The success rates of TMS therapy depend on the type used. For example, newer, more targeted forms of TMS show significantly higher success rates than the most common protocols.
In this article, we explore the success rates for the main types of TMS available today, comparing them to other common treatments for depression, including antidepressant medications, electroconvulsive therapy (ECT), and ketamine.
Note: The success rates discussed here apply to major depressive disorder (MDD), which we treat at our clinic. Success rates for obsessive-compulsive disorder (OCD), bipolar disorder, post-traumatic stress disorder (PTSD), and other mental health conditions treated with TMS are not covered in this article.
Key Factors That Influence TMS Success Rates
Transcranial Magnetic Stimulation (TMS) is a noninvasive, FDA-approved procedure that uses magnetic pulses to restore normal activity levels in a part of the brain called the dorsolateral prefrontal cortex (DLPFC), which is commonly affected by depression and other mood disorders.
During a TMS session, an electromagnetic coil is placed over the patient’s head, directly above the DLPFC, and pulses are applied at specific intervals to stimulate nerve cells in that region.
The main factors that influence TMS success rates are:
-
Types of pulses: Success rates are influenced by the type and pattern of pulses used during TMS sessions which vary depending on the method used.
-
Methods to target the DLPFC: Various methods to locate the treatment target area influence success rates, ranging from manual measurements of the patient’s head to precision targeting with a functional MRI brain scan.
-
Methods to place the coil: Clinicians must find the treatment target area consistently and reliably for every treatment session. Different types of TMS use different methods which can significantly influence the effectiveness of treatment.
TMS Success Rates by Protocol
In this section, we’ll see how these three factors affect treatment success rates across different types of TMS. Success rates are typically expressed as response rates, where patients experience some improvements but still have lingering symptoms of depression, and remission rates, where patients are symptom-free. Whenever possible, we also refer to relapse rates to measure long-term success, indicating when symptoms return after a period of remission.
Repetitive Transcranial Magnetic Stimulation (rTMS)
The first type of TMS developed, called repetitive transcranial magnetic stimulation (rTMS), was initially applied to treat depression in the mid-90s and remains the most common method today.
rTMS treatments involve daily sessions, five days a week, with 20–30 sessions delivered over 4–6 weeks. Patients receive a repetitive pattern of pulses for 5–10 seconds, followed by 30–60-second pauses, with each session lasting about 40 minutes. Typically, patients start to see improvements after 2–4 weeks, although some may only experience benefits after completing the treatment.
With repetitive TMS, the most common method for locating the treatment target area is the 5 cm method. This approach involves manually measuring the patient’s head to estimate the correct location, and it’s easy to perform as it doesn’t require specialized equipment. However, studies show that this method can be unreliable because it doesn't account for individual variations in brain size and head shape. Even small deviations in targeting the DLPFC can significantly affect treatment outcomes, as missing the area by a few millimeters can reduce the effectiveness of treatment.
In terms of overall success rates, about 50% of patients respond well to rTMS with over 30% achieving full remission. Patients who have not responded to multiple antidepressant medications are more challenging to treat, but around 30% still respond to treatment, and 19% achieve remission.
Despite these positive results, rTMS should not be seen as a permanent cure for depression. In some cases, symptoms return gradually after the initial period of improvement. Around 50% of individuals who recover from depression following rTMS interventions experience a relapse within 12 months.
Deep Transcranial Magnetic Stimulation (dTMS)
Deep TMS, a less common protocol, has shown higher efficacy compared to rTMS.
In a randomized sham-controlled trial, 82% of patients responded and 65% achieved remission after 30 sessions of dTMS. Even just 20 sessions led to a 74% response and 58% remission rate. Similar to rTMS, dTMS is less effective with patients who had previously failed to improve after multiple antidepressant medications, but almost 30% still reached remission.
This trend was confirmed in a study directly comparing rTMS and dTMS. While the overall values were slightly lower than in other studies, the results showed that about 40% of patients achieved remission after rTMS, compared to over 60% with dTMS.
That said, due to its less targeted approach, dTMS carries a slightly higher potential for serious side effects and other unintended effects. Our previous article on deep TMS versus rTMS explains this in greater detail. Be sure to read it if you’re considering deep TMS treatment.
Intermittent Theta-Burst Stimulation (iTBS)
In 2018, the Food and Drug Administration approved a new version of TMS called Intermittent Theta-Burst Stimulation (iTBS). Unlike the simple repetitive pattern used in rTMS, iTBS mimics theta waves involved in memory formation, meditation, and certain phases of sleep. iTBS uses bursts of three pulses (called triplets) delivered for 200 ms every 10 seconds. This condensed pattern reduces session duration from 37 minutes with rTMS to just 3 minutes with iTBS.
Most studies show that response and remission rates after iTBS are similar to rTMS, but iTBS appears to have a longer-lasting effect. Many patients also reported a decrease in suicidal ideation, suggesting that iTBS could be a better option for rapidly treating patients at high risk of suicide. Additionally, the shorter duration of iTBS sessions allows patients to undergo multiple sessions per day, significantly reducing the course of treatment while maintaining its efficacy.
fMRI-Guided iTBS (SAINT Protocol)

A comparison of remission rates for rTMS/iTBS, electroconvulsive therapy (ECT), and SAINT-iTBS.
In September 2022, the FDA approved a new protocol developed by a team of researchers from Stanford University called Stanford Intelligent Accelerated Neuromodulation Therapy (SAINT). This is now regarded as the “gold standard” treatment for treatment-resistant depression.
What distinguishes SAINT from previous TMS protocols is the use of functional MRI (fMRI) to precisely locate the DLPFC for each patient, along with special software called neuronavigation to ensure the coil is placed over that exact spot during every TMS session. This approach offers much greater accuracy than other methods, reducing inconsistency that can lead to less impactful results for depressed patients.
After completing the fMRI scan, patients undergo 10 short sessions per day over 5 days, totaling 50 sessions. In a double-blind randomized clinical trial, about 86% of patients responded to the SAINT-iTBS treatment, and around 79% reached remission. All participants had treatment-resistant depression and had failed at least two other depression treatments. One month after treatment, 60% were still in remission.
The speed with which SAINT-iTBS can achieve high response and remission rates makes it one of the most effective treatments for depression available today. However, there is limited data on the durability of these outcomes and how well they hold up over time. Some patients experience lasting remission or symptom reduction, while others require follow-up treatments to maintain effectiveness. Studies show that TMS maintenance sessions can be extremely helpful, sometimes allowing patients to remain symptom-free for up to eight years.
Our Utah-based clinic, Cognitive FX, is one of fewer than ten clinics in the U.S. that currently offers SAINT-iTBS. If you’re interested in our program, click here to learn more.
TMS Success Rates Compared to Other Depression Treatments
In deciding whether to try TMS therapy and which type would be best for you, it’s helpful to compare TMS with other common treatment options, such as antidepressant medications, ketamine, and electroconvulsive therapy. Here, we’ll provide a summary of the differences and link to other articles we’ve written that explore these comparisons in more detail.
TMS Compared to Antidepressant Medication
First-line depression treatments, such as SSRIs, have lower success rates compared to TMS. A reanalysis of the largest antidepressant study conducted revealed a remission rate of only 35% after patients had tried four different antidepressants. Additionally, fewer than 2% of patients found relief with a third or fourth medication after their depression persisted despite two unsuccessful antidepressant attempts.
Given the low response rate to third or fourth-line antidepressant treatments, both doctors and patients should consider the risks and side effects of continuing with additional medications after two unsuccessful trials. At this point, exploring alternative treatments like TMS may offer greater benefits.
Antidepressants also come with a range of side effects, including stomach pain, diarrhea or constipation, loss of appetite, dizziness, insomnia, and headaches. In contrast, TMS typically has mild, short-lived side effects, such as headaches and scalp tenderness, which usually resolve after a few sessions.
Moreover, while the effects of TMS can often be felt within days, antidepressant medications may take 6 to 8 weeks to show results, and patients often need to try multiple medications before finding an effective one.
TMS Compared to Ketamine
Ketamine is becoming an increasingly popular treatment for patients with depression who don’t respond to standard antidepressant medications. Many patients begin feeling relief just hours after treatment, with 50% continuing to experience improvements up to a week later. However, ketamine doesn’t provide the long-term benefits associated with TMS. After six months of ongoing ketamine treatments, only 26% of patients still respond, and just 15% achieve remission.
A major drawback of ketamine compared to TMS is the high risk of relapse. When patients stop taking ketamine, symptoms often return within days or weeks. In contrast, TMS offers more durable benefits, with many patients experiencing symptom relief that lasts for several months or even longer. While some may benefit from occasional maintenance sessions, they often remain largely symptom-free.
Additionally, ketamine has a higher risk of severe side effects than TMS. Common side effects include disorientation, confusion, dizziness, headaches, nausea, vomiting, increased blood pressure, elevated heart rate, rapid breathing, heightened body temperature, and hallucinations.
Further reading: Ketamine vs. TMS: Compare Side Effects, Effectiveness & Costs
TMS Compared to Electroconvulsive Therapy (ECT)
ECT can be a safe option to treat depression with success rates that often exceed those of standard rTMS or iTBS (but not SAINT-iTBS).
Studies show that over half of patients with depression respond to ECT within the first week. Overall, almost 80% show significant improvements, and about 40% to 60% of patients achieve remission after a few weeks of treatment.
However, ECT comes with a higher risk of unpleasant side effects compared to TMS. Some patients experience adverse cognitive effects, including confusion, difficulty concentrating, and memory loss.
Further reading: ECT vs. TMS: Compare Side Effects, Effectiveness, and Cost
Receive the Safest and Most Effective Depression Treatment at Cognitive FX
At Cognitive FX, we’re one of fewer than ten clinics in the U.S. that currently offer SAINT-iTBS for treatment-resistant depression.
To improve long-term outcomes for our patients, we incorporate cognitive behavioral therapy (CBT) into our treatment plan. This combination is likely to produce the best long-term results, as brain stimulation and talk therapy reinforce each other, improving the brain areas affected by depression.
While no studies have yet combined iTBS and CBT, one study found that combining rTMS and CBT significantly improved response and remission rates by ~8% and ~19%, respectively. We expect CBT to help our patients experience sustained improvement for a longer period after their SAINT treatment is concluded.
Our one-week program 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 who have a history of seizures or those who are actively suicidal and require crisis care.
If you’re interested in receiving SAINT TMS at Cognitive FX, click here to learn more.
Cited Research