreatment. We recommend TMS retreatment for patients whose depressive symptoms relapse 2 months or later after the end of the acute TMS therapy course.

• We recommend maintenance-TMS therapy on weekly bases for 6 months after the second course of TMS therapy to delay further relapses. 

• As of now, and because of the lack of insurance coverage for maintenance TMS, FLORIDA TMS CLINIC offers maintenance TMS therapy free of charge to our patients who meet the above criteria.

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