How Long Do the Effects of TMS Last? Maintaining Results After Treatment

How long do TMS results last?

There is no single expiry date for the antidepressant effects of transcranial magnetic stimulation (TMS). After a successful course, improvement can persist for months and sometimes a year or longer. Other people notice depressive symptoms returning within the first several months and may need changes to their relapse-prevention plan.

This is different from asking how long a course of TMS takes. The treatment course refers to the period during which sessions are delivered. Durability refers to how long the clinical improvement continues after the acute course ends. Treatment schedules differ by protocol and individual circumstances, so the expected course should be discussed with the treating clinic.

TMS does not have to be delivered indefinitely for its clinical benefit to continue after the final acute session. However, it is not considered a permanent cure for depression, and a future depressive episode remains possible.

What does the research show at 3, 6 and 12 months?

A systematic review and meta-analysis examined 19 studies that followed people who had responded to an initial course of repetitive TMS. Approximately 67% of these initial responders continued to meet response criteria at three months, 53% at six months and 46% at 12 months.

These figures should not be interpreted as a personal forecast or as the success rate among everyone beginning treatment. The analysis included only people who had already responded, and the studies differed in patient populations, TMS protocols, definitions of response and follow-up care. Some participants received maintenance or rescue TMS, and other treatments such as antidepressant medication could also have influenced durability. The 12-month estimate was based on fewer studies and participants than the earlier estimates, making it less certain.

A separate naturalistic study followed 257 adults treated in routine clinical settings. Among 120 people who were responders or remitters after acute TMS, 62.5% met response criteria at every three-month assessment through one year. In that study, participants could receive ongoing medication management and TMS reintroduction when clinically indicated; it therefore reflects a package of continuing care rather than the isolated effect of the acute course.

Taken together, the evidence supports a practical conclusion: TMS benefits can be durable, but symptom return is common enough that follow-up and relapse planning matter. Results vary substantially between individuals.

Response, remission and the return of depression

Research papers use several terms that can sound interchangeable but describe different outcomes. Exact thresholds vary by study and symptom scale.

• Response means a substantial improvement in depressive symptoms, often defined in research as a reduction of at least 50% on a rating scale. A person can respond while still having some symptoms.
• Remission means symptoms have become minimal or fall below a defined threshold. Remission does not mean that depression can never return.
• Relapse or recurrence means clinically significant depression returns after improvement. Researchers sometimes distinguish relapse within the same episode from a new recurrent episode, but patient-facing discussions often group them together as the return of depression.

Does TMS eventually wear off?

People sometimes describe symptom recurrence as TMS “wearing off,” but this phrase can be misleading. Depression is often an episodic or recurrent illness, and symptoms can return after improvement with TMS, medication, psychotherapy or other treatments. Recurrence does not prove that the original TMS course failed.

If symptoms return, the next step depends on their severity, timing, previous treatment response, current medications, psychological and social factors, and safety concerns. Options can include closer monitoring, medication or psychotherapy changes, TMS retreatment, or another clinically appropriate intervention.

How can TMS results be made more durable?

There is no proven way to guarantee that a TMS response will last. The best approach is usually a relapse-prevention plan rather than relying on TMS alone.

Some strategies have direct but still incomplete evidence in the period after TMS—particularly continuation or maintenance TMS and symptom-triggered retreatment. Other measures are based largely on broader evidence and clinical practice for depression relapse prevention. They should not be interpreted as proven ways to prolong a specific biological effect of TMS.

• Complete an adequate acute course. Treatment should be reviewed rather than stopped early solely because improvement has begun. The appropriate number of sessions and any taper depend on the protocol, response and clinical assessment.
• Continue appropriate pharmacotherapy. If medication is part of the treatment plan, do not stop or reduce it without speaking with the prescriber. The observational durability evidence often includes patients receiving ongoing medication care, so it does not establish that medication can routinely be discontinued after TMS.
• Continue or begin appropriate psychotherapy. Psychotherapy can address residual symptoms, coping patterns, relationships, stressors and early warning signs. Its specific ability to extend a TMS response requires further study, but it remains an established component of depression care for many patients.
• Treat relevant comorbidities. Anxiety disorders, post-traumatic stress symptoms, substance-use problems, sleep disorders and medical conditions can affect functioning and complicate depression management. Treatment should be coordinated rather than focused on a symptom score alone.
• Protect sleep and reduce harmful substance use. Regular sleep patterns and avoiding problematic alcohol or drug use support general mental health. These are sensible depression-management strategies, not established stand-alone methods for making TMS effects last longer.
• Monitor symptoms. Brief rating scales, scheduled follow-up and observations from trusted supports can help detect a meaningful pattern before impairment becomes severe.
• Know personal warning signs. Changes in sleep, motivation, concentration, social engagement, self-care or hopelessness can be early indicators, although signs differ between people.
• Arrange follow-up before treatment ends. A written plan can clarify who to contact, which symptoms require reassessment and whether maintenance or rescue TMS is worth considering.

What are continuation and maintenance TMS?

Terminology varies across studies. In general, continuation TMS refers to treatment delivered after the acute course to consolidate improvement during the following months. Maintenance TMS refers to longer-term sessions intended to reduce the risk of symptom return. In practice, the terms sometimes overlap.

A planned maintenance schedule provides sessions at predetermined intervals even when the patient remains well. A symptom-triggered booster, rescue or reintroduction approach begins additional sessions when depressive symptoms start to worsen. Retreatment may involve more than a single session; “booster” is an informal term and does not describe one standardized dose.

Research suggests maintenance TMS can help some people, but the strength of evidence depends on study design. The 2019 durability meta-analysis found that studies using maintenance treatment had higher sustained response rates at three and six months. That association does not prove maintenance caused the difference because much of the evidence was open-label or observational and potentially affected by other treatments and patient selection.

A 2025 meta-analysis also found overall improvement during maintenance TMS across 14 studies, but results varied markedly. When analysis was restricted to three small randomized trials, maintenance TMS did not show a statistically significant advantage. This tension matters: the broader evidence is encouraging, while the more controlled evidence remains limited.

Fixed and rescue schedules have not been shown conclusively to differ in effectiveness. Published protocols range from regular weekly or monthly sessions to clustered or symptom-triggered courses. There is no single universally established frequency, and every person who responds to acute TMS does not automatically require maintenance treatment.

Do booster TMS sessions work if symptoms return?

Retreatment can help some previous responders. In one six-month study cited in the supplied research, 32 of 38 patients with symptom worsening regained clinical benefit after TMS was reintroduced. A separate one-year naturalistic study also found that TMS was commonly reintroduced as part of ongoing care.

These findings are useful but do not guarantee that retreatment will reproduce the original result. Evidence is affected by observational study designs, differing definitions and concurrent treatments. Earlier recognition of worsening may allow more treatment options, but the decision to restart TMS requires reassessment.

What should you do if depressive symptoms begin returning?

Contact the treating clinician or usual mental health provider rather than waiting for symptoms to become severe. Record when changes began, how they affect sleep and daily functioning, and whether medication, substance use, stress or physical health has changed. Do not alter prescribed medication on your own.

NeuroLinks provides individualized assessment and TMS in Nanaimo for appropriately selected patients from Vancouver Island and elsewhere in British Columbia. To discuss assessment, follow-up or possible retreatment, contact NeuroLinks.