Published peer-reviewed research shows that Cognitive FX treatment leads to meaningful symptom reduction in post-concussion symptoms for 77% of study participants. Cognitive FX is the only PCS clinic with third-party validated treatment outcomes.
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Transcranial Magnetic Stimulation (TMS) works extremely well for the right patient — and not at all for the wrong one. This quiz uses validated clinical screens to tell you, in about two minutes, whether TMS is likely to help — or whether your symptoms point toward an underlying cause that needs a different treatment.
Educational only. Not a diagnosis or medical advice.
TMS is a non-invasive treatment that uses focused magnetic pulses, delivered through a coil placed against the scalp, to stimulate neurons in a targeted region of the brain. The pulses don't reach the deep brain directly, but they modulate activity in the targeted cortex, which in turn affects connected networks involved in mood, attention, and motivation. Treatment is performed in an outpatient setting, with the patient awake. There is no anesthesia, no recovery time, and no cognitive side effects of the kind seen with electroconvulsive therapy (ECT).
As of 2025, the FDA has cleared TMS for several distinct indications:
Notably, TMS is not FDA-cleared as a standalone treatment for generalized anxiety, PTSD, bipolar depression, post-concussion syndrome, long COVID, or dysautonomia. Clinics may use it off-label for some of those, but the evidence base and insurance coverage differ.
Reputable TMS clinics, and most insurance plans, use a fairly consistent set of criteria when screening candidates for depression-focused TMS. You're likely a strong candidate if you can answer "yes" to most of the following:
You can also be a TMS candidate for the other FDA-cleared indications. The clearest one most people miss is OCD. If you have prominent intrusive thoughts or compulsive behaviors alongside depression, TMS for OCD uses a different coil and protocol, and that distinction matters when choosing a clinic.
Some exclusions are absolute. TMS isn't safe for you, full stop. Others are relative, meaning your clinician will weigh them with you before proceeding.
Absolute safety exclusions:
Relative exclusions, a careful conversation is required:
For a deeper look at the safety profile, see Side Effects of TMS: Benefits vs. Risks.
This is the question most TMS clinics skip, and it's the one that matters most for people who've already tried TMS and didn't get the result they hoped for. Depression can be a primary mood disorder, or it can be downstream of a treatable physical condition that needs different care. The latter group often "fails" TMS because the treatment is aimed at the symptom, not the cause.
Watch for these red flag clusters:
Post-concussion or TBI signature. Headaches, sensitivity to light and noise, dizziness or vestibular symptoms, brain fog with word-finding difficulty, and most distinctively, worsening with mental or physical exertion. People often miss the link because the concussion was years (sometimes decades) ago, was never formally diagnosed, or seemed mild at the time. Even one "bell rung" moment from a fall, car accident, or contact sport raises the odds. See Post-Concussion Syndrome: Symptoms and Recovery.
Dysautonomia or POTS signature. Lightheadedness when standing, racing or pounding heart with position change, exercise intolerance, heat intolerance, GI dysmotility (early fullness, nausea, constipation), and feeling significantly better lying down than sitting or standing. These autonomic patterns are not features of primary depression, but they are routinely misdiagnosed as anxiety because the heart racing and chest tightness mimic panic attacks. See Why POTS Is So Often Misdiagnosed as Anxiety.
Long COVID or post-viral signature. Symptoms that began during or after a COVID infection (or other viral illness), with post-exertional malaise, a 12 to 48 hour crash after physical, cognitive, or emotional effort that's disproportionate to what triggered it. Unrefreshing sleep, new shortness of breath, and palpitations are also common. Long COVID roughly doubles the population depression rate, but the mechanism is inflammatory and autonomic, not a primary mood-circuit problem. See Long COVID, POTS, and Dysautonomia.
If any of these patterns sound like you, the most accurate next step isn't another TMS consultation. It's an evaluation that can distinguish primary mood disorder from secondary mood symptoms.
About one in three patients experiences the TMS dip, a temporary worsening of mood, anxiety, or sleep in weeks 2 to 4, usually resolving within days to two weeks. The dip is not a predictor of treatment failure and is often interpreted as a sign of neural reorganization.
A different question is why some patients complete a full TMS course without meaningful improvement. The peer-reviewed literature identifies several predictors of non-response that are worth knowing:
For more on expected timelines, see How Long Does TMS Take to Work?
Most TMS clinics use either scalp measurements ("5 cm rule") or a fixed anatomical landmark to position the coil. Both approaches assume every brain is the same. fMRI-guided TMS scans your actual brain, identifies the dysregulated network unique to you, and aims the coil at the personalized target.
When fMRI-guided targeting is combined with intermittent theta-burst stimulation (iTBS), a faster pulse pattern that condenses a 37-minute session into about 3 minutes, and an accelerated schedule (multiple sessions per day rather than 6 weeks of daily visits), the results in the published literature are striking.
| Approach | Remission rate | Source |
|---|---|---|
| Standard rTMS (real-world) | ~30 to 37% | Carpenter LL et al. Depress Anxiety 2012 (PMID 22689344) |
| iTBS vs. 10 Hz rTMS, non-inferior | similar to standard | Blumberger DM et al. Lancet 2018 (PMID 29726344) |
| SAINT, fMRI + iTBS + accelerated (open-label pilot) | 90.5% | Cole EJ et al. Am J Psychiatry 2020 (PMID 32252539) |
| SNT, fMRI + iTBS + accelerated (sham-controlled RCT) | 78.6% active vs. 13.3% sham | Cole EJ et al. Am J Psychiatry 2022 (PMID 34711062) |
The Stanford SAINT/SNT protocol is the clearest published demonstration of what's possible when targeting, pulse pattern, and schedule are all optimized. CFX's Precision Mental Health program uses these same principles, fMRI-derived individualized targeting in its own protocol. (CFX's protocol is its own and is not identical to SAINT/SNT.) See also SAINT TMS Locations for context on where this approach is offered.
The honest answer depends on which bucket you fall into.
If you have a hard safety exclusion (metal in the head, cochlear implant, brain stimulator, active epilepsy), don't pursue TMS without a neurologist or psychiatrist reviewing your specific situation. Many alternative treatments, including non-magnetic options like the EPIC program at Cognitive FX, remain accessible to you.
If your symptoms point to post-concussion syndrome, dysautonomia, or long COVID, the better first step is an evaluation that can directly visualize what's happening in your brain. Cognitive FX uses functional NeuroCognitive Imaging (fNCI) to identify regions of disrupted neurovascular coupling, and the EPIC treatment program addresses the underlying dysfunction in a 1-week intensive. Many CFX patients travel from out of state for this evaluation precisely because most local TMS clinics never screened for these causes.
If TMS failed for you previously, it's worth understanding why before assuming TMS as a category doesn't work. Was the target chosen by scalp measurements or by fMRI? Was the protocol accelerated or standard? Were you on a benzodiazepine that may have suppressed response? These questions can change the answer. See TMS for Treatment-Resistant Depression for more context.
If you haven't yet tried antidepressants or therapy, TMS isn't the standard starting point, and most insurance plans won't cover it as a first-line treatment. Start with your primary care doctor or a psychiatrist. If first-line treatments don't help, that's when the TMS conversation becomes the right one.
Most US commercial insurance plans and Medicare cover TMS for treatment-resistant major depressive disorder, but coverage typically requires documentation of 2 to 4 failed antidepressant trials plus failed psychotherapy in the current episode. Coverage for OCD, anxious depression, and adolescent indications varies by plan.
About one-third of patients experience the TMS dip, a temporary worsening that usually resolves within days. Sustained worsening is less common but can happen, particularly in people with undiagnosed bipolar disorder (where TMS can trigger a manic switch) or in people whose mood symptoms are downstream of an unaddressed physical cause. See Can TMS Make Anxiety Worse?
The fastest screen is the free 2-minute candidacy quiz below. It walks you through the same questions a clinician would ask in an initial intake, including the red-flag questions most TMS clinics skip.
No. ECT (electroconvulsive therapy) uses electrical current and induces a brief seizure under general anesthesia. TMS uses magnetic pulses, is performed awake in an outpatient chair, and does not induce seizures (except as a rare adverse event). TMS has no anesthesia recovery, no memory side effects, and a much shorter session duration.
A remote, recovered concussion is not an absolute contraindication. But if you have active post-concussion symptoms, such as headaches, brain fog, or vestibular issues, depression-focused TMS is unlikely to resolve them, because the depression in that case is downstream of the brain injury. A different evaluation is usually the better first step.
TMS is FDA-cleared for OCD as a separate indication using a different coil and protocol. Coverage for OCD varies more than depression coverage. Check with your insurance and with any clinic you're considering.
Dr. Lynn Gaufin graduated from the University of Utah and then attended medical school at Cornell University in New York City. After medical school he join the Army and was a surgeon in the military before finishing his Neurological Residency at University of California Los Angeles. Dr. Gaufin specializes in cervical and lumbar spine surgery, brain tumors, brain hemorrhages, and treatment of traumatic brain injuries. Dr. Gaufin is one of the emergency trauma neurosurgeons on call at Utah Valley Hospital. Before he began his practice in Utah he saw a significant amount of traumatic brain injuries during his career in the Army and his residency in Los Angeles. As a surgeon who treats individuals who suffer from mild to severe traumatic brain injuries he recognized a problem in the post operative rehabilitation. Individuals who suffered severe trauma would be admitted into speciality facilities where they would receive months of care. But patients who had a more mild trauma would be released and would largely be on their own when it came to restoring their cognitive function. That problem is what lead Dr. Gaufin to team up with Dr. Fong and Dr. Allen in the creation of Cognitive FX. Cognitive FX was able to take the research that Dr. Fong and Dr. Allen started in their Phd programs and bring it into the clinical environment.
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Published peer-reviewed research shows that Cognitive FX treatment leads to meaningful symptom reduction in post-concussion symptoms for 77% of study participants. Cognitive FX is the only PCS clinic with third-party validated treatment outcomes.
READ FULL STUDY
