---
title: "Theta Burst Stimulation TMS Treatment: A Patient’s Guide"
description: Learn what theta burst TMS is, its effectiveness, how much it costs, and more in this patient guide to theta burst stimulation for depression.
image: https://www.cognitivefxusa.com/hubfs/theta-burst-stimulation-tms-treatment.jpg
---

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3. Theta Burst Stimulation TMS Treatment: A Patient’s Guide

# Theta Burst Stimulation TMS Treatment: A Patient’s Guide

![Image of Dr. Mark Allen, Ph.D.](https://www.cognitivefxusa.com/hubfs/Mark_150px.webp)

 Dr. Mark Allen, Ph.D. 

•

 Updated on 16 May, 2025 

•

 Medically Reviewed by

[Dr. Diane Spangler, Ph.D.](https://www.cognitivefxusa.com/blog/author/dr-diane-spangler-phd)

<http://www.facebook.com/share.php?u=https://www.cognitivefxusa.com/blog/theta-burst-stimulation-tms-treatment> [mailto:?subject=Check%20out%20https://www.cognitivefxusa.com/blog/theta-burst-stimulation-tms-treatment%20&body=Check%20out%20https://www.cognitivefxusa.com/blog/theta-burst-stimulation-tms-treatment&media=https://2921058.fs1.hubspotusercontent-na1.net/hubfs/2921058/theta-burst-stimulation-tms-treatment.jpg](mailto:?subject=Check%20out%20https://www.cognitivefxusa.com/blog/theta-burst-stimulation-tms-treatment%20&body=Check%20out%20https://www.cognitivefxusa.com/blog/theta-burst-stimulation-tms-treatment&media=https://2921058.fs1.hubspotusercontent-na1.net/hubfs/2921058/theta-burst-stimulation-tms-treatment.jpg)

Intermittent theta burst stimulation (iTBS) has been growing in popularity since receiving FDA approval for treating major depression in 2018. This new brain stimulation method uses a series of short, high-frequency magnetic pulses that can be delivered in just a few minutes per session instead of the 40-minute session required for conventional TMS.

In addition, because iTBS sessions can be delivered in a fraction of the time, it's being used to provide accelerated TMS protocols. **Patients can complete a treatment course in just five days instead of the conventional TMS protocol of daily sessions, five days per week for four to six weeks.**

In this article, we’ll go over the most important aspects of Theta Burst Stimulation to help you decide if it’s the right treatment option for you.

- [What is theta burst stimulation?](https://www.cognitivefxusa.com/blog/theta-burst-stimulation-tms-treatment#what-is-theta-burst-stimulation-tbs-how-is-it-different-from-conventional-tms)
- [Is it more effective than conventional TMS (rTMS)?](https://www.cognitivefxusa.com/blog/theta-burst-stimulation-tms-treatment#is-theta-burst-stimulation-more-effective-than-conventional-tms)
- [How long does it take to work?](https://www.cognitivefxusa.com/blog/theta-burst-stimulation-tms-treatment#how-long-does-theta-burst-stimulation-take-to-work)
- [How much does it cost? Is it covered by insurance?](https://www.cognitivefxusa.com/blog/theta-burst-stimulation-tms-treatment#how-much-does-theta-burst-stimulation-cost-is-it-covered-by-insurance)
- [Is it easy to find a clinic offering TBS treatment?](https://www.cognitivefxusa.com/blog/theta-burst-stimulation-tms-treatment#is-it-easy-to-find-a-clinic-offering-theta-burst-stimulation)

*Our clinic, based in Provo, Utah, offers accelerated fMRI-guided TBS (the most precise and effective form of theta burst TMS) for treatment-resistant depression. *[*Take our quiz*](https://www.cognitivefxusa.com/tms-new-patient-paperwork)* to see if you’re a good fit for our accelerated treatment protocol. *

## What Is Theta Burst Stimulation (TBS)? How Is It Different From Conventional TMS?

Theta Burst Stimulation (TBS) is a faster and more advanced form of transcranial magnetic stimulation (TMS), a treatment that uses magnetic pulses to stimulate an area of the brain called the left dorsolateral prefrontal cortex (L-DLPFC), which can help reduce symptoms of depression.

Traditional TMS (repetitive transcranial magnetic stimulation) has been used for years and typically takes about 40 minutes per session. TBS is a newer approach that delivers a different type of stimulation in a more natural rhythm—similar to how your brain works when you’re relaxed, daydreaming, or learning something new.

One type of TBS treatment, called **intermittent TBS (iTBS)**, takes just **3 minutes per session**. Despite the shorter treatment time, research [suggests](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30295-2/abstract) it may work even better for some people than rTMS treatment.

It's believed that TBS induces changes in [neuroplasticity](https://www.sciencedirect.com/science/article/pii/S1877065715000792#bib0245), helping the brain become more flexible and able to form new connections—something that’s often disrupted in people with depression. While we don’t fully understand exactly how it works, [studies](https://pubmed.ncbi.nlm.nih.gov/29726344/) show it can be highly effective, and the shorter sessions make it easier to fit treatment into daily life. Some clinics also offer **accelerated TBS**, where patients can receive multiple sessions in a single day to speed up recovery (more on this below).

### Is Theta Burst Stimulation FDA-Approved?

In 2018, the U.S. Food and Drug Administration cleared intermittent theta burst stimulation (iTBS) delivered to the left DLPFC for the treatment of major depressive disorder (MDD) in adults.

The approval of theta burst TMS was granted following the positive results obtained on the [THREE-D trial](https://pubmed.ncbi.nlm.nih.gov/29726344/). This large-scale trial compared the efficacy and patient experience with iTBS and rTMS and included 414 participants diagnosed with major depressive disorder (MDD). Results showed that **50% of participants treated with iTBS experienced improvements in their depressive symptoms, and 33% achieved remission**. This option was found to be **at least as effective and safe as repetitive TMS, **with the advantage that it can be delivered in less than 5 minutes.

## Is Theta Burst Stimulation More Effective Than Conventional TMS?

Research shows that **intermittent Theta Burst Stimulation (iTBS)** works [just as well](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30295-2/abstract)—or even better—than regular TMS for treating depression. About [half](https://www.nature.com/articles/s41386-020-00829-y) of patients see meaningful improvements in their symptoms, and some report a faster drop in [suicidal](https://www.frontiersin.org/articles/10.3389/fnhum.2016.00480/full) thoughts with iTBS, making it a promising option for those in crisis.

The results can be even more impressive when iTBS is combined with advanced brain imaging to guide treatment. A team at Stanford developed a version of iTBS called the **SAINT™ protocol**, which uses neuroimaging to precisely locate the part of the brain targeted in TMS treatment.

Instead of manually measuring a patient's head to place the magnetic coil—which fails to account for [variations](https://pubmed.ncbi.nlm.nih.gov/11457424/) in head size, shape, and individual brain structure and can significantly reduce the treatment’s effectiveness—doctors can pinpoint the exact right spot for each person, leading to better outcomes.

SAINT™ delivers **10 short treatments a day for 5 days**—a total of 50 sessions. In a double-blind randomized controlled clinical trial, nearly [**86% of patients improved**](https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2021.20101429?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed), and about **79% went into remission**, even though all of them had previously tried and failed other treatments. One month later, **60% were still in remission**.

*![A comparison of remission rates for rTMS/iTBS, electroconvulsive therapy (ECT), and SAINT-iTBS.](https://www.cognitivefxusa.com/hs-fs/hubfs/SAINT%20Shown%20to%20Outperform%20Other%20Treatments.png?width=808&height=561&name=SAINT%20Shown%20to%20Outperform%20Other%20Treatments.png)  
A comparison of remission rates for rTMS/iTBS, electroconvulsive therapy (ECT), and SAINT-iTBS.*

If symptoms return, SAINT can be repeated. In fact, **9 out of 10 patients** who relapsed after their first round of SAINT went into remission again after a [second round](https://psychiatryonline.org/doi/10.1176/appi.ajp.20230113?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed)—showing that retreatment can be very effective.

## Is Theta Burst Stimulation Safe? What Are the Potential Side Effects?

Intermittent TBS is characterised by [mild, short-term side effects](https://www.cognitivefxusa.com/blog/side-effects-of-tms-benefits-vs-risks) and high tolerability. The most common side effects include headaches and scalp discomfort, which, if needed, can be treated with over-the-counter painkillers. A few patients report hearing problems or dizziness after their TMS session, but this is only temporary.

The most serious adverse event that may result from these treatments is seizures, but the risk is [minimal](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4492646/). The risk was slightly higher in the early days of TMS, but additional safety features have been implemented in the procedure, significantly reducing patient risk.

For iTBS, current estimates suggest that fewer than 3 patients experience a seizure per 100,000 sessions. Seizures are more likely in patients with a history of seizures or suffering from neuropsychiatric diseases, including epilepsy, multiple sclerosis, [traumatic brain injury](https://www.cognitivefxusa.com/blog/therapy-for-traumatic-brain-injury), and Alzheimer’s disease.

In addition, iTBS is a noninvasive procedure that does not require anesthesia or a lengthy recovery period. Patients can return to their normal activities immediately after their treatment, making TMS sessions easy to incorporate into daily routines without blocking off large portions of their schedules.

In comparison, other treatments for depression are much more likely to trigger serious side effects, including memory loss and confusion after [electroconvulsive therapy (ECT)](https://www.cognitivefxusa.com/blog/rtms-vs-ect), or sleep disturbances and feeling agitated with [antidepressant medication](https://www.cognitivefxusa.com/blog/why-arent-my-antidepressant-medications-working).

## How Long Does Theta Burst Stimulation Take to Work?

There is great variation in how patients respond to iTBS. Some experience improvements within the first few days of treatment, while others don’t see noticeable changes until weeks later. It’s important to note that not feeling a change as quickly as another person is not an indicator that the treatment isn’t effective or that the patient is more likely to relapse.

In contrast, antidepressant medications take 6 to 8 weeks to show results, and patients often need to try multiple medications before finding an effective one.

## How Much Does Theta Burst Stimulation Cost? Is It Covered by Insurance?

In general terms, iTBS and the original TMS are approximately the same price, typically ranging from $6,000 to $15,000, but could be higher in clinics offering specialized technology or additional treatments alongside TMS.

A [cost analysis](https://www.cda-amc.ca/sites/default/files/symp-2019/presentations/april15-2019/B1-presentation-amendlowitz.pdf) revealed that iTBS has the potential to be a cheaper option for patients as it becomes more widespread. This is mostly because shorter sessions in iTBS treatments are associated with lower costs for staff and equipment.

At the moment, iTBS is not covered by insurance companies. In practical terms, this means iTBS is only possible for patients who can cover the costs themselves.

## Is It Easy to Find a Clinic Offering Theta Burst Stimulation?

In recent years, the number of [clinics offering rTMS](https://www.cognitivefxusa.com/blog/find-and-evaluate-tms-clinics-near-you) therapy in the United States has increased significantly. Finding a local clinic offering the rTMS protocol is now relatively easy.

In contrast, [clinics offering iTBS](https://www.cognitivefxusa.com/blog/accelerated-tms-near-you) are less common because they require newer equipment. For this reason, patients may need to travel to access iTBS treatment. This can add to the overall cost and may be a barrier to care for those with limited mobility or resources.

## Receiving Theta Burst TMS Treatment at Cognitive FX

Our clinic in Provo, Utah, provides an alternative to SAINT™ TMS that offers **the same precision of personalized treatment targeting, combined with FDA-approved theta burst stimulation at a significantly lower cost**. This approach delivers the same core elements that make SAINT so revolutionary.

The only difference between our treatment and SAINT™ (a trademark licensed to Stanford Medical) is our targeting method. Our target locations are determined by fMRI and our prescribing neuroscientist and physician, rather than their proprietary software.

Comparison Chart

# Accelerated fMRI - TMS vs. Magnus SAINT™ TMS

|  | Accelerated fMRI - TMS | Magnus SAINT™ TMS |
| --- | --- | --- |
| FDA-Approved iTBS | ✔ | ✔ |
| FDA-Approved Neuronavigators | ✔ | ✔ |
| FDA-Approved Figure 8 Coils | ✔ | ✔ |
| Number of Treatment Days | 5 | 5 |
| Treatments per Day | 10 | 10 |
| Total Treatments | 50 | 50 |
| Number of TMS Pulses | Approx. 90,000 | 90,000 |
| Resting motor threshold pulse intensity | 90–120% | 90–120% |
| FDA-Approved Personalized DLPFC Targeting | ✘ | ✔ |
| Personalized DLPFC Targeting Assists Doctor in Target Location | ✔ | ✘ |
| Personalized E Field Coil orientation | ✔ | ✘ |
| Cost | $9,000 to $12,000 | $30,000+ |

 

This accelerated protocol of iTBS is:

- **Safe: **Widely tolerated and associated with mild, short-lasting side effects.
- **Precise: **fMRI ensures that the treatment target area is precisely located for each patient, accounting for variations in head size and shape. Neuronavigation ensures the magnetic coil is placed over that exact spot for every treatment session.
- **Fast: **Treatment courses are reduced to a single week, making it easier to complete alongside life and work commitments (compared to 4 to 6 weeks of standard TMS and accelerated TMS protocols).
- **Effective: **Precision coil placement combined with theta burst stimulation produces the [best TMS treatment results to date](https://www.cognitivefxusa.com/blog/most-effective-depression-treatments).

To improve patient outcomes, 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](https://journals.lww.com/co-psychiatry/fulltext/2019/09000/repetitive_transcranial_magnetic_stimulation.8.aspx) by ~8% and ~19%, respectively. Additionally, CBT is likely to produce sustained improvement over time once treatment has concluded.

Our brain stimulation treatment is ideal for most patients with treatment-resistant depression. However, we do not treat patients under the age of 18 or over 65. Additionally, as a safety measure, we do not treat patients who have a history of seizures or who are currently actively suicidal and in need of crisis care.

[***Click here***](https://www.cognitivefxusa.com/tms-new-patient-paperwork)* to learn more about receiving accelerated fMRI TMS therapy at Cognitive FX.*

## Cited Research

- [Theta Burst TMS Technology: Great Promise and a Lot to Learn](https://www.psychiatryonline.org/doi/10.1176/appi.ajp.20230879#core-B4)
- [Effectiveness of Theta Burst versus High-Frequency Repetitive Transcranial Magnetic Stimulation in Patients with Depression (THREE-D): A Randomised Non-Inferiority Trial](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30295-2/abstract)
- [Stanford Neuromodulation Therapy (SNT): A Double-Blind Randomized Controlled Trial](https://psychiatryonline.org/doi/10.1176/appi.ajp.2021.20101429?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub++0pubmed)
- [Sustained Efficacy of Stanford Neuromodulation Therapy (SNT) in Open-Label Repeated Treatment](https://psychiatryonline.org/doi/10.1176/appi.ajp.20230113?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed)

---

![Image of Dr. Mark Allen, Ph.D.](https://www.cognitivefxusa.com/hs-fs/hubfs/Mark_150px.webp?height=150&name=Mark_150px.webp)

### About the author

[Dr. Mark Allen, Ph.D.](https://www.cognitivefxusa.com/blog/author/dr-mark-allen-phd)

Dr. Mark D. Allen holds a Ph.D. in Cognitive Science from Johns Hopkins University and received post-doctoral training in Cognitive Neuroscience and Functional Neuroimaging at the University of Washington. As a co-founder of Cognitive Fx, he played a pivotal role in establishing the unique and exceptional treatment approach. Dr. Allen is renowned for his pioneering work in adapting fMRI for clinical use. His contributions encompass neuroimaging biomarkers development for post-concussion diagnosis and innovative research into the pathophysiology of chronic post-concussion symptoms. He's conducted over 10,000 individualized fMRI patient assessments and crafted a high-intensity interval training program for neuronal and cerebrovascular recovery. Dr. Allen has also co-engineered a machine learning-based neuroanatomical discovery tool and advanced fMRI analysis techniques, ensuring more reliable analysis for concussion patients.

## Related Posts

![rTMS vs. iTBS: Learn the Similarities, Differences & Limitations](https://www.cognitivefxusa.com/hs-fs/hubfs/theta-burst-stimulation-itbs-vs-rtms.png?height=175&name=theta-burst-stimulation-itbs-vs-rtms.png)

### rTMS vs. iTBS: Learn the Similarities, Differences & Limitations

![Image of Dr. Mark Allen, Ph.D.](https://www.cognitivefxusa.com/hs-fs/hubfs/Mark_150px.webp?height=70&name=Mark_150px.webp)

[Dr. Mark Allen, Ph.D.](https://www.cognitivefxusa.com/blog/author/dr-mark-allen-phd)

If you’re considering brain stimulation therapy for treating major depression, you may wish to understand the differences between repetitive transcranial magnetic stimulation (rTMS) and the more...

[Read the full article

](https://www.cognitivefxusa.com/blog/theta-burst-stimulation-itbs-vs-rtms)

![Is TMS Safe? Answers for Patients Considering TMS Therapy](https://www.cognitivefxusa.com/hs-fs/hubfs/is-tms-safe.jpg?height=175&name=is-tms-safe.jpg)

### Is TMS Safe? Answers for Patients Considering TMS Therapy

![Image of Dr. Mark Allen, Ph.D.](https://www.cognitivefxusa.com/hs-fs/hubfs/Mark_150px.webp?height=70&name=Mark_150px.webp)

[Dr. Mark Allen, Ph.D.](https://www.cognitivefxusa.com/blog/author/dr-mark-allen-phd)

If you’re considering transcranial magnetic stimulation (TMS) therapy, one of the first and most important questions you’re likely to ask is: “Is TMS safe?”

[Read the full article

](https://www.cognitivefxusa.com/blog/is-tms-safe)

![What If TMS Doesn’t Work? Advice for Patients](https://www.cognitivefxusa.com/hs-fs/hubfs/what-if-tms-doesnt-work.jpg?height=175&name=what-if-tms-doesnt-work.jpg)

### What If TMS Doesn’t Work? Advice for Patients

![Image of Dr. Mark Allen, Ph.D.](https://www.cognitivefxusa.com/hs-fs/hubfs/Mark_150px.webp?height=70&name=Mark_150px.webp)

[Dr. Mark Allen, Ph.D.](https://www.cognitivefxusa.com/blog/author/dr-mark-allen-phd)

If you’re wondering what to do when [transcranial magnetic stimulation](https://www.cognitivefxusa.com/blog/tms-for-treatment-resistant-depression) (TMS) doesn’t work, you might be:

[Read the full article

](https://www.cognitivefxusa.com/blog/what-if-tms-doesnt-work)

![Does Insurance Cover TMS Therapy? Complete Patient Guide](https://www.cognitivefxusa.com/hs-fs/hubfs/does-insurance-cover-TMS-therapy.jpg?height=175&name=does-insurance-cover-TMS-therapy.jpg)

### Does Insurance Cover TMS Therapy? Complete Patient Guide

![Image of Dr. Mark Allen, Ph.D.](https://www.cognitivefxusa.com/hs-fs/hubfs/Mark_150px.webp?height=70&name=Mark_150px.webp)

[Dr. Mark Allen, Ph.D.](https://www.cognitivefxusa.com/blog/author/dr-mark-allen-phd)

Over the past few years, [Transcranial Magnetic Stimulation (TMS)](https://www.cognitivefxusa.com/blog/tms-for-treatment-resistant-depression) has become an increasingly popular treatment option for patients who [haven’t found symptom relief from antidepressant medications](https://www.cognitivefxusa.com/blog/why-arent-my-antidepressant-medications-working).

[Read the full article

](https://www.cognitivefxusa.com/blog/does-insurance-cover-tms-therapy)

![Can TMS Make Anxiety Worse? Addressing Patient Concerns](https://www.cognitivefxusa.com/hs-fs/hubfs/can-tms-make-anxiety-worse.png?height=175&name=can-tms-make-anxiety-worse.png)

### Can TMS Make Anxiety Worse? Addressing Patient Concerns

![Image of Dr. Mark Allen, Ph.D.](https://www.cognitivefxusa.com/hs-fs/hubfs/Mark_150px.webp?height=70&name=Mark_150px.webp)

[Dr. Mark Allen, Ph.D.](https://www.cognitivefxusa.com/blog/author/dr-mark-allen-phd)

In general, increased anxiety is not a common side effect of transcranial magnetic stimulation (TMS), though some patients have experienced a temporary increase in anxiety during or after treatment.

[Read the full article

](https://www.cognitivefxusa.com/blog/can-tms-make-anxiety-worse)

![TMS Therapy vs. Neurofeedback: Which Is Better for Depression?](https://www.cognitivefxusa.com/hs-fs/hubfs/tms-therapy-vs-neurofeedback-for-depression.jpg?height=175&name=tms-therapy-vs-neurofeedback-for-depression.jpg)

### TMS Therapy vs. Neurofeedback: Which Is Better for Depression?

![Image of Dr. Mark Allen, Ph.D.](https://www.cognitivefxusa.com/hs-fs/hubfs/Mark_150px.webp?height=70&name=Mark_150px.webp)

[Dr. Mark Allen, Ph.D.](https://www.cognitivefxusa.com/blog/author/dr-mark-allen-phd)

Transcranial magnetic stimulation (TMS) and neurofeedback are gaining popularity as non-invasive, medication-free options for treating depression—especially for people who haven’t found relief from [...](https://www.cognitivefxusa.com/blog/why-arent-my-antidepressant-medications-working)

[Read the full article

](https://www.cognitivefxusa.com/blog/tms-therapy-vs-neurofeedback-for-depression)

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