Which Type of TMS Therapy Is Best?

Different treatment variations have developed over the decades since transcranial magnetic stimulation (TMS) was proven effective at treating major depressive disorder in the 1980s. It’s critical for patients to understand these distinctions to have a clear picture of their treatment options. Patients should discuss the various types of TMS with their primary provider as well as the team at their prospective TMS clinic to find the best solution for their needs.

How TMS Works

First, it’s helpful to know how TMS works to understand its effectiveness. TMS is an FDA-cleared treatment that uses magnetic technology to produce painless electrical currents in the brain. These currents stimulate brain tissue and nerve cells to restore proper brain function and alleviate symptoms associated with depression. TMS can also be used to treat obsessive compulsive disorder (OCD).

The process itself is simple. While a patient sits in a comfortable chair, an electromagnetic coil is placed on the scalp near the left temple. This placement targets the areas of the brain that govern mood and are associated with depression. Patients only feel a slight tapping on their scalp during treatment.

There are several benefits to TMS. This treatment is non-invasive, performed on an outpatient basis, and does not require medication or anesthesia. Unlike medication, TMS doesn’t have taxing drug-related side effects such as weight gain or insomnia. TMS side effects are limited to mild headaches and scalp discomfort. And once the treatment session is finished, there’s no downtime or need to have someone drive the patient home. TMS is easily scheduled even during a busy day because patients can resume normal activities post-treatment.

Standard TMS treatments sessions take anywhere from 18 to 45 minutes. A course of treatment lasts between four and six weeks, with five sessions per week.

Are All TMS Treatments the Same?

The difference between the assorted types of TMS may involve the magnetic pulse rate or the type of equipment used. A TMS provider should be able to explain which type of treatment is used and how it may help you.

The first category of TMS treatments varies in terms of pulse rate:

• Single-pulse TMS



One pulse is administered at a steady rate every few seconds.

• Paired-pulse TMS: Two pulses are applied at the same time. These pulses can either target the same brain hemisphere or both of them, depending on the desired results for each individual patient.
• Repetitive TMS (rTMS): This is probably the most common type of TMS treatment. A series of pulses are delivered at once with different frequencies achieving different objectives. Fewer pulses have a suppressive or inhibiting effect on the brain, while more pulses have an excitatory effect. The pulse rate is based on each patient’s particular circumstances. The patient’s motor threshold is measured to determine this optimal rate, using the lowest amount of magnetic energy required to activate muscle fibers and cause the thumb to twitch. There is no difference between TMS vs. rTMS; the terms are generally interchangeable.
• Theta-burst stimulation TMS (TBS): Time is the biggest differentiator when it comes to TMS vs. TBS. Unlike a typical course of TMS treatment, which can last up to 45 minutes, TBS takes only one to three minutes. That’s because TBS delivers its magnetic pulses at a much quicker rate, one that’s similar in frequency to brainwaves. Cleared by the FDA in 2018, this version of TMS is often referred to as express or accelerated TMS.

Then there are two other forms of TMS, which use different equipment compared to standard TMS.

• Deep TMS (dTMS): Deep TMS treatment gets its name because it uses a specific type of machine with a different coil than rTMS. The manufacturer of dTMS machines claims the coil allows the magnetic pulses to travel deeper into the brain (about 4 cm in, compared to about 1.5 with rTMS). But when it comes to pulse rate for dTMS vs. rTMS, they’re similar in delivering several pulses at once. 
• Functional MRI or Neuro-navigated TMS (fMRI TMS): During treatment, a neuroimaging device such as MRI measures brain activity for real-time assessment of brain function while TMS is administered. The MRI can also be used for placing the coils on the brain to best effect. 

Find the Best TMS Treatment for You

Still wondering about the benefits of deep TMS vs. TMS vs. express TMS? This is when it’s advantageous to work with an experienced TMS provider. A clinic with in-depth expertise in TMS can help you settle on the best option for your specific needs. Talk with our patient consultants to find out if TMS therapy is right for you or a loved one or schedule your free consultation.