How Long Does TMS Last? The First Year and Follow-Up
How long does TMS last? Benefits can continue after the initial course, but their duration varies, and some people need additional treatment. The first year after starting TMS can include meaningful improvement, ongoing symptoms, changes in other care, and sometimes additional TMS. There is no single year-long schedule or guaranteed outcome. An initial course should lead into a continuing depression-care plan, with clear ways to assess benefit and respond if symptoms return. [1,5,6]
For people who have already spent months or years seeking relief, a realistic timeline matters. It can make space for hope without implying that everyone reaches remission, that improvement follows a weekly script, or that the final treatment appointment ends the need for care.
Before treatment: establish what needs to change
The starting point is a careful review of depression and earlier treatment. A history of inadequate relief is important, but the clinician needs details: which treatments were used, for how long, at what dose when relevant, and with what benefit or side effects. This helps distinguish an incomplete treatment trial from persistent illness despite appropriate care. [2,7]
A depression evaluation should also consider medical conditions, substance use, sleep, anxiety, and the history of mood episodes. Past periods of unusually elevated or irritable energy with much less need for sleep may call for assessment for bipolar disorder, which can change the treatment approach. [2,3]
If TMS is being considered, review the specific device, protocol, potential benefits, alternatives, and safety concerns. The NeuroStar TMS information describes Sophroneo's listed offering, but a device name alone cannot predict an individual result.
Write down two or three personal goals alongside the baseline symptom assessment. Examples might include returning to a manageable work routine, taking interest in meals again, or being able to participate in family life. These are goals to discuss, not milestones that everyone should reach by a certain week.
The first several weeks: completing and evaluating the initial course
A conventional TMS course commonly requires visits on most weekdays for several weeks. The treatment team determines the actual schedule. TMS uses magnetic stimulation while the patient is awake, and the procedure itself does not deliver a medication. People may nevertheless continue medication or psychotherapy during the course. [1,4]
Early visits can involve learning the routine and communicating about comfort. Scalp discomfort or headaches can occur, and a seizure is a rare risk. Tell the team about side effects, medication changes, poor sleep, or other new health concerns rather than assuming they are irrelevant to a nonmedication procedure. [1,7]
Benefit should be assessed over time, not inferred from the strength of the tapping sensation or the mood of a single afternoon. Some people improve, some improve incompletely, and some do not obtain meaningful relief. There is no reliable promise that a particular symptom will lift during a specific week. [1]
Ask when formal progress reviews will occur and what would prompt an earlier one. A course should not become an exercise in silently enduring symptoms while waiting for an advertised result.
What counts as improvement?
Improvement, response, and remission describe different outcomes. Improvement can mean that symptoms are less severe. In research, response commonly means a substantial reduction on a symptom scale, often at least half. Remission means symptoms have fallen below a specified threshold. Neither term automatically means that work, relationships, confidence, and sleep have fully recovered. [7]
The guide to tracking TMS progress discusses questionnaires and everyday functioning. Both deserve attention. A lower questionnaire score is encouraging, but continuing difficulty getting through ordinary responsibilities still belongs in the clinical conversation.
Keep tracking practical. You might record sleep, interest, concentration, and one meaningful activity at agreed intervals. Use the same approach consistently enough to compare, without turning every hour into a test of whether treatment has worked.
With permission, a trusted person can contribute observations about changes they notice. Their perspective can add useful information, but it should not override what the patient reports or become pressure to appear better.
When the initial course ends: make the handoff explicit
The next step should be agreed before the final appointment whenever possible. Ask who will oversee continuing depression care, when the next review will occur, and how to contact the team between visits. If the TMS clinician and medication prescriber are different people, clarify how they will communicate.
Do not stop prescribed treatment simply because symptoms improve. Medication changes should be planned with the prescriber; psychotherapy may continue to address symptoms, coping, or problems that remain after mood begins to improve. [2,4]
Some plans include additional TMS visits, while others use monitoring and other ongoing care. Terms such as taper, continuation, maintenance, and retreatment can describe different approaches. Ask the clinician to explain the purpose of any proposed visits rather than assuming that every clinic uses those words identically. Evidence has not established a universal maintenance schedule. [7]
Clarify practical details too: which visits are recommended, which are available, what insurance authorization may be needed, and what costs could arise. An initial course being covered does not by itself answer the question of later coverage.
How long do TMS benefits last? Evidence at one year
Some people sustain benefit over a year, but the evidence needs context. A multisite observational follow-up study followed 257 adults after an initial TMS course. Among the 120 who met response or remission criteria at the end of that course, 75, or 62.5%, continued to meet response criteria throughout follow-up. [5]
That percentage applies to the initially responding subgroup, not to everyone who began treatment. Participants continued antidepressant care, and the study allowed TMS retreatment when symptoms returned. It therefore does not show that one course, by itself, kept nearly two-thirds of all patients well for a year. [5]
The study was observational, meaning treatment followed clinical practice rather than a randomized comparison designed to isolate the effect of a particular follow-up strategy. Its results support the possibility of durable benefit within continuing care, not a personal forecast. [5]
A later systematic review also found that some initial responders maintained benefit at one year, with substantial variation across studies. Differences in follow-up treatment and study design make a single headline percentage an incomplete guide. [6]
Months three to six: decide what continuing care is accomplishing
Follow-up should ask more than whether depression has returned. Are symptoms continuing to improve, staying stable, or worsening? Are side effects interfering with life? Is the plan workable financially and practically? What matters to the person may change as the initial treatment burden recedes.
Sleep deserves its own discussion. Someone may report a better mood but still have trouble falling asleep, oversleep, or feel unrefreshed. The article on TMS and sleep provides context, but TMS for depression should not be assumed to treat every cause of disturbed sleep. [1,2]
Persistent worry or avoidance may also need attention through anxiety care. Improvement in one problem does not mean that all accompanying symptoms have resolved. Tell the clinician which difficulties remain most limiting.
Maintenance TMS: who may need follow-up sessions?
Maintenance treatment aims to preserve benefit after a successful initial course. Research is developing, and schedules differ. A 2025 professional consensus review highlighted uncertainty about which patients benefit most, whether visits should be scheduled or triggered by symptoms, and how frequently treatment should occur. [7]
The MAINT-R randomized clinical trial compared weekly maintenance rTMS with lithium in 75 adults who had responded to acute bilateral rTMS. All participants continued venlafaxine. Over 24 weeks, seven participants in each group relapsed, and the primary depression-score outcome did not differ significantly. [8]
This study offers evidence for a specific maintenance approach in a selected population. It does not establish that every TMS responder needs weekly treatment, that maintenance works without other medication, or that its findings prove equal outcomes for a full year. The individual recommendation should explain both the rationale and the uncertainty. [8]
If depression returns after TMS: plan for reassessment
A difficult week is not automatically a depressive relapse, but a sustained return of symptoms deserves assessment. Contact the treating clinician if loss of interest, worsening mood, sleep disruption, withdrawal, or reduced functioning persists or is becoming hard to manage. The clinician can assess the pattern and other possible contributors. [2]
Returning symptoms do not erase earlier benefit, and they are not a personal failure. They do mean the current plan may need review. Depending on the clinical picture, that review might include medication, psychotherapy, another TMS course, or a different treatment. Retreatment should follow an assessment, not an automatic assumption that the original settings remain appropriate. [1,2,5]
Seek prompt advice about unusually high energy, sharply reduced need for sleep, impulsive behavior, or marked agitation. These symptoms need evaluation rather than being celebrated as evidence that depression has lifted. [3]
If symptoms include thoughts of suicide or inability to stay safe, call or text 988 in the United States. For immediate physical danger or a life-threatening emergency, call 911 or seek emergency care. Do not wait for the next routine TMS appointment. [2]
What if TMS doesn't work well enough?
Insufficient improvement should lead to a clear discussion of the next options. Ask what the clinician learned from the course, whether the diagnosis or contributing conditions need another look, and what evidence supports continuing, changing, or stopping the proposed intervention.
There may be further options within a coordinated plan, including psychotherapy, medication adjustments, and other treatments for depression. ECT is a different brain stimulation treatment that may be considered for severe illness or situations requiring a different approach. Its benefits, risks, and procedure need their own discussion; it is not interchangeable with TMS. [1,2]
You do not have to interpret a lack of benefit as proof that depression is untreatable. At the same time, it is reasonable to ask why another intervention is being recommended and what would count as enough benefit to justify its burden.
Months six to twelve: review recovery in ordinary life
As the year continues, the review can become broader. Are you able to maintain daily routines? Is there room for relationships, interests, and responsibilities? Are ongoing appointments and costs sustainable? A symptom score is useful, but these questions make the treatment's practical value clearer.
Recovery can also involve rebuilding routines after a long period of illness. A plan might include discussing a gradual return to activities or identifying support for unresolved stresses. Such steps should fit the person's energy and circumstances; they are not a requirement to demonstrate that treatment succeeded.
Before the next seasonal change, major life transition, or expected stressor, ask whether the follow-up plan needs adjustment. That is a planning conversation, not a prediction that a setback will happen.
A short written plan can cover:
The next scheduled clinical review and the person responsible for it.
Symptoms and functional changes to keep tracking.
Which concerns warrant contacting the team sooner.
How medication, therapy, and any further TMS will be coordinated.
What to do if symptoms become urgent or unsafe.
What a useful first-year plan should deliver
The first year should produce a clearer understanding of what helps, what remains difficult, and what to do next. For some people, that means maintaining substantial improvement. For others, it means adapting the plan or choosing a different treatment. Research supports meaningful benefit for some patients while leaving important questions about individual durability and maintenance unanswered. [1,6,7]
Coordinated mental health services can support these decisions across treatment changes. To discuss TMS and follow-up in the context of your history, contact Sophroneo Behavioral Health & TMS.
This is general educational guidance, not an individual treatment timeline.
Sources
[1] National Institute of Mental Health. Brain Stimulation Therapies. Accessed October 22, 2026.
[2] National Institute of Mental Health. Depression. Accessed October 22, 2026.
[3] National Institute of Mental Health. Bipolar Disorder. Revised 2025.
[4] National Institute of Mental Health. Mental Health Medications. Last reviewed December 2023.
[5] Dunner DL, Aaronson ST, Sackeim HA, et al. A multisite, naturalistic, observational study of transcranial magnetic stimulation for patients with pharmacoresistant major depressive disorder: durability of benefit over a 1-year follow-up period. Journal of Clinical Psychiatry. 2014;75(12):1394–1401.
[6] Senova S, Cotovio G, Pascual-Leone A, Oliveira-Maia AJ. Durability of antidepressant response to repetitive transcranial magnetic stimulation: Systematic review and meta-analysis. Brain Stimulation. 2019;12(1):119–128.
[7] Trapp NT, Purgianto A, Taylor JJ, et al. Consensus Review and Considerations on TMS to Treat Depression: A Comprehensive Update Endorsed by the National Network of Depression Centers, the Clinical TMS Society, and the International Federation of Clinical Neurophysiology. Clinical Neurophysiology. 2025.
[8] Noda Y, Wada M, Mimura Y, et al. Repetitive Transcranial Magnetic Stimulation as Maintenance Treatment of Depression: The MAINT-R Randomized Clinical Trial. JAMA Network Open. 2025;8(6):e2515881.
Frequently Asked Questions
Does everyone need maintenance TMS for a year?
No. There is no established maintenance calendar that applies to every responder. A clinician should explain whether additional TMS is recommended, why, and how it fits with monitoring and other treatment. Access and coverage also need confirmation. [7,8]
Does feeling better mean I can stop medication?
No medication change should be assumed from a successful TMS course. Discuss benefits, side effects, and any wish to reduce medication with the prescriber. A planned change can be monitored; stopping independently may complicate recovery. [4]
Is a second TMS course guaranteed to reproduce the first result?
No. Retreatment can be considered when clinically appropriate, but an earlier benefit is not a guarantee of the same outcome. Reassessment should consider the current symptoms, intervening health changes, safety, and other treatment options. [1,5]
How can a family member help without monitoring every mood change?
Ask what kind of support is welcome. Practical help with appointments, a shared plan for contacting the clinician, and specific observations offered with permission can be more useful than repeatedly asking whether treatment worked. Respect the patient’s role in decisions and privacy.
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