Quick facts
- What it is
- Non-invasive magnetic pulses that stimulate mood-regulating brain circuits.
- FDA-cleared for
- Major depression (2008), OCD (2018), anxious depression (2021).
- Typical course
- 30 to 36 sessions, about six weeks of daily treatment, then a taper.
- Anesthesia or downtime
- None. You stay awake and can drive yourself.
- Led by
- Dr. Khaled Bowarshi, dual board-certified psychiatrist and Duke-certified TMS specialist.
- Locations
- Wesley Chapel and Tampa, Florida.
- Insurance
- Many plans cover TMS when medical criteria are met; we check your benefits first.
- Call
- (813) 867-2378
Why patients consider TMS
About one-third of people with depression don't improve with medication alone.
- Persistent sadness, loss of joy
- Low energy, poor focus
- Trouble sleeping or appetite changes
- Nervousness, constant worry
- Medication side effects such as weight gain, sexual dysfunction, dizziness or stomach upset
- Feeling like you need "a pill to counter a pill"
Read the transcript
What is TMS therapy? TMS stands for transcranial magnetic stimulation. Transcranial means "through the skull." That means that it goes through the skull [inaudible]. Magnetic stimulation means that we use a magnetic pulse to stimulate particular areas of the brain that are responsible for depression.
TMS is safe, effective, and FDA approved. It is an alternative treatment for depression for patients who do not want to take medications or who have not responded to antidepressant medications.
What is TMS therapy?
Transcranial Magnetic Stimulation (TMS) uses gentle, focused magnetic pulses to stimulate mood-regulating brain circuits. Treatments are non-invasive, outpatient, and well-tolerated, with no systemic side effects.
When these circuits are underactive in depression, TMS helps "reactivate" them and restore healthier patterns of activity.
- Non-invasive
- No anesthesia
- No downtime
- Clinic-based
Your TMS questions, answered
Pick a question to watch a short answer from our team.
Read the transcript
What should you expect during your TMS treatment? You come to the clinic on a daily basis. You are seated in a very comfortable room on a very comfortable reclining chair. A magnetic coil is placed on the frontal lateral area of your head, delivering the magnetic pulses. This lasts for about 19 minutes.
You are completely awake during this time. There is no sedation involved, and you can return to normal activities after treatment. Most of our patients drive themselves to the clinic and drive back to work or school after treatment.
FDA-cleared uses
- Major Depressive Disorder, cleared in 2008
- Obsessive-Compulsive Disorder, cleared in 2018
- Anxious depression (MDD with comorbid anxiety symptoms), cleared in 2021
"Anxious depression" refers to anxiety symptoms occurring together with MDD, not standalone generalized anxiety disorder (GAD).
Conditions we treat with TMS
- Major Depressive Disorder
- Anxious depression and anxiety symptoms with MDD
- Obsessive-Compulsive Disorder (OCD)
- Post-Traumatic Stress Disorder (PTSD), evaluated case by case
- Substance use disorders (adjunctive, case by case)
How does TMS work?
TMS works by sending a targeted pulsed magnetic field into the brain, targeting nerve cells that control mood. These magnetic pulses are similar in strength to those of an MRI.
Read the transcript
How does TMS therapy work? In a depressed brain, there are certain areas that are hypoactive, or sleepy. When we use magnetic stimulation, we activate those areas of the brain and bring them back into normal function. We may also be inducing what is called neuroplasticity.
What is neuroplasticity? Neuroplasticity is when a brain cell builds new connections with another brain cell. When we do TMS, we are doing that on a massive scale for multiple brain cells in a certain area. That brings new connections between brain circuits and brings someone out of depression with a long-lasting effect.
Think of TMS therapy as a workout routine, but instead of being for your muscles, it is for your brain. You do not go to the gym, lift weights once, and expect to build muscle mass. Instead, you do it in sets, every day, for a few weeks, and then you expect some muscle growth.
It is similar with TMS. We stimulate the brain repetitively, on a daily basis, for a few weeks, and then we have a long-lasting antidepressant effect on the brain.
What to expect during TMS therapy
TMS requires no medication and has little or no significant side effects. You can drive to and from appointments without other support. All sessions are taken seated in a very comfortable chair in a calm, quiet room. You remain awake and alert, and you are welcome to bring your phone for games or music, or a book to read.
During a treatment you will notice a tapping sensation or clicking sound as the stimulation is delivered. Most patients get used to it very quickly. A small number report discomfort, which usually lessens after a few more sessions as they acclimate.
Read the transcript
Many of our patients ask, "How do I spend my time during TMS treatments?" TMS therapy is very relaxing. We still want you to be awake during your treatment sessions. Research shows that an active brain responds to TMS therapy better than an inactive brain.
Some of our patients use their phones to go through a therapy app during treatment. Others watch relaxation and meditation videos on YouTube during treatment. Most of our patients end up catching up on their favorite shows on Netflix and [inaudible] during treatment.
How many sessions, and how often?
The number of TMS sessions depends on the patient, condition, contraindications, and system protocol. A typical course takes 30 to 36 sessions, including the last six that taper you off. The bulk of sessions happen in the first six weeks, then slowly reduce.
- One session a day, 5 days a week, for 6 weeks
- Then one session a day, 3 days a week
- Then one session a day, 2 days a week
- Then one session in the last week
Read the transcript
How many sessions does TMS therapy require? A full course of TMS therapy is done daily, Monday through Friday, five days a week, for six weeks. That is a total of 30 treatment sessions in six weeks.
For patients who respond to treatment, we then use a tapering protocol. That is six sessions over three weeks: three sessions in week one, two sessions in week two, and one session in week three.
The total number of treatments is 36 sessions, completed over nine weeks.
Accelerated TMS (10 sessions a day for 5 days) is also available for suitable patients.
Pros and cons of TMS therapy
TMS is one of the least invasive options for depression, and it is not right for everyone. Here is a balanced look at what to weigh before you decide.
| Advantages | Things to consider |
|---|---|
| Non-invasive, with no sedation or anesthesia | Daily visits over several weeks |
| No stomach, weight or sexual side effects of the kind linked to some medications | Mild scalp discomfort or headache in some patients, usually easing after the first sessions |
| You can drive yourself and go back to work or normal activities afterward | A small seizure risk, so tell your doctor about any seizure history |
| Not habit-forming, with no known effect on memory | Insurers set their own criteria, and some need documented medication trials first |
| Covered by most major insurers for depression when criteria are met | Without coverage, out-of-pocket cost can be significant |
Non-invasive, with no sedation or anesthesia
Things to consider: Daily visits over several weeks
No stomach, weight or sexual side effects of the kind linked to some medications
Things to consider: Mild scalp discomfort or headache in some patients, usually easing after the first sessions
You can drive yourself and go back to work or normal activities afterward
Things to consider: A small seizure risk, so tell your doctor about any seizure history
Not habit-forming, with no known effect on memory
Things to consider: Insurers set their own criteria, and some need documented medication trials first
Covered by most major insurers for depression when criteria are met
Things to consider: Without coverage, out-of-pocket cost can be significant
A typical standard session runs about 19 minutes, and theta burst sessions can be about 3 minutes. Your doctor will tell you which protocol fits you.
Who should not get TMS?
Your doctor reviews your history at the evaluation. TMS may not be a fit, or needs extra care, in situations such as:
- Metal implants or devices in or near the head that a magnet could affect
- A history of seizures or epilepsy
- Certain implanted devices, such as some cochlear or stimulation implants
- Conditions or medications that lower the seizure threshold, which your doctor will review with you
Read the transcript
Who should not get TMS therapy? TMS therapy is safe for most people. Patients who have metal implants in their head should not get TMS therapy. The magnetic field could interfere with that metal object in their head.
Also, patients who have an active seizure disorder should not get TMS therapy either.
This list is a general guide only. Your psychiatrist decides what is safe for you.
TMS compared with at-home brain stimulation devices
You may see consumer devices that use mild electrical current, such as tDCS or cranial electrotherapy headsets. These are different from TMS. TMS uses magnetic pulses delivered by a clinic-based, FDA-cleared system, directed at a specific brain area and supervised by a physician. At-home electrical devices have a different mechanism and a different evidence base, and they should not be treated as equivalent.
If you are using one now, tell us at your evaluation. It will not stop you from being considered for TMS.
Other uses being studied
TMS is FDA-cleared for major depression and OCD in adults, with additional clearances for certain other uses. Researchers are also studying TMS for other conditions, including PTSD, bipolar depression, postpartum depression, insomnia, fibromyalgia, migraine, smoking cessation and some symptoms in autism spectrum disorder.
These uses are considered off-label, evidence varies by condition, and insurance usually does not cover them. If you are wondering whether TMS could help with one of them, bring it up at your evaluation and Dr. Bowarshi will tell you honestly what is known.
Your first steps as a new TMS patient
- 1. Phone screening to see if TMS therapy is right for you
- 2. Pre-assessment with electronic intake forms
- 3. Full evaluation: meet Dr. Bowarshi in person for an hour for a full psychiatric evaluation
- 4. Start TMS: brain mapping, then daily TMS therapy at our Wesley Chapel or Tampa office
Why Florida TMS Clinic?
Many patients experience significant, long-lasting relief, and remission, after a full TMS course.
- Expert care: Dr. Khaled Bowarshi is dual board-certified and a Duke-certified TMS specialist.
- Personalized plans: protocols tailored to your goals and history.
- Local and trusted: serving Wesley Chapel, Tampa, and patients traveling from across Florida and the U.S.
StimGuide 3D navigation
We use StimGuide 3D Navigation to help deliver pulses with consistent accuracy and patient-specific positioning, supporting comfort and outcomes.
Ready to take the next step?
If medications haven't worked, or their side effects have, TMS may be your path forward. Care is available in Wesley Chapel and Tampa.
Frequently asked questions
Medical information on this page is educational and not a substitute for professional advice. Individual results vary.