<img height="1" width="1" style="display:none" src="https://www.facebook.com/tr?id=1056215754466548&amp;ev=PageView&amp;noscript=1">
280 W River Park Drive Suite 110 Provo, UT

Back to Blog

How to Find & Evaluate TMS Clinics Near You

Image of Dr. Mark Allen, Ph.D.
Updated on 10 February, 2025
Medically Reviewed by

Dr. Diane Spangler, Ph.D.

How to Find & Evaluate TMS Clinics Near You

The stakes of finding the right TMS provider can feel understandably high. After all, patients suffering from mental health conditions such as major depressive disorder (MDD) or obsessive-compulsive disorder (OCD) are often in desperate need of relief. And any time you plan to receive a treatment that affects your brain chemistry, you want to be certain that you can trust your provider.

To be clear, TMS is a safe, FDA-approved procedure for treating these conditions. Common side effects tend to be mild and minimal, and it's proven to be an effective treatment for relieving depression symptoms.

Still, choosing the right TMS clinic requires consideration. There are numerous matters to weigh such as costs and insurance coverage, duration of treatment, the type of TMS offered, and more.

In this article, we cover some important things you should know and consider throughout the process of seeking a treatment center, including:

Note: This article focuses on TMS therapy for depression because that’s what we offer and treat at our clinic. However, much of what is covered can apply to assessing TMS clinics for treating other conditions.

Important Questions to Ask When Evaluating TMS Clinics


If you’re considering TMS therapy as a treatment for your depression, the following are some key questions that you should seek to answer to pick the right clinic for you.

1. What type(s) of TMS does the clinic offer?


One of the most important questions you need to ask the clinics you’re considering is what type or types of TMS they offer. Here’s a brief overview of the main types you will encounter:

rTMS

The most common form is called repetitive transcranial magnetic stimulation (rTMS) and was first applied to treat depression in the mid-90s. This outpatient procedure involves repeated electromagnetic pulses delivered by a magnetic coil placed on the patient’s scalp to improve neuronal activity. The coil generates low-frequency magnetic pulses to regulate brain activity in an area of the brain called the dorsolateral prefrontal cortex (DLPFC). The DLPFC is linked to executive functioning, including distinguishing between ideas, actions, and outcomes. Its main functions include working memory, decision-making, reasoning, and planning.

Standard treatments using rTMS involve daily sessions, five days a week, with 2030 sessions delivered over 46 weeks. Typically, patients start to see improvements after 24 weeks. However, some only see the benefits after treatment is completed. About 50% of patients respond well to treatment with over 30% showing complete remission.

Accelerated TMS

To reduce the time commitments needed for rTMS, some clinics offer a form of TMS called accelerated TMS. This option involves much shorter sessions (3 minutes vs. 30 minutes with rTMS) and patients can undergo multiple sessions per day reducing the length of the treatment.

Studies show accelerated TMS is as safe as rTMS and potentially more effective. Patients receiving multiple sessions each day tend to experience improvements in symptoms faster than patients receiving single daily sessions, and the effects are still visible months after their treatment.

Intermittent Theta-Burst Stimulation (iTBS)

In 2018, the FDA approved a new version of accelerated TMS called Intermittent Theta-Burst Stimulation (iTBS). This method uses theta waves, the neural frequencies that the hippocampus uses to connect to other brain regions, form new memories, and regulate certain sleep phases.

This method is safe and effective; many patients experience improvements shortly after starting treatment. In addition, patients also noticed a decrease in suicidal ideation, suggesting that iTBS could be an option to rapidly treat patients at high risk of suicide. As it requires more specialized equipment, this protocol is currently offered by fewer clinics in the U.S.

SAINT-iTBS

Finally, the method used by our team at Cognitive FX was approved by the FDA to treat patients with depression in September 2022. This method, developed by researchers from Stanford University, is known as the SAINT protocol. SAINT stands for Stanford Intelligent Accelerated Neuromodulation Therapy. It uses an fMRI brain scan to determine exactly where the DLPFC is located in the brain and a neuronavigation device to ensure the coil is placed over that exact spot during every iTBS session.

SAINT treatment involves 10 sessions per day over 5 days for an efficient one-week treatment plan. Following this protocol significantly reduced depressive symptoms and suicidal ideation within 5 days, without negative side effects. It’s currently considered the “gold standard” treatment for treatment-resistant depression.

A comparison of remission rates for rTMS/iTBS, electroconvulsive therapy (ECT), and SAINT-iTBS.
A comparison of remission rates for rTMS/iTBS, electroconvulsive therapy (ECT), and SAINT-iTBS.

2. How is the target area of the brain located? And how is the magnetic coil placed for each treatment session?


One of the crucial aspects of TMS is how the brain region for the treatment is located and how the coil is placed for each session. This can significantly impact the overall results of treatment, as even missing it by a few millimeters can lower the treatment’s effectiveness.

At the moment, the different methods of coil placement include:

The 5 cm Method (Most Common; Least Accurate)

When TMS was developed in the mid-1990s, the first method to identify the location of the DLPFC involved a simple measurement of the skull. This procedure, which is still commonly used today, is called the 5 cm method. It involves identifying an area located on top of the head called the motor cortex.

Once the motor cortex is located, operators measure 5 cm along the parasagittal plane anterior to the activation hotspot. However, since the motor cortex is roughly the size of a golf ball, operators cannot determine which section they are targeting with the pulses. This means that the starting point to measure the 5 cm can change from session to session and often miss the right area for the treatment. Even slight deviations of a few millimeters can result in poorer outcomes.

You may find that several of the clinics that you’re considering use this procedure. This method is easy to carry out because it doesn’t require any specialized equipment. However, many studies now show that this method can be unreliable and doesn’t take into account individual variations in brain size and shape between patients.

Beam F3 Method (EEG Cap)

Issues with the 5 cm approach have been apparent since the early 2000s and there is increasing interest in developing and validating alternative methods. One of these methods relies on the International 10–20 EEG system to locate the DLPFC. This procedure uses a standard grid which is divided into multiple sections. In practical terms, this involves placing a cap on the patient’s head. Once the cap is correctly placed, the operator marks position F3 to place the magnetic coil.

This method is inexpensive and scalable, as it does not require any additional equipment or specialized operator training. For these reasons, it has become popular in many TMS clinics. Although studies show that the F3 method is slightly more accurate and reliable compared to the 5 cm rule, differences are minor and unlikely to be substantially better. In addition, even a simple haircut can change how the cap fits the patient, which means it can vary from session to session.

Structural MRI

The main problem with the methods described above is that they fail to account for differences in patients’ head sizes and shapes, leading to inaccuracies in targeting the correct brain area and higher variability in treatment outcomes. To overcome this issue, researchers developed various neuronavigation methods to locate the target area more precisely and consistently. As a general rule, neuronavigation can be used with any type of TMS, including rTMS, but it’s more commonly found in clinics that offer advanced TMS options such as accelerated TMS or SAINT-iTBS.

The most common neuronavigation method involves a structural MRI to accurately identify the location of the DLPFC. Using neuronavigation software with the results from the scan allows operators to accurately guide the magnetic coil to the intended area with millimeter precision for each patient. In addition, using brain scans also reduces variation caused by the operator, which is a major problem with the methods described above.

The downside of using neuronavigation is that it involves relatively complex equipment, and patients need to undergo an expensive MRI scan, which increases overall costs. In addition, fewer clinics offer these services and you may need to travel some distance to find one suitable for you.

NIHMS Article PMC10026380 Figure 5: Study shows the distance from the target is higher and more variable using a cap compared to neuronavigation.
Study shows the distance from the target is higher and more variable using a cap compared to neuronavigation. [Source - Fig. 5.]

Functional MRI (fMRI)

While structural MRIs show detailed images of the brain, they cannot reveal how specific areas are functioning. Functional MRI (fMRI), on the other hand, can identify active brain regions, which is useful for targeting during treatment.

With fMRI, doctors can focus even more precisely on the DLPFC, which is connected to another region known as the subgenual anterior cingulate cortex (sgACC). High activity in the sgACC is linked to depression, and targeting it indirectly through the left DLPFC with TMS can reduce its activity, leading to symptom improvement.

fMRI provides much greater accuracy than other methods in locating these brain areas. For example, using fMRI ensures that the sgACC is properly stimulated through the left DLPFC in nearly all patients, while simpler brain measurements are successful in less than half. This precision explains why fMRI-guided treatment, like the method used at our clinic, has high success rates.

In a double-blind randomized clinical trial, about 85% of patients responded to the treatment and around 78% reached remission. At the one-month mark, 60% were still in remission. For patients who didn’t respond to rTMS before, fMRI-guided TMS like the SAINT protocol may help. With fMRI's accuracy, there is a better chance of recovery.

If possible, choose a TMS clinic that uses MRI and neuronavigation to precisely position the coil, as this can significantly improve treatment results.

3. Does the clinic offer other therapies alongside TMS?


Some clinics combine TMS with other therapies to improve treatment outcomes for their patients. Common examples of additional therapies include psychotherapy, neurofeedback, eye movement desensitization and reprocessing (EMDR), or yoga.

From our perspective, pairing cognitive behavioral therapy (CBT) with TMS (as we do at our clinic) is likely to have the highest positive impact on patients' long-term outcomes. TMS on its own can help provide fast-acting symptom relief, but CBT has been proven to offer long-lasting benefits.

In comparison to other types of psychotherapy, CBT has significantly more scientific and empirical support for treating depression, including a greater number of randomized controlled trials supporting its efficacy. Most meta-analyses comparing different types of psychotherapy for depression indicate that CBT outperforms others in both the short-term and particularly in the long term (e.g., 6 months to 1 year post-treatment). Once treatment concludes, the benefits of CBT are sustained over time. In contrast, the benefits of other forms of psychotherapy (and medications for that matter) are not as durable, with patients often experiencing relapses of depression once these treatments conclude.

Overall, research shows that CBT is superior to other psychotherapies and medication for depression in both short- and long-term outcomes, with a notable advantage in the long term. The response rate to CBT across studies ranges from 61%–87% with large effect sizes.

4. What is the cost of treatment and is it covered by insurance?


TMS treatment can be costly, so a crucial factor for patients when selecting a clinic is how they will manage the expenses.

Many insurance companies consider TMS a medically necessary treatment option to address major depressive disorder (MDD) and treatment-resistant depression (TRD) and therefore cover TMS in their policies.

Each insurer has its criteria for TMS coverage. For instance, some require patients to have failed four antidepressant medications and psychotherapy, while others are less strict, requiring failure of only two medications. Some insurers specify which types of medications — such as antipsychotics or different classes of antidepressants — must be tried first. Additionally, coverage may vary based on the severity of symptoms, with some insurers covering moderate cases, while others limit coverage to severe conditions.

Currently, the only form of TMS that is covered by insurance is repetitive TMS (rTMS). This involves daily treatment sessions, five days a week for four to six weeks. Even after receiving insurance approval, patients should expect to pay a copay and/or deductible, which can vary depending on the specific insurance plan. In some cases, insurance covers the full cost or a percentage of the cost of the treatment. For patients who require further financial assistance, payment plans, healthcare financing or medical credit cards from companies like CareCredit may be an option.

If patients are covering the costs of treatment with personal finances, they are not restricted to rTMS. Many clinics around the US offer more advanced types of TMS which are not covered by insurance companies. The main advantage is that more recent methods like the SAINT protocol have increased effectiveness with mild side effects.

Key Takeaways

  • Types of TMS: It's important to understand the different types of TMS offered by clinics, such as rTMS, accelerated TMS, iTBS, or the SAINT protocol, as they vary in effectiveness and session duration.

  • Precision Matters: Accurate targeting of the brain's DLPFC using advanced methods like neuronavigation with MRI can significantly improve treatment outcomes.

  • Combination Therapy: Pairing TMS with Cognitive Behavioral Therapy (CBT) can lead to better long-term outcomes for patients.

  • Cost and Insurance: TMS can be expensive, so patients should inquire about insurance coverage, out-of-pocket costs, and payment plan options.

  • Tailored Treatment: Choosing a clinic that offers personalized treatment plans with advanced TMS methods can lead to better recovery outcomes for patients with depression.

How to Approach Finding a TMS Clinic That’s Right for You


As we’ve seen in this article, there is a lot to consider, from the type of TMS offered to treatment costs. Here are a few tips for finding the best clinic for you:

Be Wary of Using Directory Sites


If you’ve googled “TMS clinics near me,” you may have come across several directory sites claiming to help you find a suitable TMS clinic. While they can be helpful, it’s important to note that many of these sites are run by TMS device manufacturers and only include clinics that use their devices.

Understand What Questions to Ask


Simply googling “TMS clinics near me” will yield many results, but it’s crucial to analyze them. For instance, if your work and family commitments won’t allow you to take six weeks to complete the treatment, then rTMS may not be a viable option for you.

Conversely, if you need your insurance company to cover your treatment, find a clinic that offers rTMS (the only option currently covered by insurance) combined with neuronavigation, which significantly increases your chances of improvement after the treatment.

Contact the Clinics and Get Your Questions Answered


Choose 2 to 3 potential clinics you’re considering and reach out to them with your questions. A good starting point is the questions we discussed earlier. Gather detailed information about their offerings to make an informed decision.

Red Flags to Keep an Eye Out For


Even after choosing a TMS clinic for your treatment, it’s important to keep an eye out for any red flags that may suggest that the treatment you’re receiving is inadequate.

Inability to Establish Motor Threshold


The resting motor threshold is the minimum intensity of the TMS machine required to evoke an involuntary movement of the patient’s hand when magnetic pulses are applied to the motor cortex. Some trial and error is involved in determining this value, but experienced operators should typically only need to test a few different pulse intensities.

If you find that the operators in your clinic need repeated attempts to find the motor threshold before each session, it may be a red flag indicating they lack sufficient training to perform this procedure.

Painful Treatment


Patients should expect some tenderness and discomfort in the scalp, especially during the first few TMS sessions. However, it should not be painful enough to make you consider stopping the treatment. Some patients experience mild headaches, which can typically be treated with over-the-counter painkillers and usually dissipate after a few sessions as the body adjusts to treatment.

If you consistently experience strong headaches after each session and your medical team insists this is normal, we recommend seeking treatment elsewhere. Persistent headaches may indicate that the TMS machine settings are too high or that the coil is improperly positioned.

Not Informing Patients About Different TMS Options


Most clinics offer only one type of TMS, but they should inform you about other options. This is especially important if they provide rTMS without mentioning alternatives like iTBS or the SAINT protocol, which have demonstrated higher efficacy.

Asking Patients to Stop Their Antidepressant Medication


Some clinics insist that patients stop taking their antidepressant medication, but there is no evidence that these medications are harmful during TMS treatment.

These clinics often request that patients stop their medications for the ease of conducting TMS sessions. However, this is unnecessary, as a skilled operator should be able to manage patients on antidepressants. This approach allows patients to begin their TMS sessions immediately, without needing to wait to be weaned off their medication.

Receiving Cutting-Edge SAINT-iTBS Treatment at Cognitive FX


Our clinic, Cognitive FX, offers the most targeted, safe, and effective form of TMS: fMRI-guided intermittent theta-burst stimulation or SAINT-iTBS. As mentioned above, 85.7% of patients responded to this treatment in a double-blind randomized controlled trial, with 60% of patients still in remission one month later. This FDA-approved treatment, which has minimal side effects, is offered by fewer than ten clinics in the U.S.

In contrast to rTMS, which can take four to six weeks to complete, our iTBS treatment is completed in just one week. Patients receive ten TMS sessions daily for five days, with each session consisting of 10 minutes of magnetic pulses and a 50-minute break between sessions.

To improve outcomes for our patients, we also include cognitive behavioral therapy (CBT) as a part of our treatment. When combined with the traditional method of TMS (rTMS), CBT improved response and remission rates by ~8% and ~19%, respectively, in the short term. We expect the addition of CBT to SAINT- iTBS to improve both the initial outcome and longer-term outcome; that is, the addition of CBT significantly increases the durability of effects following the conclusion of iTBS.

Our TMS treatment is ideal for most patients with treatment-resistant depression. However, we do not treat patients under the age of 16 or over 65. Additionally, as a safety measure, we do not treat patients with a history of seizures or those who are currently actively suicidal and in need of crisis care.

If you’re interested in receiving TMS therapy at Cognitive FX, click here to learn more.

Cited Research


SAINT TMS Locations: Where Can You Get SAINT Treatment?

SAINT TMS Locations: Where Can You Get SAINT Treatment?

SAINT TMS treatment remains difficult to access in the United States, having gained FDA approval less than two years ago. With fewer than ten locations currently offering this cutting-edge treatment,...

Read the full article
Treatment-Resistant Depression Clinic in Provo, Utah

Treatment-Resistant Depression Clinic in Provo, Utah

Suffering from treatment-resistant depression (TRD) is both common (you are not alone) and extremely difficult. It can feel incredibly discouraging when you’ve tried antidepressant medication or...

Read the full article