You finished your TMS treatment. Your mood lifted, your energy returned, and for the first time in a long time, you felt like yourself again. But now a nagging question keeps surfacing: Will this last? Am I going to need TMS sessions for the rest of my life?
It is one of the most common questions we hear from patients at Cognitive FX, and it makes complete sense. You have already invested time, money, and emotional energy into treatment. The idea of being locked into indefinite sessions feels discouraging before you have even had a chance to enjoy the results.
Here is the honest answer: No, most people do not need TMS forever. But the fuller picture is more nuanced than a simple yes or no. What the latest research shows is that some patients benefit enormously from periodic booster sessions, while others maintain their gains for a year or longer without any additional treatment. The difference often comes down to how personalized and proactive your maintenance strategy is.
This article breaks down what the science actually says about TMS durability, who is most likely to need booster sessions, and why the future of TMS maintenance is shifting toward a smarter, more personalized approach that keeps you feeling well with the least amount of treatment necessary.
This is the question everyone wants answered first, so let us start here.
The most comprehensive look at TMS durability comes from a meta-analysis published in Brain Stimulation that pooled data from 19 studies and up to 732 patients. Among people who responded to their initial TMS course, roughly 67% maintained their improvement at 3 months, 53% at 6 months, and 46% at 12 months without any structured maintenance plan [1].
Those numbers tell an important story. The majority of TMS responders hold their gains for several months. But by the one-year mark, about half of patients have experienced some degree of symptom return. That does not necessarily mean a full relapse into severe depression. For many, it means a gradual drift back toward lower mood, disrupted sleep, or reduced motivation that signals the brain could use a tune-up.
The largest real-world follow-up study tracked 257 patients across 42 clinics in the United States for a full year after treatment. Among those who achieved remission, 70.5% did not fully relapse during the 12-month follow-up period [2]. However, about one-third of all patients did receive some form of retreatment during that year, averaging around 16 booster sessions. That retreatment worked: 84% of patients who received booster sessions regained their improvement [3].
The takeaway is reassuring but practical. TMS produces real, lasting changes in how your brain functions. For many patients, a single course of treatment is enough for months or even years of sustained relief. For others, especially those with a long history of recurrent depression, periodic booster sessions are part of an effective long-term strategy. Think of it less like a treatment that "wears off" and more like an ongoing investment in brain health, similar to how someone with a chronic condition might occasionally see a specialist to stay on track.
The SAINT protocol (Stanford Accelerated Intelligent Neuromodulation Therapy) represents a fundamentally different approach to TMS. Instead of spreading 30 to 36 sessions over six weeks, SAINT delivers the equivalent stimulation in just five days using fMRI-guided targeting. The results from clinical trials have been striking: the original double-blind randomized controlled trial showed 78.6% remission immediately after treatment, compared to 0% for the sham group [4]. A larger replication study confirmed 50% remission at one month, which is comparable to what electroconvulsive therapy achieves but without the cognitive side effects [5].
But the question patients care about most is whether those rapid results hold up over time.
The first study to track SAINT outcomes beyond four weeks followed 46 patients and found that while 70% achieved remission in the week following treatment, only 33% remained in remission at 12 weeks without any maintenance strategy in place [6]. The average duration of remission was approximately 11 weeks, and the average duration of treatment response was about 15 weeks. The researchers noted that this durability profile is comparable to both ECT and standard TMS, which means SAINT is not trading speed for staying power. You get the same caliber of lasting benefit, just delivered in a fraction of the time.
Where the story gets really interesting is what happens when you pair SAINT with a smart maintenance approach. More on that in the next section.
For years, the standard approach to TMS maintenance was essentially a guessing game. Clinics would offer a fixed tapering schedule after treatment, perhaps stepping sessions down from three times a week to twice a week to once a week, then monthly. Some patients thrived on this. Others relapsed anyway. Still others received more sessions than they actually needed.
The problem was that these schedules were designed around averages, not around individual patients. Your brain, your depression history, your stress load, and your treatment response are all unique. A maintenance plan built for the "typical" TMS patient is bound to miss the mark for a significant number of people.
The latest research is moving decisively toward a different model: personalized, biomarker-guided maintenance that adjusts to what your brain actually needs rather than following a predetermined calendar.
The most compelling evidence for personalized TMS maintenance comes from a 2025 study on personalized continuation therapy (PCT) with the SAINT protocol [7]. Instead of putting patients on a fixed maintenance schedule, researchers monitored them remotely for 12 months after their initial SAINT treatment using a combination of biometric data and regular psychological assessments. When early warning signs of symptom return appeared, patients came back for a brief booster course of just one to five days of SAINT treatment.
The results were remarkable. 86% of patients maintained remission across the full 12 months using this approach. Most retreatment courses required only one to two days rather than a full five-day protocol. Over the entire year, patients averaged about 15 treatment days total, and the original brain imaging from their initial treatment remained valid for targeting the right brain regions, so there was no need for expensive repeat fMRI scans.
Compare that 86% sustained remission rate to the 33% remission rate at 12 weeks when patients received no maintenance at all [6]. The difference is staggering, and it underscores a critical point: it is not that TMS does not last. It is that the traditional approach of treating and then walking away leaves too many patients vulnerable to preventable relapse.
The personalized approach works for several reasons that make intuitive sense once you understand how depression and brain stimulation interact.
It catches problems early. Depression relapse is not like flipping a switch. It develops gradually, often over weeks. By the time a patient realizes they are fully relapsed, they may need a complete retreatment course. But if you catch the early warning signs, a brief one- or two-day booster is often enough to course-correct. The SAINT PCT study proved this: patients who received early intervention needed dramatically less treatment than those who waited.
It avoids unnecessary treatment. A fixed monthly schedule means some patients are coming in for sessions they do not need, adding cost and time without benefit. One of the consistent findings across the maintenance literature is that two or fewer sessions per month is not enough to prevent relapse for those who need it [8], while more frequent sessions may be excessive for patients whose brains are maintaining the changes well on their own. Personalized monitoring threads this needle by only triggering treatment when the data says it is warranted.
It respects the fact that every brain is different. Research has identified several factors that predict who is more likely to need maintenance sessions. Patients with incomplete remission after their initial course, those with a longer history of depressive illness, people who have failed multiple medications, and those without concurrent antidepressant therapy are all at higher risk for relapse [1][9][10]. A personalized plan accounts for these individual risk factors rather than treating everyone the same.
Retreatment keeps working. One concern patients sometimes voice is whether TMS will "stop working" if they need repeated courses. A 2024 study specifically addressing this question found that repeat SAINT courses produce comparable antidepressant effects to the initial treatment [11]. The protocol does not lose its punch with repeated use. This is an important reassurance for anyone considering a long-term maintenance approach.
The 2024 consensus statement from the National Network of Depression Centers, the Clinical TMS Society, and the International Federation of Clinical Neurophysiology acknowledged that standardized maintenance schedules are still being developed. But the expert panel affirmed that maintenance TMS should be considered for patients with frequent relapse, defined as two or more depressive episodes per year [12].
Here is what the current evidence supports for different maintenance approaches.
A tapering schedule gradually reduces the frequency of sessions after your acute treatment course ends. A commonly used approach starts with three sessions per week for two weeks, then drops to two per week for two weeks, followed by weekly sessions for two months, then biweekly for up to eight months [13]. An optimized version proposed in 2023 simplifies this to weekly sessions for two months, biweekly for two months, then monthly for two months [9].
Tapering works well for patients who want a structured plan with a clear endpoint. It provides ongoing support during the highest-risk period (the first several months after treatment) while progressively building confidence that the brain can sustain improvements independently.
Instead of frequent single sessions, cluster maintenance delivers five to ten sessions over two to three consecutive days each month. This reduces the total number of clinic visits while still providing an adequate "dose" of stimulation. The largest maintenance trial to date tested this approach in 281 patients and found that monthly clustered TMS combined with antidepressant medication produced a relapse rate of just 15.9% over 12 months, compared to 44.4% for medication alone [14]. That combination cut relapse risk by 70%.
Cluster maintenance is particularly appealing for patients who travel for treatment or who have demanding work schedules that make frequent weekly appointments difficult.
Rather than following a fixed schedule, rescue protocols reintroduce TMS only when symptoms start to return. This is the approach used in the SAINT PCT study, and it produced the strongest outcomes in the research literature. The key requirement is regular monitoring, either through scheduled check-ins with your treatment team or through remote tracking tools, so that early symptom return is caught before it progresses to full relapse.
Booster sessions are typically shorter than the initial treatment course. Where a full acute course might involve 30 to 36 sessions for standard TMS or five full days for SAINT, a booster course might be five to ten sessions of standard TMS or one to two days of SAINT.
The data consistently shows that roughly one-third to one-half of TMS responders will benefit from some form of retreatment within the first year [2][3]. But that still means half or more of patients do not need additional treatment during that period.
Several factors help predict where you are likely to fall.
You may need maintenance if you have: a history of multiple depressive episodes (three or more lifetime), incomplete remission after your initial TMS course with some residual symptoms, a long duration of depressive illness before starting TMS, tried and failed multiple antidepressant medications, depression complicated by significant anxiety, or you are not taking any concurrent antidepressant medication [1][9][10].
You are more likely to maintain gains independently if you: achieved full remission (not just partial improvement) from your initial course, have a shorter history of depression, responded to fewer medication trials before TMS, are younger, maintain active engagement in therapy and healthy lifestyle habits, or are taking a well-tolerated antidepressant alongside your TMS treatment [10][12].
The single strongest predictor of needing maintenance is incomplete remission after your acute treatment. Patients who achieve full remission have substantially better durability than those who improve but still have lingering symptoms. This is one reason why the quality of your initial treatment matters so much. A protocol that achieves deeper remission up front, such as fMRI-guided SAINT targeting, may reduce the need for maintenance down the road.
Patients often frame the maintenance question as a comparison: "Is needing TMS boosters any different from needing to take antidepressants every day for the rest of my life?"
It is a fair question, and the comparison actually favors TMS in several important ways.
Treatment burden is dramatically different. Daily medication means swallowing a pill every single day, indefinitely. TMS maintenance, even in the most intensive protocols, means a handful of sessions spread across the year. The SAINT PCT patients averaged 15 treatment days over an entire year. That is far less intrusive than 365 daily medication doses.
Side effect profiles are not comparable. Long-term antidepressant use commonly causes weight gain, sexual dysfunction, emotional blunting, gastrointestinal problems, and discontinuation syndrome if you try to stop. TMS maintenance sessions carry the same mild, transient side effects as the initial treatment: brief scalp discomfort during the session and occasionally a mild headache afterward. There are no systemic side effects because TMS works locally on the brain rather than flooding the entire body with a chemical.
The trajectory is different. With antidepressants, most patients need to stay on the same dose indefinitely, and attempting to taper often triggers withdrawal symptoms or relapse. With TMS maintenance, the trend generally moves toward less frequent treatment over time, not more. As your brain consolidates the neuroplastic changes from treatment, the intervals between booster sessions often lengthen.
Cost-effectiveness favors TMS. Multiple health economic analyses have found that TMS is 32 to 41% more cost-effective than antidepressant therapy over time, with higher quality-adjusted life years [15]. For younger patients especially, TMS offers significant lifetime cost savings.
None of this means medication is bad or unnecessary. In fact, the strongest maintenance outcomes in the research come from combining TMS with antidepressant medication. That combination produced the lowest relapse rate in any maintenance study: just 15.9% at one year [14]. For many patients, the ideal long-term plan includes both a well-tolerated medication and the option for periodic TMS boosters when needed.
One of the most empowering things about TMS maintenance is that you can learn to recognize when your brain needs a tune-up. Depression does not return overnight. It creeps back gradually, and catching it early makes all the difference.
Watch for these early warning signs in the weeks and months after your treatment:
Sleep changes are often the first signal. If you notice that your sleep is becoming disrupted again, whether that means difficulty falling asleep, waking in the early morning hours, or sleeping excessively, pay attention. Sleep disturbance was likely one of the first symptoms that improved with TMS, and its return often precedes broader mood changes.
Energy and motivation start to slip. Tasks that felt manageable during your best weeks after treatment begin to feel heavy again. You start putting things off, avoiding commitments, or feeling like simple activities require more effort than they should.
Negative thought patterns resurface. You catch yourself engaging in the kind of harsh self-talk or hopeless thinking that depression thrives on. Maybe you start doubting your worth, catastrophizing about the future, or withdrawing from people who care about you.
Interest fades. Activities you enjoyed during your recovery period start to feel flat or pointless. You stop reaching out to friends, skip the gym, or lose interest in hobbies.
The critical insight from the SAINT personalized continuation research is that acting on these early signals produces dramatically better outcomes than waiting until you are fully relapsed. A brief one- to two-day booster during the early stages of symptom return is far more effective, less expensive, and less disruptive to your life than a full retreatment course after a complete relapse [7].
Your treatment team can guide your maintenance plan, but there is a lot you can do on your own to extend the benefits of TMS and reduce the likelihood that you will need frequent booster sessions.
Stay in therapy. Concurrent psychotherapy, particularly cognitive behavioral therapy (CBT), has been shown to improve TMS response rates by approximately 8% and remission rates by 19% [12]. Therapy helps you build the cognitive and behavioral habits that reinforce the neuroplastic changes TMS creates. It is one of the most evidence-backed ways to make your results stick.
Prioritize sleep. Your brain consolidates the changes from TMS during sleep. Aim for seven to nine hours on a consistent schedule, even on weekends. Sleep disruption is both a symptom of depression returning and a factor that can accelerate relapse.
Move your body regularly. Thirty minutes of moderate exercise most days of the week supports the same brain-derived neurotrophic factor (BDNF) pathways that TMS activates. Exercise is not a replacement for treatment, but it is a powerful complement.
Limit alcohol. Alcohol is a central nervous system depressant that can undermine the mood improvements from TMS. Even moderate drinking can interfere with sleep quality and neuroplasticity.
Keep your follow-up appointments. Regular check-ins with your treatment provider allow early detection of symptom changes. Many clinics now offer remote monitoring tools that make this easier than ever. The earlier a problem is caught, the simpler the solution.
Track your mood. Whether you use a journal, a mood-tracking app, or a simple daily rating scale, consistent self-monitoring helps you spot trends that might otherwise sneak up on you. Bring this data to your follow-up appointments so your team can make informed decisions about whether a booster is warranted.
At Cognitive FX, we believe that the quality and precision of your initial treatment sets the foundation for everything that follows. That is why we use fMRI-guided targeting with our accelerated and ONE-D TMS protocols rather than relying on anatomical landmarks alone. By identifying the exact brain networks involved in your depression and stimulating them with precision, we aim to achieve deeper remission from the start, which the research shows leads to longer-lasting results [6][10].
Our approach to maintenance reflects what the latest science is telling us: that personalized care beats one-size-fits-all schedules. After your initial treatment, we work with you to develop a monitoring and maintenance plan that accounts for your specific risk factors, your treatment response, and your life circumstances. For some patients, that means a structured tapering schedule. For others, it means periodic check-ins with the option for brief booster sessions if and when early warning signs appear.
What we do not do is leave you on your own to figure it out. The data is clear that the period following TMS treatment is critical, and patients who have a proactive plan in place fare dramatically better than those who simply hope for the best [1][7][14].
If you are considering TMS for treatment-resistant depression, or if you have already completed a course elsewhere and are looking for guidance on maintaining your results, we are here to help. Schedule a consultation to discuss whether TMS is right for you and what a personalized long-term plan might look like.
No. TMS is not a treatment you need to take every day for the rest of your life. Most patients experience significant relief from a single treatment course lasting several months to over a year. Some patients never need retreatment. For those who do experience symptom return, periodic booster sessions (typically much shorter than the initial course) can restore improvement. The overall trend for most patients is toward less frequent treatment over time.
This varies considerably from person to person. Research shows that roughly one-third to one-half of TMS responders may benefit from some form of booster treatment within the first year. The timing and frequency depend on factors like your depression history, whether you achieved full remission, and whether you are taking concurrent medication. Some patients need a brief booster at six months, others at nine to twelve months, and some not at all during the first year.
The first long-term SAINT durability study found an average remission duration of approximately 11 weeks and response duration of about 15 weeks without maintenance. However, when patients were monitored and received personalized booster sessions as needed, 86% maintained remission for a full 12 months. This suggests that SAINT durability is comparable to other established depression treatments, and that a proactive maintenance strategy can dramatically extend the benefits.
No. Research on repeated SAINT courses has shown that retreatment produces comparable antidepressant effects to the initial treatment. TMS does not lose its effectiveness with repeated use. For standard TMS, retreatment success rates range from 60 to 84%, confirming that your brain continues to respond to stimulation even after multiple courses.
Most major insurers now cover initial TMS treatment courses for treatment-resistant depression. However, coverage for maintenance or booster sessions varies significantly between plans. Some insurers cover a limited number of tapering sessions after the acute course but do not cover ongoing maintenance. When a full relapse occurs with documented severity, insurers are generally more willing to approve a complete repeat course. Your treatment team can help you navigate coverage options and appeal processes.
Maintenance TMS refers to ongoing, scheduled sessions designed to prevent symptom return, such as weekly or biweekly sessions that gradually taper in frequency. Retreatment (also called rescue or booster TMS) refers to a condensed course of sessions initiated only when symptoms begin to return. Both approaches are supported by evidence, and modern personalized protocols often combine elements of both.
This is a decision to make with your prescribing physician, not independently. The research shows that the strongest long-term outcomes come from combining maintenance TMS with antidepressant medication, with one major study showing a relapse rate of just 15.9% for the combination versus 44.4% for medication alone. If reducing or discontinuing medication is a goal, discuss a careful plan with your provider that includes monitoring and a maintenance TMS strategy as a safety net.
If you’re wondering what to do when transcranial magnetic stimulation (TMS) doesn’t work, you might be:
Over the past few years, Transcranial Magnetic Stimulation (TMS) has become an increasingly popular treatment option for patients who haven’t found symptom relief from antidepressant medications.
