TMS for depression

An advanced option when medication isn't enough

Transcranial Magnetic Stimulation (TMS) is an advanced, non-invasive treatment that uses targeted magnetic pulses to activate underactive brain circuits involved in mood regulation. It's done entirely in the clinic, with no anesthesia, no systemic side effects, and no downtime.

We offer evidence-based protocols for depression and related conditions at Florida TMS Clinic in Wesley Chapel and Tampa.

Does TMS work for depression?Florida TMS Clinic · Press play to watch

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Does transcranial magnetic stimulation work for depression? The answer is a big yes. It has been approved by the FDA since 2008 for the treatment of depression. In particular, it was approved for patients who had tried at least one antidepressant in the past without success.

If you have tried antidepressants in the past and they did not work for you, you would be an ideal patient for transcranial magnetic stimulation therapy.

What is TMS therapy?

TMS delivers brief, focused magnetic pulses through a treatment coil placed on the scalp. These pulses safely pass through the skull and stimulate nerve cells in brain regions implicated in depression, helping restore healthy communication between networks that regulate mood, motivation, and cognition.

How does TMS work?

While the exact mechanism continues to be studied, clinical trials show TMS is safe and effective for many patients who have not responded to medications or therapy alone.

• Gentle magnetic pulses target mood-related brain regions that are underactive in depression.
• Stimulation promotes synaptic plasticity and circuit normalization over a multi-week course.
• Patients remain awake and comfortable. Most read, listen to music, or relax during treatment.

Why choose TMS for depression?

• FDA-cleared for Major Depressive Disorder, including treatment-resistant depression.
• No anesthesia, no surgery, and no systemic side effects like weight gain or sexual dysfunction.
• Outpatient, with no restrictions on driving or work after sessions.

Risks and side effects

Common and usually mild and short-lived: headache, scalp discomfort at the stimulation site, and lightheadedness. Your provider can adjust stimulation and suggest simple remedies, such as over-the-counter pain relievers, if needed.

• Rare: seizure (very rare)
• Rare: brief hypomania or mania, typically in the bipolar spectrum
• Rare: hearing discomfort without adequate ear protection

Current evidence does not show long-term harmful effects from TMS.

Who should avoid TMS?

TMS is not appropriate for patients with certain implanted or metallic devices in the head or neck. Always share your full medical history and device details with your provider.

• Pacemakers or defibrillators
• Aneurysm clips or coils
• Cochlear implants
• Deep brain stimulators
• Neurostimulators or medication pumps
• Electrodes for brain monitoring
• Metal plates, screws or bullet fragments
• Other magnetic implants

How to prepare

• Complete a pre-treatment diagnostic evaluation.
• Bring a current list of medications and supplements with doses.
• Discuss seizure history, head injuries, or neurological conditions.
• Confirm coverage and out-of-pocket costs with your insurance.

What to expect

Your first session is mapping, about 45 minutes: you sit in a comfortable chair with ear protection, we take head measurements to locate the target area, test your motor threshold to personalize stimulation, then position the coil. You may feel tapping and hear clicking.

• Typically 5 days a week for 4-6 weeks, depending on protocol
• Sessions of about 19-40 minutes (for example iTBS versus rTMS)
• No downtime: drive and resume normal activities afterward

Treatment-resistant depression (TRD)

Depression is considered treatment-resistant when symptoms have not improved enough after adequate trials of antidepressant medication. Roughly a third of people with major depression do not respond adequately to standard antidepressants, so it is common, and it is not a personal failing.

TMS is FDA-cleared for major depression in adults who have not improved enough with medication. Other options for TRD include Spravato® (esketamine) and, in some cases, ECT. Dr. Bowarshi can talk through which route makes sense for you.

Can TMS and Spravato® be combined?

Both TMS and ketamine-type treatments are thought to support the brain's ability to form new connections. There is some research on combining TMS with IV ketamine, but much less on combining it with nasal Spravato® (esketamine), so this is something we would only consider case by case with your doctor.

Results and ongoing care

• Many patients notice improvement within 2-4 weeks.
• Benefits can be durable. If symptoms return, re-induction is available and often covered by insurance.
• Some patients consider maintenance sessions alongside standard depression care.

Insurance and next steps

Many insurance plans cover TMS for depression when medical criteria are met. We check your benefits before you start. Call (813) 867-2378 to schedule an evaluation.

Frequently asked questions

Sources and further reading

1. Perera T, et al. The Clinical TMS Society consensus review and treatment recommendations for TMS therapy for major depressive disorder. Brain Stimul. 2016;9(3):336–346. Clinical TMS Society
2. Trapp NT, et al. Consensus review and considerations on TMS to treat depression. Clin Neurophysiol. 2025;170:206–233. Clinical TMS Society / NNDC / IFCN
3. Carpenter LL, et al. TMS for major depression: a multisite, naturalistic, observational study of acute treatment outcomes in clinical practice. Depress Anxiety. 2012;29:587–596. Depression and Anxiety
4. Dunner DL, et al. Durability of TMS benefit over a 1-year follow-up period. J Clin Psychiatry. 2014;75:1394–1401. Journal of Clinical Psychiatry
5. Depression. National Institute of Mental Health
6. Brain Stimulation Therapies. National Institute of Mental Health