Transcranial magnetic stimulation

{{Short description|Brain stimulation using magnetic fields}} {{Use dmy dates|date=January 2016}} {{Infobox medical intervention | Name = Transcranial magnetic stimulation | Image = File:Transcranial magnetic stimulation.jpg| Caption = Transcranial magnetic stimulation<br />(schematic diagram)| Speciality = Psychiatry, neurology | ICD10 = | ICD9 = | MeshID = D050781 | OtherCodes = | }} '''Transcranial magnetic stimulation''' ('''TMS''') is a noninvasive neurostimulation technique in which a changing magnetic field is used to induce an electric current in a targeted area of the brain through electromagnetic induction. A device called a stimulator generates electric pulses that are delivered to a magnetic coil placed against the scalp. The resulting magnetic field penetrates the skull and induces a secondary electric current in the underlying brain tissue, modulating neural activity.<ref name="NICE2014">{{cite web|publisher=National Institute for Health and Care Excellence|date=January 2014|url=https://www.nice.org.uk/guidance/IPG477|title=Transcranial magnetic stimulation for treating and preventing migraine}}</ref><ref name=Harvard>{{cite web|first1=Michael Craig|last1=Miller|publisher=Harvard Health Publishing|date=July 26, 2012|url=http://www.health.harvard.edu/blog/magnetic-stimulation-a-new-approach-to-treating-depression-201207265064|title=Magnetic stimulation: a new approach to treating depression?}}</ref>

<!-- Medical uses --> Medical devices delivering repetitive transcranial magnetic stimulation (rTMS) appear to provide reasonably safe and effective treatments for major depressive disorder (MDD), chronic pain, and obsessive-compulsive disorder (OCD).<ref name=Mann>Multiple sources: * {{cite book|last1=Mann|first1=Sukhmanjeet Kaur|last2=Malhi|first2=Narpinder K.|chapter=Repetitive Transcranial Magnetic Stimulation (rTMS)|title=StatPearls|date=6 March 2023|publisher=StatPearls Publishing|location=Treasure Island (FL)|pmid=33760474|chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK568715/|access-date=16 January 2025}} * {{cite web|date=17 August 2018|title=FDA News Release: FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder|url=https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-transcranial-magnetic-stimulation-treatment-obsessive-compulsive-disorder|publisher=Food and Drug Administration|access-date=17 January 2026|archive-url=https://web.archive.org/web/20251221023315/https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-transcranial-magnetic-stimulation-treatment-obsessive-compulsive-disorder|archive-date=21 December 2025|url-status=live}} * {{cite web|url=https://www.apaservices.org/practice/business/technology/on-the-horizon/transcranial-magnetic-stimulation|date=4 December 2025|title=FDA clears transcranial magnetic stimulation (TMS) for youth, and a shorter version for adults|location=Washington, D.C.|publisher=American Psychological Association Services, Inc.|access-date=16 January 2026|archive-url=https://web.archive.org/web/20260116202343/https://www.apaservices.org/practice/business/technology/on-the-horizon/transcranial-magnetic-stimulation|archive-date=16 January 2026|url-status=live}}</ref><ref name=":1" /> However, evidence quality is variable, effect sizes are modest, and placebo responses are large; the extent of its efficacy and optimal treatment protocols are not certain.<ref name=":2" />

<!-- Side effects --> Adverse effects of TMS appear rare and include fainting and seizure, which occur in roughly 0.1% of patients and are usually attributable to administration error.<ref name=Rossi>{{cite journal |last1=Rossi |display-authors=et al. |title=Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: Expert Guidelines. |journal=Clinical Neurophysiology |date=January 2021 |volume=132 |issue=1 |pages=269–306 |doi=10.1016/j.clinph.2020.10.003 |pmid=33243615 |pmc=9094636 |s2cid=225049093 }}</ref> {{TOC limit|3}}

== Medical uses == thumb|285x285px|A magnetic coil is positioned on the patient's head.<ref name=":0" /> TMS does not require surgery or electrode implantation. Its use can be diagnostic and/or therapeutic. Effects vary based on frequency and intensity of the magnetic pulses as well as the length of treatment, which dictates the total number of pulses given.<ref>{{Cite journal|date=2015-09-01|title=Basic principles of transcranial magnetic stimulation (TMS) and repetitive TMS (rTMS)|journal=Annals of Physical and Rehabilitation Medicine|language=en|volume=58|issue=4|pages=208–213|doi=10.1016/j.rehab.2015.05.005|issn=1877-0657|doi-access=free|last1=Klomjai|first1=Wanalee|last2=Katz|first2=Rose|last3=Lackmy-Vallée|first3=Alexandra|pmid=26319963}}</ref>

The Food and Drug Administration (FDA) has cleared rTMS devices for use in the treatment of depression in the United States (US). The National Institute for Health and Care Excellence (NICE) has issued guidance in the United Kingdom (UK) for that use. Private clinics and some Veterans Affairs medical centers provide treatments for that use. TMS stimulates cortical tissue without the pain sensations produced in transcranial electrical stimulation.<ref>{{cite book |first=Jean-Pascal |last=Lefaucher |chapter=37. Transcranial magnetic stimulation |chapter-url=https://www.sciencedirect.com/science/article/abs/pii/B9780444640321000370 |editor-first=Kerry H. |editor-last=Levin |editor2-first=Patrick |editor2-last=Chauvel |series=Handbook of Clinical Neurology |publisher=Elsevier |doi=10.1016/B978-0-444-64032-1.00037-0 |date=2019 |isbn=978-0-444-64032-1 |pages=559–580 |volume=160 |title=Clinical Neurophysiology: Basis and Technical Aspects|pmid=31277876 }}</ref>

=== Diagnosis === TMS can be used clinically to measure activity and function of specific brain circuits in humans, most commonly with single or paired magnetic pulses.<ref name=diagnostic1>{{cite journal | vauthors = Groppa S, Oliviero A, Eisen A, Quartarone A, Cohen LG, Mall V, Kaelin-Lang A, Mima T, Rossi S, Thickbroom GW, Rossini PM, Ziemann U, Valls-Solé J, Siebner HR | display-authors = 6 | title = A practical guide to diagnostic transcranial magnetic stimulation: report of an IFCN committee | journal = Clinical Neurophysiology | volume = 123 | issue = 5 | pages = 858–882 | date = May 2012 | pmid = 22349304 | pmc = 4890546 | doi = 10.1016/j.clinph.2012.01.010 }}</ref> The most widely accepted use is in measuring the connection between the primary motor cortex of the central nervous system and the peripheral nervous system to evaluate damage related to past or progressive neurologic insult.<ref name=diagnostic1 /><ref>Multiple sources: * {{cite journal | vauthors = Rossini PM, Rossi S | title = Transcranial magnetic stimulation: diagnostic, therapeutic, and research potential | journal = Neurology | volume = 68 | issue = 7 | pages = 484–8 | date = February 2007 | pmid = 17296913 | doi = 10.1212/01.wnl.0000250268.13789.b2 | s2cid = 19629888}} * {{cite journal | vauthors = Dimyan MA, Cohen LG | title = Contribution of transcranial magnetic stimulation to the understanding of functional recovery mechanisms after stroke | journal = Neurorehabilitation and Neural Repair | volume = 24 | issue = 2 | pages = 125–135 | date = February 2010 | pmid = 19767591 | pmc = 2945387 | doi = 10.1177/1545968309345270}} * {{cite journal | vauthors = Nowak DA, Bösl K, Podubeckà J, Carey JR | title = Noninvasive brain stimulation and motor recovery after stroke | journal = Restorative Neurology and Neuroscience | volume = 28 | issue = 4 | pages = 531–544 | year = 2010 | pmid = 20714076 | doi = 10.3233/RNN-2010-0552 }}</ref> TMS has utility as a diagnostic instrument for myelopathy, amyotrophic lateral sclerosis, and multiple sclerosis.<ref name="Chen2008">{{cite journal |vauthors=Chen R, Cros D, Curra A, Di Lazzaro V, Lefaucheur JP, Magistris MR, Mills K, Rösler KM, Triggs WJ, Ugawa Y, Ziemann U |title=The clinical diagnostic utility of transcranial magnetic stimulation: report of an IFCN committee |journal=Clin Neurophysiol |volume=119 |issue=3 |pages=504–532 |date=March 2008 |pmid=18063409 |doi=10.1016/j.clinph.2007.10.014 }}</ref>

=== Treatment and efficacy === The FDA has found that devices producing rTMS are reasonably safe and effective for the treatment of MDD, chronic pain, and OCD; only minor adverse effects have usually accompanied these improvements.<ref name=Mann/> Guidelines issued through 2018 have claimed that TMS has shown strong evidence of effectiveness for depression, neuropathic pain, and post-stroke motor recovery, probable benefit for several other conditions, and insufficient evidence for the rest.<ref name="upd">{{cite journal |vauthors=Lefaucheur JP, Aleman A, Baeken C, Benninger DH, Brunelin J, Di Lazzaro V, Filipović SR, Grefkes C, Hasan A, Hummel FC, Jääskeläinen SK, Langguth B, Leocani L, Londero A, Nardone R, Nguyen JP, Nyffeler T, Oliveira-Maia AJ, Oliviero A, Padberg F, Palm U, Paulus W, Poulet E, Quartarone A, Rachid F, Rektorová I, Rossi S, Sahlsten H, Schecklmann M, Szekely D, Ziemann U |title=Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014-2018) |journal=Clin Neurophysiol |volume=131 |issue=2 |pages=474–528 |date=February 2020 |pmid=31901449 |doi=10.1016/j.clinph.2019.11.002 |display-authors=5 |hdl=10362/147799 |hdl-access=free }}</ref> Newer modalities of TMS, such as intermittent theta burst stimulation (iTBS), appear to match standard rTMS in efficacy while offering shorter treatment times and promising avenues for further optimization.<ref>Multiple sources: * {{cite journal|author=Nicholas T. Trapp, Anthony Purgianto, Joseph J. Taylor, Manpreet K. Singh,Lindsay M. Oberman, Brian J. Mickey, Nagy A. Youssef, Daniela Solzbacher, Benjamin Zebley, Laura Y. Cabrera, Susan Conroy, Mario Cristancho, Jackson R. Richards, Michael J. Flood, Tracy Barbour, Daniel M. Blumberger, Stephan F. Taylor, David Feifel, Irving M. Reti, Shawn M. McClintock, Sarah H. Lisanby, Mustafa M. Husain, National Network of Depression Centers Neuromodulation Task Group|title=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|journal=Clinical Neurophysiology|volume=170|year=2025|pages=206–233|url=https://pdf.sciencedirectassets.com/272006/1-s2.0-S1388245724X00139/1-s2.0-S1388245724003766/main.pdf?X-Amz-Security-Token=IQoJb3JpZ2luX2VjEPv%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FwEaCXVzLWVhc3QtMSJGMEQCIErJQuoSOz3vRTDWFTXwCNMr70HCOsjR9%2B7JT73p9%2BUuAiAZtuiJjf6dMF%2BkJoDIciS1S%2FLQkFAfWir1XD0Q0fPUsSq8BQjE%2F%2F%2F%2F%2F%2F%2F%2F%2F%2F8BEAUaDDA1OTAwMzU0Njg2NSIMnLszlfDdnrK7PtEIKpAFlqOgZhfJRkPZvTf5MK%2FiQCsH1FjPGH82pridrzS5mj0v%2BxYo1q8oeUcn5vVldLEceL5N855C2cOkPPXoqdu%2B1by4KW3yErE%2B6HoLCP204AuDQJ0tpT23NT7eBoUsx90oNh6o5wHFig7527J%2BSM9nt93w06UqpfaTOxIr7zjOFH7M13YleyVgvlLZU730qDYpHRnQWJBdr%2BUzeTt%2FcUtuedqXJi7gYqm%2FSYdYrHZTl9FtRy6CkEaDDuBwQAc0pMXVORdexr3wMQ6W4rmu1ck5aiKzdasPnB%2BNjktj6xWs8X7ocSuZh9MwA2l0h%2Ba7mN7DUj5N7X95EzsL%2FFEvFZpEHM4zh2pUM26X7VoXcrX3Kc2nj0kCtMpI9APOS3tev%2BP9doRLr9iHg3yhU5%2BowT1F9cQiyNn%2F%2B4f5BN6ap2mJQUbKsKESZ%2Fi06R0Isy9Q8qU1px4brsCG63KMRhMrnsVKHz15z5xmKyIrqvfgI%2BdedAtc9D7kf4duPzJo6GaRznbLItm957Rd1xAYhhSOTj3JL0sRP%2F%2FoNgIJhKdA%2FOfLT8w0AV%2FEjU8QBrSEz2jeSf9n70m9u5TAKX1klk16Mi3gCGVdytyI8d9aCqtNmD%2FnQ8OJZ5vqtej9wxWpUYMZ7Hi064w8LK96fFmW9lC3fL9AANKKredELC2Vc6LkWa3i09zDXsjHldcCaLk3f9QrjdLazy51YyfrQX3hpacJ8cDzOl3lScIQ%2FI1nPS8GStf%2B%2Bz2EX2xLPCDRtVhuVcv2suppAUP3j7NIpAHutFT2sd1gQu7L6QUTT1tsq3SDsCe50UZuAl6XVPFneAKzbsTUYIXIaWgIkpl%2FH%2B2R0%2BvM4d6HOeE%2BITkjssi7Xq70SY0TMz0wkNzCywY6sgHL4oBFVJ0TYxrRcS7LbhpsOHM3pvy87pOPtSZoX5Pf1rnPUZW8j1WLAfJ9zNnSrmUxqk1IVR1XA4vDuHRCCvyuMwNgBY8DhH%2F4PfGIH4OSI8sx014%2FmpS6qgjChjLtAe9OTjqyeuKQ019s9%2BOEzNGD5jNRKExjhjbM4xHcqFh%2FHlT8ItV3iGwpzbCDo8rhl5njqNrYW1QpqsdQEVHQqHaOfmnbgEvm%2FM38W%2FH70FVB15Kw&X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Date=20260121T121918Z&X-Amz-SignedHeaders=host&X-Amz-Expires=300&X-Amz-Credential=ASIAQ3PHCVTYYQP3O3Y4%2F20260121%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Signature=009cc70089ae0a65c3254fddf8fd8f56b81ff4c754ecc64b3badbc81665ac486&hash=41b3d39bd97262e5111205f4a687d9c43bf9eca0aed0acf1652188eb6b12be98&host=68042c943591013ac2b2430a89b270f6af2c76d8dfd086a07176afe7c76c2c61&pii=S1388245724003766&tid=spdf-8549f056-bf93-4ead-b174-980ef368ec0a&sid=4e4c67d5688d9949ae8a6cd5ec879ab4463egxrqa&type=client&tsoh=d3d3LnNjaWVuY2VkaXJlY3QuY29t&rh=d3d3LnNjaWVuY2VkaXJlY3QuY29t&ua=0f155c00565903505b5c5d&rr=9c16c2593da2d6f9&cc=us|doi=10.1016/j.clinph.2024.12.015|pmid=39756350 |pmc=11825283 |access-date=21 January 2026|via=Science Direct}} * {{cite journal|first1=Taro|last1=Kishi|first2=Toshikazu|last2=Ikuta|first3=Kenji| last3=Sakuma|first4=Masakazu|last4=Hatano|first5=Yuki|last5=Matsuda|first6=Jonas| last6=Wilkening|first7=Roberto|last7=Goya-Maldonado|first8=Martin|last8=Tik|first9=Nolan R.|last9=Williams|first10=Shinsuke|last10=Kito|first11=Nakao|last11=Iwata|date=June 6, 2024|title=Theta burst stimulation for depression: a systematic review and network and pairwise meta-analysis|journal=Molecular Psychiatry|volume=29|issue=12 |pages=3893–3899|doi=10.1038/s41380-024-02630-5|publisher=Springer Nature|pmid=38844532 |pmc=11609094 }}</ref> rTMS had a large effect size advantage over sham for depression (Hedges's g = 0.791) in a 2023 meta-analysis.<ref name="DalhuisenvanBrownswijkBors2022">{{cite journal | vauthors = Dalhuisen I, van Bronswijk S, Bors J, Smit F, Spijker J, Tendolkar I, Ruhé HG, van Eijndhoven P |title = The association between sample and treatment characteristics and the efficacy of repetitive transcranial magnetic stimulation in depression: A meta-analysis and meta-regression of sham-controlled trials|journal=Neurosci Biobehav Rev|volume = 141|article-number = 104848|date = October 2022|url=https://pdf.sciencedirectassets.com/271127/1-s2.0-S0149763422X00092/1-s2.0-S0149763422003372/main.pdf?X-Amz-Security-Token=IQoJb3JpZ2luX2VjEH8aCXVzLWVhc3QtMSJHMEUCIQDSmmaM3XIzOkAahjY2dCZa9Oygd%2BeIny8dQ%2FFRS%2Fi04AIgKD6uE7JpYh%2F4sggGT6Ha6OR7XvBAYJ4fB4msGkZ4FXcqsgUISBAFGgwwNTkwMDM1NDY4NjUiDFwK7edpTjHrutLZDyqPBZphglJA2G1yuoOMD00TNAzMmxXjuJhn5k2MNq4KfJQ09ej%2BNZ841b0Kx1gaUnH2%2BycywoTG3y%2B8S9b3JHQaXJDJNYRWyXvPtm6%2FSqyst54SCx20Ue%2BT747y7rGjybOpOLbP8dKPWl14hAuqcaiR6f7GQUZ%2BKTakq7Wj6puAGPZstppsN8kueAUQKPhJc3A7U%2BdJFs4OYmBWo5P179Tz6t7THB7AtPnY8LhYr9TVtU%2B4Iow04qSBKeEcXbIVRaCK19tNkgUrCyoCUSwPXVGNtJS11u%2FdL7AwTgoNBlgM3uHJTYITv4sULGfqrcehe%2F12Iqw61oqZQs9CBltoIKSTRcVfAsgHhlqAYHwv7XVGLUbvamr9vYF2qhsxp2bfGfNmHLNSN%2B4VycamBGZLJnh8rDmny2hJyk0EbSvoRjNPoK2bdwripr1vERwMHmnGvvOuSZaRe0C127XgU1EEficwM8UDq%2BHkE9ZwG7jCIlT2QRePpD3yO4wXofM58bbI4fvxykU7dhWTbpW8yk3IZDw4kRtEaAofyDAXMl%2BdkqEMAscFfryDFHPZRJZKXQWRbmllONieo8pudjAf%2BQYXaeprhHvWm%2BoZbC9%2F9FPNzLI5c2sDKOc%2Buy9jknWECWdTBPTBuErxjpVM2Rpzcp6LYhQUZzDtktNCVn6ZLQtY1kNIXmqSDU%2BuZmpdGDJvLPbZO8Rlo%2FL7pCaFfFzI8hHOEHFsdmjG5hRwu5mRRV6Rei9U9WWYaSWANHVM59OZKfVO%2F%2BTp8Oj9NPkfTqKx%2FaPrVdFwbhZEtBlpNW3TEnj4tMKh%2F33%2BWcKFlSWB0SjRMnoqzfocSBAU%2F7%2BZzmEmBgRobEtONxiFSP%2BfsGoPATocxSdbYH8w0MSnywY6sQEsllnrnoPIjuh8xE1bz8BSCh4xORYn%2BKJ9uh5hFfLyxkV28akJxzSo36Xqe1sVOkWFFcgdt9uKJkgplW5TlQ8DYpzX06jcEn9QV0zwoyDimL5JUzLBB5nS8%2BMIAacIRw6XSF8bZGjF2f83eUI%2FIIecuYw25V0XxwfB3nIpqKbe7SWHvG5qaedV2C0xT1sfdEYe%2BUsDPP8OzIQPgAcQeiSX%2ByDi7XgLU1iZRP5xGiq188c%3D&X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Date=20260116T080851Z&X-Amz-SignedHeaders=host&X-Amz-Expires=300&X-Amz-Credential=ASIAQ3PHCVTY2NGMS5XA%2F20260116%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Signature=b9dde2968de4dce3155d18188cead778a332a080972ed2f4acc706db62b35fc8&hash=52f82c8073f9b7dda1ddde220911c74d8ce8716f8b41f9c84e50ea7c55c1097e&host=68042c943591013ac2b2430a89b270f6af2c76d8dfd086a07176afe7c76c2c61&pii=S0149763422003372&tid=spdf-71c06314-9abb-4634-ba22-bfc7dcf6fe82&sid=e43a3f0a61e082485679e576ed34ccd8578bgxrqa&type=client&tsoh=d3d3LnNjaWVuY2VkaXJlY3QuY29t&rh=d3d3LnNjaWVuY2VkaXJlY3QuY29t&ua=0f155c01020c5252575c57&rr=9bec20999ba7f569&cc=us| pmid = 36049675 | doi = 10.1016/j.neubiorev.2022.104848|hdl=2066/253508|hdl-access=free|via=Science Direct}}</ref>

Existing evidence suggests that rTMS, particularly targeting the dorsolateral prefrontal cortex (DLPFC) and the supplementary motor area, reduces OCD symptoms. Results for the medial prefrontal cortex and anterior cingulate cortex using deep transcranial magnetic stimulation are more variable; the overall heterogeneity of studies highlights the need for further research.<ref name=":1">{{Cite journal |last1=Kar |first1=Sujita Kumar |last2=Agrawal |first2=Aditya |last3=Silva-Dos-Santos |first3=Amílcar |last4=Gupta |first4=Yogesh |last5=Deng |first5=Zhi-De |date=2024 |title=The Efficacy of Transcranial Magnetic Stimulation in the Treatment of Obsessive-Compulsive Disorder: An Umbrella Review of Meta-Analyses |journal=CNS Spectrums |volume=29 |issue=2 |pages=109–118|doi=10.1017/S1092852923006387 |issn=1092-8529 |pmc=11524532 |pmid=38053347}}</ref>

However, the effectiveness of rTMS and the quality of evidence behind it for treatment of depression have long been questioned.<ref name=":2">Multiple sources: *{{cite journal|last1=Rodriguez-Martin|first1=JL|last2=Barbanoj|first2=JM|last3=Schlaepfer|first3=T|last4=Clos|first4=SSC|last5=Pérez|first5=V|last6=Kulisevsky|first6=J|last7=Gironel|first7=A.|title=Transcranial magnetic stimulation for treating depression|journal=Cochrane Database of Systematic Reviews|date=22 April 2002|volume=2018 |issue=2|article-number=CD003493 |id=Article No. CD003493|doi=10.1002/14651858.CD003493|pmid=12076483 |pmc=6516872 |quote=The information in this review suggests that there is no strong evidence for benefit from using transcranial magnetic stimulation to treat depression, although the small sample sizes do not exclude the possibility of benefit.}} *{{cite journal|first1=Biju|last1=Basil|first2=Jamal|last2=Mahmud|first3=Maju|last3=Mathews| first4=Carlos|last4=Rodriguez|first5=Babatunde|last5=Adetunji|title=Is There Evidence for Effectiveness of Transcranial Magnetic Stimulation in the Treatment of Psychiatric Disorders?|journal=Psychiatry (Edgmont)|date=November 2005|volume=2|issue=11|pages=64–69|pmc=2993526|pmid=21120098|quote=There have been more than 20 randomized, controlled trials investigating the efficacy of rTMS in the treatment of major depression. The most common deficiency noted is the relatively small sample sizes of these studies. The sample size varied from 6 to 70. Most of the studies used sample sizes less than 20.}} *{{cite journal|first1=Jonas Z|last1=Hines|first2=Peter|last2=Lurie|first3=Sidney M|last3=Wolfe|author3-link=Sidney M. Wolfe|title=Reply to Lisanby et al.: ''Post Hoc'' Analysis Does Not Establish Effectiveness of rTMS for Depression|url=https://www.nature.com/articles/npp200922|journal=Neuropsychopharmacol|volume=34|pages=2053–2054|year=2009|issue=8 |doi=10.1038/npp.2009.22|pmid=19528946|access-date=27 January 2026|archive-url=https://web.archive.org/web/20221124022657/https://www.nature.com/articles/npp200922|archive-date=24 November 2022|url-status=live}} *{{cite journal | vauthors = Malhi GS, Bell E, Outhred T, Singh AB, Hopwood M, Mulder R, Bassett D, Mannie Z | title = Is rTMS Ready for Primetime? | journal = Can J Psychiatry | volume = 66 | issue = 10 | pages = 873–877 | date = October 2021 | pmid = 33955792 | pmc = 8573708 | doi = 10.1177/07067437211016238}} *{{cite journal |last1=Amad|first1=A|last2=Fovet|first2=T|title=rTMS for depression: The difficult transition from research to clinical practice|journal=Aust N Z J Psychiatry|volume=56 |issue=1|pages=14–15|date=January 2022|url=https://journals.sagepub.com/doi/10.1177/00048674211011242|pmid=33982627|doi=10.1177/00048674211011242|publisher=Sage Publishing|access-date=3 February 2026|archive-url=https://web.archive.org/web/20230106120100/https://journals.sagepub.com/doi/10.1177/00048674211011242|archive-date=6 January 2023|url-status=live|url-access=subscription}} *{{cite journal | vauthors = Brini S, Brudasca NI, Hodkinson A, Kaluzinska K, Wach A, Storman D, Prokop-Dorner A, Jemioło P, Bala MM | title = Efficacy and safety of transcranial magnetic stimulation for treating major depressive disorder: An umbrella review and re-analysis of published meta-analyses of randomised controlled trials | journal=Clin Psychol Rev| volume = 100 | issue = | article-number = 102236 | date = March 2023 | pmid = 36587461 | doi = 10.1016/j.cpr.2022.102236|quote=We included 29 systematic reviews and re-analysed 15 meta-analyses. ..... Authors of all included meta-analyses interpreted findings to suggest TMS is safe and effective for MDD despite lack of comprehensive investigation of heterogeneity. Our re-analysis revealed the direction and magnitude of treatment effects vary widely across different settings. We also found high risk of bias in the majority of included systematic reviews and presence of small-study effects in some meta-analyses. Because of these reasons, we argue TMS for MDD may not be as effective and potentially less tolerated in some populations than current evidence suggests.|url =https://pdf.sciencedirectassets.com/271858/1-s2.0-S0272735822X0010X/1-s2.0-S0272735822001210/main.pdf?X-Amz-Security-Token=IQoJb3JpZ2luX2VjEID%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FwEaCXVzLWVhc3QtMSJHMEUCIQD9kP%2BvKwAqXvyLNdMWMB83ILscj%2BD%2Bq7kL99lN0oPHRQIgIpGiTEb6JYkuszpK1rYCkVWrp5kLCowkT5%2BiaiKoD4oqswUISBAFGgwwNTkwMDM1NDY4NjUiDPL97NtY26%2FJ5MIF3yqQBbgHi2gm6WP8aaDkZ30O%2FzetznO%2BreWiVKkgNiULEHax00u87nhSSC0XrEBQiR1U450WyLWCAfL82B19rQokOmHfR6ykK83OLJOjANCeOC9j3iMFZn2EOVugZRDwk6CdPE283FHy%2B44Hq%2B%2BwXSRJu18vuzw2qAZ0MiXPMgUF3VkB%2BemEy5cem3PvXBSpEeWE4qBxdvTpR91bw15pN7REgkgHvJ5hefuIAzts4cUETFEgz1kfQCX%2B4JMzuD4pyUW47Efro8d7KJbwJsPxp6DKIFNk6b0LydglKjy%2BsWxNXyYBcnb2RTFw4WHiI%2F0Om8hZBvAs05e0V0P0OFC0k9m%2B4h7jlSHfJXuSJ%2B3DqFvzXuUNesvQbRYHWp0B1PBIJy%2FXp72idYg6%2B4FRLtdP%2B4ISOamSxsXZwJvCdgVLP7PYUpgWL7a5sgnUr89X895eR4qe9RGv80TyjESeBZ7%2Fqj4uZNM7gQxcneqa5093X917Eq9NVxIeFbQTf1QA4rivAD5YRM8%2Fr9aXZo3MTgEYAL43uXsiBiuWfL3HCjpm1%2FL7paXrkRB4Jfjw%2B2HqYmp0jOvWhpfYal9crDfbV0yU8eGOJsovMErbK4q4n1x9%2FGl3TuxzAugRAkhMoEZjlvvdfZ9kkX8EcA1k63usyYRWAQyU7I43oXMCcvV7FJ7vdZ09mfIq9s3X4%2BBRAilWzrDEcfYtpq4cH4sbuE4QR9Ym4OJ%2FZ6iPeK%2Fh7qaNOdYo4ZWUkv1y3FY7hWx%2Bhq2nGMWSYDDH%2BdlPkGnAGoZg2ToIiitvbCs4tcORTNI%2BEWkg6svtgQTn1IaTC%2BYFDvl%2Bbcacpe%2BEXX8oLUEDAHNckByV370nOS48Y0T7OgHcy1%2FPHwu%2Bh%2FxHMPbKp8sGOrEBCf4Ep7gSeq44Ya2K%2BDhSTKslBgLjaxj4KGTtBGuBHu8JpJ6md%2Fk%2BOqHiPjD5WI13LQWbSCxbFpdI%2FCm1JIngqGdEnCqtS6QkinzrrHQoyfdNzNkTahZIyZoiFfRmaQu31Itc1ucjmFG85CcNJUGLltViSIEM1RgHkJ62woIrq6IkH5JigMAlKS3xiurgr%2Bhep5vhhDQ%2FMm84SGTUQm02y9oI9dfV2IumhjIaLb%2FPYzqI&X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Date=20260116T081755Z&X-Amz-SignedHeaders=host&X-Amz-Expires=300&X-Amz-Credential=ASIAQ3PHCVTY6VZI6OJB%2F20260116%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Signature=4a0a67c36064373d7b28dcec79a20d0f66ce2d1c6970ccb14e6ae4261fea2e0b&hash=d836fc3ace9426ff3d65a00d9fc351c8ece2bde826748e194e498ab3f122e144&host=68042c943591013ac2b2430a89b270f6af2c76d8dfd086a07176afe7c76c2c61&pii=S0272735822001210&tid=spdf-fb968ba5-4b95-44e3-bc31-292a6203a0de&sid=e43a3f0a61e082485679e576ed34ccd8578bgxrqa&type=client&tsoh=d3d3LnNjaWVuY2VkaXJlY3QuY29t&rh=d3d3LnNjaWVuY2VkaXJlY3QuY29t&ua=0f155c01020c52060b570a&rr=9bec2de2dd49c466&cc=us|via=Science Direct}}</ref> A 2023 re-analysis of 15 meta-analyses on TMS for major depression found that treatment effects vary widely, many reviews have a high risk of bias, and the apparent safety and efficacy of TMS may be overstated.<ref name=":3">{{Cite journal |last1=Brini |first1=S. |last2=Brudasca |first2=N. I. |last3=Hodkinson |first3=A. |last4=Kaluzinska |first4=K. |last5=Wach |first5=A. |last6=Storman |first6=D. |last7=Prokop-Dorner |first7=A. |last8=Jemioło |first8=P. |last9=Bala |first9=M. M. |date=2023 |title=Efficacy and safety of transcranial magnetic stimulation for treating major depressive disorder: An umbrella review and re-analysis of published meta-analyses of randomised controlled trials |journal=Clinical Psychology Review |volume=100 |article-number=102236 |doi=10.1016/j.cpr.2022.102236 |issn=1873-7811 |pmid=36587461}}</ref> As with antidepressants and other interventions for depression, there is a large placebo response with sham control groups in rTMS trials (Hedges's g = 0.8).<ref>{{cite journal | vauthors = Razza LB, Moffa AH, Moreno ML, Carvalho AF, Padberg F, Fregni F, Brunoni AR | title = A systematic review and meta-analysis on placebo response to repetitive transcranial magnetic stimulation for depression trials | journal = Prog Neuropsychopharmacol Biol Psychiatry | volume = 81 | issue = | pages = 105–113 | date = February 2018 | pmid = 29111404 | doi = 10.1016/j.pnpbp.2017.10.016 | url = | quote = Placebo response was large (g=0.8, 95% CI=0.65-0.95, p<0.01) regardless of the modality of intervention.}}</ref>

A 2011 review found that only 13.5% of 96 randomized control studies of rTMS to the DLPFC had reported blinding success and that, in those studies, people in real rTMS groups were significantly more likely to think that they had received real rTMS, compared with those in sham rTMS groups.<ref>{{cite journal|first1=Hannah J|last1=Broadbent|first2=Frederique|last2=van den Eynde|first3=Sebastien|last3= Guillaume|first4=Emma L|last4=Hanif|first5=Daniel|last5=Stahl|first6=Anthony S|last6= David|first7=Iain C|last7=Campbell|first8=Ulrike|last8=Schmidt|title=Blinding success of rTMS applied to the dorsolateral prefrontal cortex in randomised sham-controlled trials: a systematic review|journal=World J Biol Psychiatry|year=2011|volume=12|issue=4|pages=240–248|pmid=21426265|doi=10.3109/15622975.2010.541281|doi-access=free}}</ref> Depending on the research question asked and the experimental design, matching the discomforts of rTMS (such as muscle twitching and pain) to distinguish the true effects of treatments from those of placebos can be an important and challenging issue.<ref>{{cite journal|first1=Simone|last1=Rossi|first2=Mark|last2=Hallett|author2-link=Mark Hallett (neurologist)|first3=Paolo M.|last3= Rossini|first4=Alvaro|last4=Pascual-Leone|author4-link=Alvaro Pascual-Leone|last5=The Safety of TMS Consensus Group|year=2009|title=Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research|journal=Clin Neurophysiol|volume=120|issue=12|pages=2008–2039|pmid=19833552|doi=10.1016/j.clinph.2009.08.016|pmc=3260536 |quote=Mimicking the cutaneous sensation experienced during rTMS has been a challenging aspect of developing an optimal sham condition (see Ruohonen, et al., 2000; Lisanby, et al., 2001; Sommer et al., 2006a; Rossi et al., 2007b; Arana et al., 2008). The cutaneous sensation is caused when rTMS stimulates scalp muscles producing a twitch in the scalp or upper face that can be uncomfortable for some, painful for others.}}</ref>

Two pivotal clinical trials led to the first FDA marketing authorizations for rTMS devices indicated for use in treatment-resistant MDD in 2011 and 2013.<ref name=Stade>Multiple sources: * {{cite web|title=FDA Executive Summary: NeuroStarTM TMS System for the treatment of Major Depressive Disorder|date=26 January 2007|url=http://www.fda.gov/ohrms/dockets/ac/07/briefing/2007-4273b1_01-FDAExecutiveSummary.pdf|publisher=Food and Drug Administration|archive-url=https://web.archive.org/web/20100330043820/http://www.fda.gov/ohrms/dockets/ac/07/briefing/2007-4273b1_01-FDAExecutiveSummary.pdf|archive-date=30 March 2010}} * {{cite web|date=7 October 2008|title=Device Classification Under Section 513(f)(2)(De Novo): NeuroStar TMS System|url=https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/denovo.cfm?ID=DEN070003|publisher=Food and Drug Administration|access-date=18 January 2026|archive-url=https://web.archive.org/web/20250815132854/https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/denovo.cfm?ID=DEN070003|archive-date=15 August 2025|url-status=live}} * {{cite web|first=Jonette|last=Foy|title=Classification letter: NeuroStar TMS System|date=March 23, 2011| url=https://www.accessdata.fda.gov/cdrh_docs/pdf6/K061053.pdf|publisher=Food and Drug Administration|access-date=18 January 2026|archive-url=https://web.archive.org/web/20260116040311/https://www.accessdata.fda.gov/cdrh_docs/pdf6/K061053.pdf|archive-date=16 January 2026|url-status=live}} * {{cite journal|last=Stade|first=Nancy K.|title=Medical Devices; Neurological Devices; Classification of Repetitive Transcranial Magnetic Stimulation System: Food and Drug Administration, HHS: Final rule|url=https://www.govinfo.gov/content/pkg/FR-2011-07-26/pdf/2011-18806.pdf|journal=Federal Register|volume=76|issue=143|pages=44489–44491|date=26 July 2011|id=FR Doc. 2011-18806|access-date=18 Jan 2026|archive-url=https://web.archive.org/web/20250213030832/https://www.govinfo.gov/content/pkg/FR-2011-07-26/pdf/2011-18806.pdf|archive-date=13 February 2025|url-status=live|quote=On May 23, 2007, Neuronetics, Inc., submitted a petition requesting classification, under section 513(f)(2) of the FD&C Act, of the NeuroStar® TMS System for the treatment of major depressive disorder in patients who have failed to receive benefit from one antidepressant trial. The manufacturer recommended that the device be classified into class II}} * {{cite web|title=Repetitive Transcranial Magnetic Stimulation (rTMS) Systems - Class II Special Controls Guidance for Industry and FDA Staff|date=26 July 2011|publisher=Food and Drug Administration|url=https://www.fda.gov/medical-devices/guidance-documents-medical-devices-and-radiation-emitting-products/repetitive-transcranial-magnetic-stimulation-rtms-systems-class-ii-special-controls-guidance|access-date=19 January 2016|archive-url=https://web.archive.org/web/20251214133305/https://www.fda.gov/medical-devices/guidance-documents-medical-devices-and-radiation-emitting-products/repetitive-transcranial-magnetic-stimulation-rtms-systems-class-ii-special-controls-guidance|archive-date=14 December 2025|url-status=live}} * {{cite web|title=Product Classification: Transcranial Magnetic Stimulator|url=https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpcd/classification.cfm?id=4081|publisher=Food and Drug Administration|access-date=18 January 2026}}</ref><ref name=Brainsway>Multiple sources: * {{cite web|title=510(k) Premarket Notification: Brainsway Deep TMS System|date=7 January 2013|url=https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=k122288|publisher=Food and Drug Administration|access-date=18 January 2026|archive-url=https://web.archive.org/web/20250225143927/https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=k122288|archive-date=25 February 2025|url-status=live}} * {{cite web|date=7 January 2013|title=510(K) Summary: Brainsway Deep TMS System|url=https://www.accessdata.fda.gov/CDRH510K/K122288.pdf|publisher=Food and Drug Administration|access-date=18 January 2026|archive-url=https://web.archive.org/web/20230606214003/https://www.accessdata.fda.gov/CDRH510K/K122288.pdf|archive-date=6 June 2023|url-status=live}} * {{cite web|title=Repetitive Transcranial Magnetic Stimulation (rTMS) Systems - Class II Special Controls Guidance for Industry and FDA Staff|date=26 July 2011|publisher=Food and Drug Administration|url=https://www.fda.gov/medical-devices/guidance-documents-medical-devices-and-radiation-emitting-products/repetitive-transcranial-magnetic-stimulation-rtms-systems-class-ii-special-controls-guidance|access-date=19 January 2016|archive-url=https://web.archive.org/web/20251214133305/https://www.fda.gov/medical-devices/guidance-documents-medical-devices-and-radiation-emitting-products/repetitive-transcranial-magnetic-stimulation-rtms-systems-class-ii-special-controls-guidance|archive-date=14 December 2025|url-status=live}} * {{cite web|title=Product Classification: Transcranial Magnetic Stimulator|url=https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpcd/classification.cfm?id=4081|publisher=Food and Drug Administration|access-date=18 January 2026}}</ref> While the results of both trials reportedly had statistical significance at 6{{nbsp}}weeks post-treatment, interventions outperformed sham by means of only 2 to 3{{nbsp}}points on the 60-point Montgomery–Åsberg Depression Rating Scale (MADRS).<ref name="O'ReardonSolvasonJanicak2007">Multiple sources: * {{cite web|title=FDA Executive Summary: NeuroStarTM TMS System for the treatment of Major Depressive Disorder|date=26 January 2007|url=http://www.fda.gov/ohrms/dockets/ac/07/briefing/2007-4273b1_01-FDAExecutiveSummary.pdf|publisher=Food and Drug Administration|archive-url=https://web.archive.org/web/20100330043820/http://www.fda.gov/ohrms/dockets/ac/07/briefing/2007-4273b1_01-FDAExecutiveSummary.pdf|archive-date=30 March 2010}} * {{cite web|author=Cigna|archive-url=https://web.archive.org/web/20170204194830/https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0383_coveragepositioncriteria_transcranial_magnetic_stimulation.pdf|archive-date=2017-02-04|url=http://www.cigna.com/assets/docs/health-care-professionals/coverage_positions/mm_0383_coveragepositioncriteria_transcranial_magnetic_stimulation.pdf|title=Cigna Medical Coverage Policy: Transcranial Magnetic Stimulation|date=2013-01-15|work=Coverage Policy Number 0383|publisher=Cigna|access-date=2013-12-11|author-link = Cigna}} * {{cite journal|last1=O'Reardon|first1=JP|last2=Solvason|first2=HB|last3=Janicak|first3=PG|last4=Sampson|first4=S|last5=Isenberg|first5=KE|last6=Nahas|first6=Z|last7=McDonald|first7=WM|last8=Avery|first8=D|last9=Fitzgerald|first9=PB|last10=Loo|first10=C|last11= Demitrack|first11=MA|last12=George|first12=MS|author12-link=Mark S. George|last13=Sackeim|first13=HA|author13-link=Harold A. Sackeim|title=Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial|journal=Biol Psychiatry|volume=62|issue=11|pages=1208–1216|date=December 2007|pmid = 17573044|doi=10.1016/j.biopsych.2007.01.018}} * {{cite journal|first1=Sarah H|last1=Lisanby|author1-link=Sarah Lisanby|first2=Mustafa M| last2=Husain|first3=Peter B|last3=Rosenquist|first4=Daniel|last4=Maixner|first5=Rosben|last5=Gutierrez|first6=Andrew|last6=Krystal|first7=William|last7=Gilmer|first8=Lauren B|last8=Marangell|first9=Scott|last9=Aaronson|first10=Zafiris J|last10=Daskalakis|first11=Randolph|last11=Canterbury|first12=Elliott|last12= Richelson|first13=Harold A|last13=Sackeim|author13-link=Harold A. Sackeim|first14=Mark S|last14=George|author14-link=Mark S. George|title=Daily Left Prefrontal Repetitive Transcranial Magnetic Stimulation in the Acute Treatment of Major Depression: Clinical Predictors of Outcome in a Multisite, Randomized Controlled Clinical Trial|url=https://www.nature.com/articles/npp2008118|journal=Neuropsychopharmacol|volume=34|pages=522–534|year=2009|issue=2 |doi=10.1038/npp.2008.118|pmid=18704101|access-date=27 January 2026}} * {{cite journal|first1=Jonas Z|last1=Hines|first2=Peter|last2=Lurie|first3=Sidney M |last3=Wolfe|author3-link=Sidney M. Wolfe|title=Reply to Lisanby et al.: ''Post Hoc'' Analysis Does Not Establish Effectiveness of rTMS for Depression|url=https://www.nature.com/articles/npp200922|journal=Neuropsychopharmacol|volume=34|pages=2053–2054|year=2009|issue=8 |doi=10.1038/npp.2009.22|pmid=19528946|access-date=27 January 2026|archive-url=https://web.archive.org/web/20221124022657/https://www.nature.com/articles/npp200922|archive-date=24 November 2022|url-status=live|quote=Lisanby, however, states that the published trial showed 'TMS to be safe and efficacious' (Lisanby et al, 2009). This is misleading. In the trial (O'Reardon et al, 2007), the difference between treatment arms was both statistically and clinically non-significant (p=0.057, 1.7 points on the 60-point Montgomery Asberg Depression Rating Scale) for the primary outcome (change in Montgomery Asberg Depression Rating Scale at 4 weeks). This finding only became statistically significant (p=0.038) after the post hoc exclusion of six patients even though they had met a priori inclusion criteria, an obviously inappropriate statistical maneuver.}} * {{cite journal|last1=George|first1=MS|author1-link=Mark S. George|last2=Lisanby|first2=SH|author2-link=Sarah Lisanby|last3=Avery|first3=D|last4=McDonald|first4= WM|last5=Durkalski|first5=V|last6=Pavlicova|first6=M|last7=Anderson|first7=B|last8= Nahas|first8=Z|last9=Bulow|first9=P|last10=Zarkowski|first10=P|last11=Holtzheimer|first11=PE|last12=Schwartz|first12=T|last13=Sackeim|first13=HA|author13-link=Harold A. Sackeim|date=May 2010|title=Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: a sham-controlled randomized trial|journal=Arch Gen Psychiatry|volume=67|issue=5|pages=507–516|pmid=20439832|doi =10.1001/archgenpsychiatry.2010.46|url=https://jamanetwork.com/journals/jamapsychiatry/fullarticle/210744|access-date=20 January 2026|archive-url=https://web.archive.org/web/20220409185948/https://jamanetwork.com/journals/jamapsychiatry/fullarticle/210744|archive-date=9 April 2022|url-status=live|url-access=subscription}} </ref> In the primary outcome measure for the second such trial, there were only 18 remitters (9.5% of the intention-to-treat population): 14.1% in the active treatment arm and 5.1% in the sham treatment arm. The odds ratio for the remitters was 4.2; 95% confidence interval, 1.32-13.24; p = .02. The number needed to treat (the average number of patients who need to be treated to prevent one additional bad outcome) was 12.<ref>{{cite journal |last1=George|first1=MS|author1-link=Mark S. George|last2=Lisanby|first2=SH|author2-link=Sarah Lisanby|last3=Avery|first3=D|last4=McDonald|first4= WM|last5=Durkalski|first5=V|last6=Pavlicova|first6=M|last7=Anderson|first7=B|last8= Nahas|first8=Z|last9=Bulow|first9=P|last10=Zarkowski|first10=P|last11=Holtzheimer|first11=PE|last12=Schwartz|first12=T|last13=Sackeim|first13=HA|author13-link=Harold A. Sackeim|title = Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: a sham-controlled randomized trial | journal = Arch Gen Psychiatry| volume = 67|issue=5|pages = 507–516 |date = May 2010 | pmid = 20439832 | doi =10.1001/archgenpsychiatry.2010.46|url=https://jamanetwork.com/journals/jamapsychiatry/fullarticle/210744|archive-url=https://web.archive.org/web/20220409185948/https://jamanetwork.com/journals/jamapsychiatry/fullarticle/210744|access-date=20 January 2026|archive-date=9 April 2022|url-status=live|url-access=subscription}}</ref>

== Adverse effects == TMS is generally advertised as a safe alternative to medications such as SSRI's. The greatest immediate risk from TMS is fainting, though this is uncommon. Seizures have been reported, but are rare.<ref name = Rossi /><ref>Multiple sources: * {{cite journal | vauthors = Dobek CE, Blumberger DM, Downar J, Daskalakis ZJ, Vila-Rodriguez F | title = Risk of seizures in transcranial magnetic stimulation: a clinical review to inform consent process focused on bupropion | journal = Neuropsychiatric Disease and Treatment | volume = 11 | pages = 2975–87 | date = 2015 | pmid = 26664122 | pmc = 4670017 | doi = 10.2147/NDT.S91126 | doi-access = free }} * {{cite book| vauthors = Fitzgerald PB, Daskalakis ZJ |chapter-url=https://books.google.com/books?id=2VFEAAAAQBAJ |title=Repetitive Transcranial Magnetic Stimulation for Depressive Disorders|chapter=7. rTMS-Associated Adverse Events|pages=81–90 |publisher=Springer |year=2013|doi=10.1007/978-3-642-36467-9_7 |isbn=978-3-642-36466-2}}</ref>

Risks are higher for therapeutic rTMS than for single or paired diagnostic TMS.<ref>{{cite journal |vauthors=van den Noort M, Lim S, Bosch P |date=December 2014 |title=Recognizing the risks of brain stimulation |url=https://hwscenter.com/how-successful-is-tms-therapy-for-depression-your-full-guide-2025/ |journal=Science |volume=346 |issue=6215 |page=1307 |doi=10.1126/science.346.6215.1307-a |pmid=25504707 |hdl-access=free |hdl=2066/133976}}</ref> Adverse effects generally increase with higher frequency stimulation.<ref name = Rossi />

==Procedure== During the procedure, a magnetic coil is positioned at the head of the person receiving the treatment using anatomical landmarks on the skull, in particular the inion and nasion.<ref name=":0">{{cite journal |vauthors = Nauczyciel C, Hellier P, Morandi X, Blestel S, Drapier D, Ferre JC, Barillot C, Millet B |display-authors = 6 |title = Assessment of standard coil positioning in transcranial magnetic stimulation in depression |journal = Psychiatry Research |volume = 186 |issue = 2–3 |pages = 232–8 |date = April 2011 |pmid = 20692709 |doi = 10.1016/j.psychres.2010.06.012 |s2cid = 25100990 }}</ref> The coil is then connected to a pulse generator, or stimulator, that delivers electric current to the coil.<ref name=Harvard />

== Physics == {{Main|Electromagnetic induction}} right|150px right|thumb|240px|TMS – butterfly coils TMS uses electromagnetic induction to generate an electric current across the scalp and skull.<ref>Multiple sources: * {{cite journal|first=Reza|last=Jalinous|journal=J Clin Neurophysiol|date=January 1991|title=Technical and practical aspects of magnetic nerve stimulation|url=https://ptacts.uspto.gov/ptacts/public-informations/petitions/1549026/download-documents?artifactId=wymIy7CT78AQEOWXJk_4SQjf5xSn52ZHYl3_o60-pGjUcGCAIF1dS_M|volume=8|issue=1|pages=10–25|doi=10.1097/00004691-199101000-00004|pmid=2019644|access-date=30 January 2026|archive-url=https://web.archive.org/web/20260130214326/https://ptacts.uspto.gov/ptacts/public-informations/petitions/1549026/download-documents?artifactId=wymIy7CT78AQEOWXJk_4SQjf5xSn52ZHYl3_o60-pGjUcGCAIF1dS_M|archive-date=30 January 2026|url-status=live|via=Patent Trial and Appeal Case Tracking System|url-access=subscription}} * {{cite journal |last1=Cavaleri|first1=R|last2=Schabrun|first2=SM|last3=Chipchase|first3=LS|title=The number of stimuli required to reliably assess corticomotor excitability and primary motor cortical representations using transcranial magnetic stimulation (TMS): a systematic review and meta-analysis|journal=Systematic Reviews|volume=6|issue=1|article-number=48|date=March 2017|pmid=28264713|pmc=5340029 |doi=10.1186/s13643-017-0440-8|doi-access=free}} </ref><ref name="NIMH">{{cite web|title=Brain Stimulation Therapies|url=https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies|website=National Institute of Mental Health, National Institutes of Health, United States Department of Health and Human Services|access-date=31 January 2026|archive-url=https://web.archive.org/web/20251215144829/https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies|archive-date=15 December 2025|url-status=live}}</ref> A plastic-enclosed coil of wire is held next to the skull and when activated, produces a varying magnetic field oriented orthogonally to the plane of the coil. The changing magnetic field then induces an electric current in the brain that activates nearby nerve cells in a manner similar to a current applied superficially at the cortical surface.<ref>{{cite book |title=Handbook of psychophysiology |year=2007 |publisher=Cambridge University Press |isbn=978-0-521-84471-0 |edition=3rd | veditors = Cacioppo JT, Tassinary LG, Berntson GG |page=121 |doi=10.1017/CBO9780511546396}}</ref>

The magnetic field is about the same strength as magnetic resonance imaging (MRI), and the pulse generally reaches no more than 5 centimeters into the brain unless using a modified coil and technique for deeper stimulation.<ref name="NIMH"/>

Transcranial magnetic stimulation is achieved by quickly discharging current from a large capacitor into a coil to produce pulsed magnetic fields between 2 and 3 teslas in strength.<ref name=Walsh>{{cite book |first1=V. |last1=Walsh |first2=A.|last2=Pascual-Leone|author2-link=Alvaro Pascual-Leone|title=Transcranial Magnetic Stimulation: A Neurochronometrics of Mind |publisher=MIT Press|location=Cambridge, MA|date=2003|isbn=978-0-262-28573-5|oclc=53889320 |doi=10.7551/mitpress/6896.001.0001}}</ref> Directing the magnetic field pulse at a targeted area in the brain causes a localized electrical current which can then either depolarize or hyperpolarize neurons at that site. The induced electric field inside the brain tissue causes a change in transmembrane potentials resulting in depolarization or hyperpolarization of neurons, causing them to be more or less excitable, respectively.<ref name=Walsh />

TMS usually stimulates to a depth from 2 to 4&nbsp;cm below the surface, depending on the coil and intensity used. Consequently, only superficial brain areas can be affected.<ref>{{cite journal |vauthors=Lefaucheur JP, André-Obadia N, Antal A, Ayache SS, Baeken C, Benninger DH, Cantello RM, Cincotta M, de Carvalho M, De Ridder D, Devanne H, Di Lazzaro V, Filipović SR, Hummel FC, Jääskeläinen SK, Kimiskidis VK, Koch G, Langguth B, Nyffeler T, Oliviero A, Padberg F, Poulet E, Rossi S, Rossini PM, Rothwell JC, Schönfeldt-Lecuona C, Siebner HR, Slotema CW, Stagg CJ, Valls-Sole J, Ziemann U, Paulus W, Garcia-Larrea L |title=Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS) |journal=Clin Neurophysiol |volume=125 |issue=11 |pages=2150–2206 |date=November 2014 |pmid=25034472 |doi=10.1016/j.clinph.2014.05.021 |url=https://hal.archives-ouvertes.fr/hal-03183867/file/S1388245719312799.pdf }}</ref> Deep TMS can reach up to 6&nbsp;cm into the brain to stimulate deeper layers of the motor cortex, such as that which controls leg motion. The path of this current can be difficult to model because the brain is irregularly shaped with variable internal density and water content, leading to a nonuniform magnetic field strength and conduction throughout its tissues.<ref>Multiple sources: * {{cite journal | vauthors = Zangen A, Roth Y, Voller B, Hallett M | title = Transcranial magnetic stimulation of deep brain regions: evidence for efficacy of the H-coil | journal = Clinical Neurophysiology | volume = 116 | issue = 4 | pages = 775–779 | date = April 2005|access-date=1 February 2026|url=https://www.sciencedirect.com/science/article/abs/pii/S1388245704004250 |archive-url=https://web.archive.org/web/20240427103216/https://www.sciencedirect.com/science/article/abs/pii/S1388245704004250|archive-date=27 April 2024|url-status=live|pmid = 15792886 | doi = 10.1016/j.clinph.2004.11.008 | s2cid = 25101101|via=Science Direct| url-access = subscription }} * {{cite journal |vauthors = Huang YZ, Sommer M, Thickbroom G, Hamada M, Pascual-Leone A, Paulus W, Classen J, Peterchev AV, Zangen A, Ugawa Y | display-authors = 6 | title = Consensus: New methodologies for brain stimulation | journal = Brain Stimulation | volume = 2 | issue = 1 | pages = 2–13| date = January 2009 | pmid = 20633398 | pmc = 5507351 | doi = 10.1016/j.brs.2008.09.007}}</ref>

===Frequency and duration=== The effects of TMS can be divided based on frequency, duration and intensity (amplitude) of stimulation:<ref>{{cite journal | vauthors = Rubens MT, Zanto TP | title = Parameterization of transcranial magnetic stimulation | journal = Journal of Neurophysiology | volume = 107 | issue = 5 | pages = 1257–9 | date = March 2012 | pmid = 22072509 | pmc = 3311692 | doi = 10.1152/jn.00716.2011 }}</ref> * Single or paired pulse TMS causes neurons in the neocortex under the site of stimulation to depolarize and discharge an action potential. If used in the primary motor cortex, it produces muscle activity referred to as a motor evoked potential (MEP) which can be recorded on electromyography (EMG). If used on the occipital cortex, 'phosphenes' (flashes of light) might be perceived by the subject. In most other areas of the cortex, there is no conscious effect, but behavior may be altered (e.g., slower reaction time on a cognitive task), or changes in brain activity may be detected using diagnostic equipment.<ref name="Handbook of Transcranial Magnetic Stimulation">{{cite book|last1=Pascual-Leone|first1=A|author1-link=Alvaro Pascual-Leone|last2=Davey|first2=N|last3=Rothwell|first3=J|last4=Wassermann|first4=EM|last5=Puri|first5=BK| year = 2002 | title = Handbook of Transcranial Magnetic Stimulation | publisher = Edward Arnold|location=London | isbn = 978-0-340-72009-7 |oclc=47824021 }}</ref> * rTMS produces longer-lasting effects that persist past the period of stimulation. rTMS can increase or decrease the excitability of the corticospinal tract depending on the intensity of stimulation, coil orientation, and frequency. Low frequency rTMS with a stimulus frequency less than 1&nbsp;Hz is believed to inhibit cortical firing, while a stimulus frequency greater than 1&nbsp;Hz, referred to as high frequency, is believed to provoke it.<ref name="ReferenceA">{{cite journal | vauthors = Cusin C, Dougherty DD | title = Somatic therapies for treatment-resistant depression: ECT, TMS, VNS, DBS | journal = Biology of Mood & Anxiety Disorders | volume = 2 | issue = 1 | article-number = 14 | date = August 2012 | pmid = 22901565 | pmc = 3514332 | doi = 10.1186/2045-5380-2-14 | doi-access = free }}</ref> Though its mechanism is not clear, it has been suggested as being due to a change in synaptic efficacy related to long-term potentiation (LTP) and long-term depression like plasticity (LTD-like plasticity).<ref name=Fitzgerald>{{cite journal | vauthors = Fitzgerald PB, Fountain S, Daskalakis ZJ | title = A comprehensive review of the effects of rTMS on motor cortical excitability and inhibition | journal = Clinical Neurophysiology | volume = 117 | issue = 12 | pages = 2584–96 | date = December 2006 | pmid = 16890483 | doi = 10.1016/j.clinph.2006.06.712 | s2cid = 31458874 }}</ref><ref>{{cite journal |vauthors=Baur D, Galevska D, Hussain S, Cohen LG, Ziemann U, Zrenner C |title=Induction of LTD-like corticospinal plasticity by low-frequency rTMS depends on pre-stimulus phase of sensorimotor μ-rhythm |journal=Brain Stimul |volume=13 |issue=6 |pages=1580–7 |date=2020 |pmid=32949780 |pmc=7710977 |doi=10.1016/j.brs.2020.09.005 }}</ref>

=== Coil types === Most devices use a coil shaped like a figure-eight to deliver a shallow magnetic field that affects more superficial neurons in the brain.<ref name=pmid22559998>{{cite journal |last1=Bersani |first1=F.S. |last2=Minichino |first2=A. |last3=Enticott |first3=P.G. |last4=Mazzarini |first4=L. |last5=Khan |first5=N. |last6=Antonacci |first6=G. |last7=Raccah |first7=R.N. |last8=Salviati |first8=M. |last9=Delle Chiaie |first9=R. |last10=Bersani |first10=G. |last11=Fitzgerald |first11=P.B. |last12=Biondi |first12=M. |title=Deep transcranial magnetic stimulation as a treatment for psychiatric disorders: A comprehensive review |journal=European Psychiatry |date=January 2013 |volume=28 |issue=1 |pages=30–39 |doi=10.1016/j.eurpsy.2012.02.006 |pmid=22559998 |s2cid=29053871 }}</ref> Differences in magnetic coil design are considered when comparing results, with important elements including the type of material, geometry and specific characteristics of the associated magnetic pulse.

The core material may be either a magnetically inert substrate ('air core'), or a solid, ferromagnetically active material ('solid core'). Solid cores result in more efficient transfer of electrical energy to a magnetic field and reduce energy loss to heat, and so can be operated with the higher volume of therapy protocols without interruption due to overheating. Varying the geometric shape of the coil itself can cause variations in focality, shape, and depth of penetration. Differences in coil material and its power supply also affect magnetic pulse width and duration.<ref>{{cite book |title=Oxford Handbook of Transcranial Stimulation |veditors=Wassermann EM, Epstein CM, Ziemann U, Walsh V, Paus T, Lisanby SH |chapter=TMS Stimulator Design | vauthors = Riehl M |year=2008 |publisher=Oxford University Press |location=Oxford |isbn=978-0-19-856892-6 |chapter-url=https://books.google.com/books?id=YeKleGrKwC4C&pg=PA13 |pages=13–23, [https://books.google.com/books?id=YeKleGrKwC4C&pg=PA25 25–32] |doi=10.1093/oxfordhb/9780198568926.013.0003 }}</ref>

A number of different types of coils exist, each of which produce different magnetic fields. The round coil is the original used in TMS. Later, the figure-eight (butterfly) coil was developed to provide a more focal pattern of activation in the brain, and the four-leaf coil for focal stimulation of peripheral nerves. The double-cone coil conforms more to the shape of the head.<ref name=roth2>{{cite journal | vauthors = Roth BJ, Maccabee PJ, Eberle LP, Amassian VE, Hallett M, Cadwell J, Anselmi GD, Tatarian GT | display-authors = 6 | title = In vitro evaluation of a 4-leaf coil design for magnetic stimulation of peripheral nerve | journal = Electroencephalography and Clinical Neurophysiology | volume = 93 | issue = 1 | pages = 68–74 | date = February 1994 | pmid = 7511524 | doi = 10.1016/0168-5597(94)90093-0 }}</ref> The Hesed (H-core), circular crown and double cone coils allow more widespread activation and a deeper magnetic penetration. They are supposed to impact deeper areas in the motor cortex and cerebellum controlling the legs and pelvic floor, for example, though the increased depth comes at the cost of a less focused magnetic pulse.<ref name = Rossi />

== Research directions == TMS is oftentimes combined with electroencephalography (EEG) to assess functional connectivity.<ref>{{Cite book |url=https://academic.oup.com/edited-volume/35468 |title=The Oxford Handbook of Transcranial Stimulation |date=2021-02-10 |publisher=Oxford University Press |isbn=978-0-19-883225-6 |editor-last=Wassermann |editor-first=Eric M.|doi=10.1093/oxfordhb/9780198832256.001.0001 |editor-last2=Peterchev |editor-first2=Angel V. |editor-last3=Ziemann |editor-first3=Ulf |editor-last4=Lisanby|editor-first4=Sarah H.|editor-last5=Siebner |editor-first5=Hartwig R. |editor-last6=Walsh |editor-first6=Vincent}}</ref> Low-profile electrodes have been developed for concurrent TMS–EEG in order to reduce mechanical coupling and maintain stable contact during stimulation; one example is the ultra-flat TMS–EEG electrode g.Ladybird, developed by g.tec medical engineering GmbH, an Austria-based neurotechnology company.<ref>{{cite web |title=g.Ladybird active EEG electrodes for TMS |publisher=g.tec medical engineering GmbH |url=https://www.gtec.at/product/g-ladybird-active-eeg-electrodes-for-tms/ |access-date=2026-01-08}}</ref>

For Parkinson's disease, early results suggest that low frequency stimulation may have an effect on medication associated dyskinesia, and that high frequency stimulation improves motor function.<ref>Multiple sources: * {{cite journal | vauthors = Machado S, Bittencourt J, Minc D, Portella CE, Velasques B, Cunha M, Budde H, Basile LF, Chadi G, Cagy M, Piedade R, Riberio P | display-authors = 6 | title = Therapeutic applications of repetitive transcranial magnetic stimulation in clinical neurorehabilitation | journal = Functional Neurology | volume = 23 | issue = 3 | pages = 113–122 | date = 2008 | pmid = 19152730 }} * {{Cite journal |last1=Liu |first1=Xuan |last2=Li |first2=Lei |last3=Liu |first3=Ye |date=2023-09-29 |title=Comparative motor effectiveness of non-invasive brain stimulation techniques in patients with Parkinson's disease: A network meta-analysis |journal=Medicine |volume=102 |issue=39 |article-number=e34960 |doi=10.1097/MD.0000000000034960 |issn=1536-5964 |pmid=37773851|pmc=10545289 }}</ref>

The cerebellar cortex as a possible target of TMS has been investigated in combination with EMG, and a reduction in the average amplitude of motor-evoked-potentials in small hand muscles has been observed when comparing paired-pulse TMS with a 6-8 ms interstimulus interval between cerebellar TMS and TMS to the primary motor cortex with single-pulse TMS to the primary motor cortex - a phenomenon termed cerebellum brain inhibition (CBI).<ref>{{Cite journal |last1=Ugawa |first1=Yoshikazu |last2=Uesaka |first2=Yoshikazu |last3=Terao |first3=Yasuo |last4=Hanajima |first4=Ritsuko |last5=Kanazawa |first5=Ichiro |date=1995 |title=Magnetic stimulation over the cerebellum in humans |url=https://onlinelibrary.wiley.com/doi/10.1002/ana.410370603 |journal=Annals of Neurology |language=en |volume=37 |issue=6 |pages=703–713 |doi=10.1002/ana.410370603 |pmid=7778843 |issn=1531-8249|url-access=subscription }}</ref><ref>{{Cite journal |last1=Fernandez |first1=Lara |last2=Major |first2=Brendan P. |last3=Teo |first3=Wei-Peng |last4=Byrne |first4=Linda K. |last5=Enticott |first5=Peter G. |date=2018-03-01 |title=Assessing cerebellar brain inhibition (CBI) via transcranial magnetic stimulation (TMS): A systematic review |url=https://linkinghub.elsevier.com/retrieve/pii/S014976341730698X |journal=Neuroscience & Biobehavioral Reviews |volume=86 |pages=176–206 |doi=10.1016/j.neubiorev.2017.11.018 |pmid=29208533 |issn=0149-7634|url-access=subscription }}</ref> Recent investigations have built upon this phenomenon to investigate the feasibility of combining EEG with cerebellar TMS to find signatures of the cerebellum-to-cerebrum functional connectivity in high temporal resultion.<ref>{{Cite journal|last1=Fernandez|first1=Lara|last2=Biabani|first2=Mana|last3=Do |first3=Michael|last4=Opie|first4=George M.|last5=Hill|first5=Aron T.|last6=Barham|first6=Michael P.|last7=Teo|first7=Wei-Peng|last8=Byrne|first8=Linda K.|last9=Rogasch|first9=Nigel C.|last10=Enticott|first10=Peter G.|date=1 May 2021|title=Assessing cerebellar-cortical connectivity using concurrent TMS-EEG: a feasibility study |url=https://journals.physiology.org/doi/10.1152/jn.00617.2020 |journal=Journal of Neurophysiology |language=en |volume=125 |issue=5 |pages=1768–1787 |doi=10.1152/jn.00617.2020 |pmid=33788622 |issn=0022-3077|url-access=subscription }}</ref> By applying control conditions accounting for multisensory input and concomitant occipital cortex stimulation, and confirming effective cerebellar TMS by assessing CBI beforehand and modelling the induced electric field, EEG signatures of cerebellar TMS were proposed - as they may be utilized as therapeutic biomarkers to test pharmacotherapy efficacy in spinocerebellar ataxia in the future.<ref>Multiple sources: * {{Cite journal |last1=Gassmann |first1=Lukas |last2=Gordon |first2=Pedro Caldana |last3=Ziemann |first3=Ulf |date=November 2022 |title=Assessing effective connectivity of the cerebellum with cerebral cortex using TMS-EEG |journal=Brain Stimulation |language=en |volume=15 |issue=6 |pages=1354–1369 |doi=10.1016/j.brs.2022.09.013|pmid=36180039 |doi-access=free }} * {{Cite journal |last1=Gaßmann |first1=Lukas |last2=Gordon |first2=Pedro Caldana |last3=Ziemann |first3=Ulf |date=November 2023 |title=Reflecting the causes of variability of EEG responses elicited by cerebellar TMS |journal=NeuroImage |language=en |volume=281 |article-number=120368 |doi=10.1016/j.neuroimage.2023.120368|pmid=37696424 |doi-access=free }}</ref><ref>{{Cite journal |last1=Gassmann |first1=Lukas |last2=Gordon |first2=Pedro Caldana |last3=Roy |first3=Olivier |last4=Kaut |first4=Oliver |last5=Hömberg |first5=Volker |last6=Ziemann |first6=Ulf |date=August 2023 |title=Cerebellar TMS-EEG in a chronic stroke patient with connectional diaschisis of the dentato-thalamo-cortical tract |url=https://linkinghub.elsevier.com/retrieve/pii/S1388245723006284 |journal=Clinical Neurophysiology |language=en |volume=152 |pages=68–70 |doi=10.1016/j.clinph.2023.05.009|pmid=37329656 |url-access=subscription }}</ref><ref>{{Cite journal |last1=Fong |first1=Po-Yu |last2=Spampinato |first2=Danny |last3=Michell |first3=Kevin |last4=Mancuso |first4=Marco |last5=Brown |first5=Katlyn |last6=Ibáñez |first6=Jaime |last7=Santo |first7=Alessandro Di |last8=Latorre |first8=Anna |last9=Bhatia |first9=Kailash |last10=Rothwell |first10=John C |last11=Rocchi |first11=Lorenzo |date=July 2023 |title=EEG responses induced by cerebellar TMS at rest and during visuomotor adaptation |url=https://linkinghub.elsevier.com/retrieve/pii/S1053811923003397 |journal=NeuroImage |language=en |volume=275 |article-number=120188 |doi=10.1016/j.neuroimage.2023.120188|pmid=37230209 |hdl=11584/367083 |hdl-access=free }}</ref> However, these EEG signatures are still openly debated in the field of Brain Stimulation due to their inconsistency - likely, differing stimulation targets due to the lack of neuronavigation in these studies explain these discrepancies in results.<ref>Multiple sources: * {{Cite journal |last1=Fong |first1=Po-Yu |last2=Rothwell |first2=John C. |last3=Rocchi |first3=Lorenzo |date=2024-04-26 |title=The Past, Current and Future Research in Cerebellar TMS Evoked Responses—A Narrative Review |journal=Brain Sciences |language=en |volume=14 |issue=5 |page=432 |doi=10.3390/brainsci14050432 |doi-access=free |issn=2076-3425 |pmc=11118133 |pmid=38790411}} * {{Cite journal |last1=Gaßmann |first1=Lukas |last2=Gordon |first2=Pedro Caldana |last3=Ziemann |first3=Ulf |date=November 2023 |title=Reflecting the causes of variability of EEG responses elicited by cerebellar TMS |journal=NeuroImage |language=en |volume=281 |article-number=120368 |doi=10.1016/j.neuroimage.2023.120368|pmid=37696424 |doi-access=free }}</ref>

== History == Luigi Galvani (1737–1798) undertook research on the effects of electricity on the body in the late-eighteenth century and laid the foundations for the field of electrophysiology.<ref name=Horvath>{{cite journal | vauthors = Horvath JC, Perez JM, Forrow L, Fregni F, Pascual-Leone A | title = Transcranial magnetic stimulation: a historical evaluation and future prognosis of therapeutically relevant ethical concerns | journal = Journal of Medical Ethics | volume = 37 | issue = 3 | pages = 137–143 | date = March 2011|url=http://www.tmslab.org/publications/017.pdf | pmid = 21106996 | doi = 10.1136/jme.2010.039966 | jstor = 23034661 | s2cid = 13262044|access-date=1 February 2026|archive-url=https://web.archive.org/web/20251012044657/http://www.tmslab.org/publications/017.pdf|archive-date=12 October 2025|url-status=live}}</ref> In the 1830s, Michael Faraday (1791–1867) discovered that an electrical current had a corresponding magnetic field, and that changing one could induce its counterpart.<ref name=Nooh>{{cite journal | vauthors = Noohi S, Amirsalari S | title = History, Studies and Specific Uses of Repetitive Transcranial Magnetic Stimulation (rTMS) in Treating Epilepsy|journal = Iranian Journal of Child Neurology|volume=10|issue= 1|pages=1–8|date=2016|pmid = 27057180|pmc = 4815479}}</ref>

Work to directly stimulate the human brain with electricity started in the late 1800s, and by the 1930s the Italian physicians Cerletti and Bini had developed electroconvulsive therapy (ECT).<ref name=Horvath/> ECT became widely used to treat mental illness, and ultimately overused, as it began to be seen as a panacea. This led to a backlash in the 1970s.<ref name=Horvath/>

In 1980, Merton and Morton successfully used transcranial electrical stimulation (TES) to stimulate the motor cortex. However, this process was very uncomfortable, and subsequently Anthony T. Barker began to search for an alternative to TES.<ref>{{cite journal|last1=Klomjai|first1=W |last2=Katz|first2=R|last3=Lackmy-Vallée A|title=Basic principles of transcranial magnetic stimulation (TMS) and repetitive TMS (rTMS)|journal=Annals of Physical and Rehabilitation Medicine|volume= 58|issue=4|pages=208–213|date=September 2015|pmid=26319963|doi=10.1016/j.rehab.2015.05.005|doi-access=free}}</ref> He began exploring the use of magnetic fields to alter electrical signaling within the brain, and the first stable TMS devices were developed in 1985.<ref name=Horvath/><ref name=Nooh/><ref>Multiple sources: * {{cite journal|first=Reza|last=Jalinous|journal=J Clin Neurophysiol|date=January 1991|title=Technical and practical aspects of magnetic nerve stimulation|url=https://ptacts.uspto.gov/ptacts/public-informations/petitions/1549026/download-documents?artifactId=wymIy7CT78AQEOWXJk_4SQjf5xSn52ZHYl3_o60-pGjUcGCAIF1dS_M|volume=8|issue=1|pages=10–25|doi=10.1097/00004691-199101000-00004|pmid=2019644|access-date=30 January 2026|archive-url=https://web.archive.org/web/20260130214326/https://ptacts.uspto.gov/ptacts/public-informations/petitions/1549026/download-documents?artifactId=wymIy7CT78AQEOWXJk_4SQjf5xSn52ZHYl3_o60-pGjUcGCAIF1dS_M|archive-date=30 January 2026|url-status=live|via=Patent Trial and Appeal Case Tracking System|url-access=subscription}} * {{cite journal|first=AT|last=Barker|title=An introduction to the basic principles of magnetic nerve stimulation|journal=J Clin Neurophysiol|date=January 1991|volume=8|issue=1|pages=26–37|doi=10.1097/00004691-199101000-00005|pmid=2019648}} * {{cite journal|last=Burgess|first=Richard C.|title=Magnetic Stimulators|url=https://journals.lww.com/clinicalneurophys/citation/1991/01000/magnetic_stimulators.15.aspx|journal=J Clin Neurophysiol|volume=8|issue=1|pages=121–129|date=January 1991|doi=10.1097/00004691-199101000-00015 |pmid=2019647 |access-date=30 January 2026|archive-url=https://web.archive.org/web/20250421191647/https://journals.lww.com/clinicalneurophys/citation/1991/01000/magnetic_stimulators.15.aspx|archive-date=21 April 2025|url-status=live|url-access=subscription}} * {{cite book|first1=Sean D|last1=Reeves|first2=Zhi-De|last2=Deng|first3=Jonathan R|last3=Young|date=12 July 2025|chapter=A History of Transcranial Magnetic Stimulation|chapter-url=https://link.springer.com/chapter/10.1007/978-3-031-92401-9_2|pages=11–27|url=https://link.springer.com/book/10.1007/978-3-031-92401-9|title=TMS and Neuroethics|publisher=Springer Nature|series=Advances in Neuroethics|editor1-first=Veljko|editor1-last=Dubljević|editor2-first=Jonathan R|editor2-last=Young|doi= 10.1007/978-3-031-92401-9|isbn=978-3-031-92401-9|oclc=1528456583|access-date=30 January 2026|archive-url=https://web.archive.org/web/20250715022208/https://link.springer.com/book/10.1007/978-3-031-92401-9|archive-date=15 July 2025|url-status=live}}</ref> They were originally intended as diagnostic and research devices, with evaluation of their therapeutic potential being a later development.<ref name=Horvath/><ref name=Nooh/> The FDA first cleared a TMS device for marketing in December 2009.<ref name=Nexstim1>{{cite web|first=Malvina B.|last=Fydelman|date=8 December 2009|title=510(k) Summary: Nexstim eXimia Navigated Brain Stimulation System|url=https://www.accessdata.fda.gov/cdrh_docs/pdf9/k091457.pdf|publisher=Food and Drug Administration|access-date=19 January 2026|archive-url=https://web.archive.org/web/20250208210921/https://www.accessdata.fda.gov/cdrh_docs/pdf9/k091457.pdf|archive-date=8 February 2025|url-status=live}}</ref>

== Regulatory status == As of January 2026, the FDA had authorized under two regulatory pathways the marketing of more than 50 TMS devices for various indications of use within the United States.<ref>Multiple sources: * {{cite journal|first1=Samantha L.|last1=Cohen|first2=Marom|last2=Bikson|first3= Bashar W.|last3=Badran|first4=Mark S.|last4=George|author4-link=Mark S. George|year=2022|title=A visual and narrative timeline of US FDA milestones for Transcranial Magnetic Stimulation (TMS) devices|journal=Brain Stimul.|volume=15|issue=1|pages=73–75|doi=10.1016/j.brs.2021.11.010|pmid=34775141|pmc=8864803}} * {{cite web|title=TPLC - Total Product Life Cycle: Transcranial Magnetic Stimulator|publisher=Food and Drug Administration|url=https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfTPLC/tplc.cfm?id=4081&min_report_year=2011|access-date=21 January 2026|archive-url=https://web.archive.org/web/20260121091402/https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfTPLC/tplc.cfm?id=4081&min_report_year=2011|archive-date=21 January 2026|url-status=live}} </ref> These pathways are (1) the premarket notification (PMN), also known as a 510(k) submission, and (2) the ''de novo'' classification request.<ref name=pathway>Multiple sources: * {{cite journal|first1=Pamela D.|last1=Scott |first2=Anita|last2=Bajaj|first3=David P.|last3=McMullen|year=2024|title=Navigating the FDA regulatory landscape|journal=Neuropsychopharmacology|volume=49|issue=1 |pages=18–22|pmid=37853093|pmc=10700528|doi=10.1038/s41386-023-01723-z}} * {{cite web|title=FDA Executive Summary: NeuroStarTM TMS System for the treatment of Major Depressive Disorder|date=26 January 2007|url=http://www.fda.gov/ohrms/dockets/ac/07/briefing/2007-4273b1_01-FDAExecutiveSummary.pdf|publisher=Food and Drug Administration|archive-url=https://web.archive.org/web/20100330043820/http://www.fda.gov/ohrms/dockets/ac/07/briefing/2007-4273b1_01-FDAExecutiveSummary.pdf|archive-date=30 March 2010|quote=When manufacturers submit a 510(k), they must compare their device to a legally-marketed predicate device that does not require review through the premarket approval (PMA) process. Substantial equivalence does not mean the device under review and predicate devices must be identical. A device is determined to be substantially equivalent to a legally-marketed predicate device if it: • has the same intended use as the predicate AND has the same technological characteristics as the predicate; OR • has the same intended use as the predicate AND has different technological characteristics and the information submitted to FDA: - does not raise new types of questions of safety and effectiveness; AND demonstrates that the device has a comparable risk-to-benefit profile to a legally marketed device.}}</ref>

The FDA clears medical devices for marketing under a PMN if it finds that the intended use and technological characteristics of a new device are "substantially equivalent" to a legally marketed device (termed a "predicate device"). The FDA also clears medical devices for marketing under a PMN if it finds that (1) a new device has the same intended use as the predicate and has different technological characteristics, (2) the information submitted to the FDA does not raise new types of questions of safety and effectiveness, and (3) the information demonstrates that the new device has a comparable risk-to-benefit profile to a legally marketed device.<ref name=pathway/> The agency grants ''de novo'' classification requests if it finds that the data and information provided demonstrate that general controls or general and special controls are adequate to provide a reasonable assurance of safety and effectiveness, and the probable benefits of the device outweigh the probable risks.<ref name=pathway/> Among the devices authorized for marketing under these two pathways are:

===Speech mapping prior to neurosurgery=== In December 2009, in response to a PMN, the Finnish company Nexstim OY obtained FDA clearance for the Nexstim eXimia Navigated Brain Stimulation System for the non-invasive mapping of the primary motor cortex of the brain to its cortical gyrus for the assessment of the primary motor cortex for pre-procedural planning.<ref name=Nexstim1/> In May 2012, in response to a subsequent PMN, the company obtained such clearance for the Nexstim Navigational Brain Stimulation System 4 and the Nexstim NBS System 4 with NEXSPEECH® for the localization and assessment of cortical areas of speech function for pre-procedural planning purposes.<ref>{{cite web|first=Malvina B.|last=Fydelman|date=22 May 2012|title=510(k) Summary: Nexstim Navigational Brain Stimulation (NBS) System 4, and Nexstim NBS System 4 with NEXSPEECH® |url=https://www.accessdata.fda.gov/cdrh_docs/pdf11/k112881.pdf|publisher=Food and Drug Administration|access-date=19 January 2026|archive-url=https://web.archive.org/web/20250427012618/https://www.accessdata.fda.gov/cdrh_docs/pdf11/k112881.pdf|archive-date=27 April 2025|url-status=live}}</ref>

===Depression=== In July 2011, in response to a petition by the US company, Neuronetics, Inc., the FDA classified under its ''de novo'' classification pathway the NeuroStar TMS System as a Class II (moderate risk) medical device for the treatment of MDD in patients who have failed to receive benefit from one antidepressant trial.<ref name=Stade/>

In January 2013, in response to a PMN by the Israeli company, Brainsway, Ltd., the FDA cleared the Brainsway Deep TMS System for the treatment of depressive episodes in adult patients suffering from MDD who failed to achieve satisfactory improvement from previous antidepressant medication treatment in the current episode.<ref name=Brainsway/>

In May 2015, in response to a PMN by the UK company, The Magstim Company Ltd., the FDA cleared the Rapid2 Therapy System for the treatment of MDD in adult patients who have failed to achieve satisfactory improvement from prior antidepressant medication in the current episode.<ref>Multiple sources: * {{cite web|first=Carlos L.|date=8 May 2015|last=Peña|title=Letter: 510(k) Premarket Notification: Rapid2 Therapy System|publisher=Food and Drug Administration|url=https://www.accessdata.fda.gov/cdrh_docs/pdf14/k143531.pdf|access-date=21 January 2026|archive-url=https://web.archive.org/web/20250307072532/https://www.accessdata.fda.gov/cdrh_docs/pdf14/k143531.pdf|archive-date=7 March 2025|url-status=live}} * {{cite web|title=510(k) Premarket Notification: Magstim Rapid Therapy System|publisher=Food and Drug Administration|url=https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K143531|access-date=21 January 2026|archive-url=https://web.archive.org/web/20250524184857/https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K143531|archive-date=24 May 2025|url-status=live}} * {{cite web|title=Product Classification: Transcranial Magnetic Stimulator|url=https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpcd/classification.cfm?id=4081|publisher=Food and Drug Administration|access-date=18 January 2026}}</ref>

In September 2021, in response to a PMN by The Magstim Company Ltd., the FDA cleared the Horizon 3.0 TMS Therapy System for the treatment of MDD in adult patients who have failed to achieve satisfactory improvement from prior antidepressant medication in the current episode.<ref>Multiple sources: * {{cite web|first=Pamela|last=Scott|date=14 September 2021|title=Letter: 510(k) Premarket Notification: Magstim Horizon 3.0 TMS Therapy System, Horizon 3.0 System, Horizon 3.0, Horizon 3.0 with Navigation|publisher=Food and Drug Administration|url=https://www.accessdata.fda.gov/cdrh_docs/pdf21/K211389.pdf|access-date=20 January 2026|archive-url=https://web.archive.org/web/20240615025148/https://www.accessdata.fda.gov/cdrh_docs/pdf21/K211389.pdf|archive-date=15 June 2024|url-status=live}}{{source-attribution}} * {{cite web|title=510(k) Premarket Notification: Magstim Horizon 3.0 TMS Therapy System, Horizon 3.0 System, Horizon 3.0, Horizon 3.0 with Navigation|publisher=Food and Drug Administration|url=https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K211389|access-date=20 January 2026|archive-url=https://web.archive.org/web/20250403165033/https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K211389|archive-date=3 April 2025|url-status=live}} * {{cite web|title=Product Classification: Transcranial Magnetic Stimulator|url=https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpcd/classification.cfm?id=4081|publisher=Food and Drug Administration|access-date=18 January 2026}}</ref>

In March 2023, in response to a PMN by The Magstim Company Ltd., the FDA cleared the Horizon 3.0 TMS Therapy System for the treatment of depressive episodes and for decreasing anxiety symptoms for those who may exhibit comorbid anxiety symptoms in adult patients suffering from MDD and who have failed to achieve satisfactory improvement from prior antidepressant medication in the current episode.<ref>{{cite web|first=Pamela|last=Scott|date=16 March 2023|title=Letter: 510(k) Premarket Notification: Magstim Horizon 3.0 TMS Therapy System, Horizon 3.0 System, Horizon 3.0, H3.0, Horizon 3.0 with StimGuide+|publisher=Food and Drug Administration|url=https://www.accessdata.fda.gov/cdrh_docs/pdf22/K223154.pdf|access-date=20 January 2026|archive-url=https://web.archive.org/web/20250414133650/https://www.accessdata.fda.gov/cdrh_docs/pdf22/K223154.pdf|archive-date=14 April 2025|url-status=live}} </ref>

In October 2023, in response to a PMN by The Magstim Company Ltd., the FDA cleared the Horizon 3.0 TMS Therapy System for the treatment of MDD in adult patients who have failed to achieve satisfactory improvement from prior antidepressant medication in the current episode, as well as an adjunct for the treatment of adult patients suffering from OCD.<ref>Multiple sources: * {{cite web|first=Pamela|last=Scott|date=25 October 2023|title=Letter: 510(k) Premarket Notification: Horizon 3.0 TMS Therapy System, Horizon 3.0 System, Horizon 3.0, H3.0, Horizon 3.0 with StimGuide+|publisher=Food and Drug Administration|url=https://www.accessdata.fda.gov/cdrh_docs/pdf23/K232235.pdf|access-date=20 January 2026|archive-url=https://web.archive.org/web/20240724174006/https://www.accessdata.fda.gov/cdrh_docs/pdf23/K232235.pdf|archive-date=24 July 2024|url-status=live}} * {{cite web|title=510(k) Premarket Notification: Magstim Horizon 3.0 TMS Therapy System, Horizon 3.0 System, Horizon 3.0, H3.0, Horizon 3.0 with StimGuide+|publisher=Food and Drug Administration|url=https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K222171|access-date=20 January 2026|archive-url=https://web.archive.org/web/20250104163143/https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K222171|archive-date=4 January 2025|url-status=live}} * {{cite web|title=Product Classification: Transcranial Magnetic Stimulator|url=https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpcd/classification.cfm?id=4081|publisher=Food and Drug Administration|access-date=18 January 2026}}</ref>

===Headache=== In March 2013, in response to a request by the US company eNeura Therapuetics LLC, the FDA classified under its ''de novo'' classification pathway as a Class II medical device the eNeura Therapeutics® CerenaTM Transcranial Magnetic Stimulator for the acute treatment of pain associated with migraine headache with aura.<ref>Multiple sources: * {{cite journal|last=Kux|first=Leslie|title=Medical Devices; Neurological Devices; Classification of the Transcranial Magnetic Stimulator for Headache; Food and Drug Administration, HHS; Final order|url=https://www.govinfo.gov/content/pkg/FR-2014-07-08/pdf/2014-15876.pdf|journal=Federal Register|volume=79|issue=130|pages=38457–38459|date=8 July 2014|id=FR Doc. 2014–15876|access-date=18 January 2026|archive-url=https://web.archive.org/web/20250208073737/https://www.govinfo.gov/content/pkg/FR-2014-07-08/pdf/2014-15876.pdf|archive-date=8 February 2025|url-status=live}} * {{cite web|title=De Novo Summary: De Novo Classification Request for Cerena Transcranial Magnetic Stimulator (TMS) Device (headache)|date=3 March 2013|publisher=Food and Drug Administration|url=https://www.accessdata.fda.gov/cdrh_docs/reviews/k130556.pdf|access-date=20 January 2026|archive-url=https://web.archive.org/web/20250627230137/https://www.accessdata.fda.gov/cdrh_docs/reviews/k130556.pdf|archive-date=27 June 2025|url-status=live}} * {{cite web|title=Device Classification Under Section 513(f)(2)(De Novo)|url=https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/denovo.cfm?id=DEN130022|access-date=20 January 2026|archive-url=https://web.archive.org/web/20250713151350/https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/denovo.cfm?id=DEN130022|archive-date=13 July 2025|url-status=live}} * {{cite web|title=Product Classification: Transcranial Magnetic Stimulator For The Treatment Of Migraine Headache|publisher=Food and Drug Administration|url=https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpcd/classification.cfm?id=4085|access-date=20 January 2026}}</ref>

=== Obsessive–compulsive disorder (OCD) === In September 2017, the FDA classified the Brainsway Deep Transcranial Magnetic Stimulation System as an adjunct for the treatment of adult patients suffering from OCD as a Class II medical device under its ''de novo'' classification pathway in response to a request from Brainsway Ltd.<ref>{{cite web|title=De Novo Summary (DEN170078): De Novo Classification Request for Brainsway Deep Transcranial Magnetic Stimulation System|url=https://www.accessdata.fda.gov/cdrh_docs/reviews/DEN170078.pdf|publisher=Food and Drug Administration|access-date=18 January 2026|archive-url=https://web.archive.org/web/20251007202815/https://www.accessdata.fda.gov/cdrh_docs/reviews/DEN170078.pdf|archive-date=7 October 2025|url-status=live}} </ref> In August 2018, the FDA permitted the marketing of the device for the treatment of OCD in response to a subsequent ''de novo'' classification request from the company.<ref>{{cite web|date=17 August 2018|title=FDA News Release: FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder|url=https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-transcranial-magnetic-stimulation-treatment-obsessive-compulsive-disorder|publisher=Food and Drug Administration|access-date=17 January 2026|archive-url=https://web.archive.org/web/20251221023315/https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-transcranial-magnetic-stimulation-treatment-obsessive-compulsive-disorder|archive-date=21 December 2025|url-status=live}}</ref>

In August 2020, the FDA cleared the MagVenture TMS Therapy system for the treatment of OCD in response to a PMN by the Danish company Tonica Elektronik A/S.<ref>Multiple sources: * {{Cite web |date=August 2020|title=MagVenture receives FDA clearance for OCD|publisher=Clinical TMS Society: www.clinicaltmssociety.org |url=https://www.clinicaltmssociety.org/news/2020-08/magventure-receives-fda-clearance-ocd-0 |access-date=11 October 2023|archive-url=https://web.archive.org/web/20200919221656/https://clinicaltmssociety.org/news/2020-08/magventure-receives-fda-clearance-ocd-0|archive-date=19 September 2020}} * {{cite web|title=510(k) Premarket Notification: Transcranial Magnetic Stimulation System For Obsessive-Compulsive Disorder: MagVenture TMS Therapy – for treatment of OCD, MagVenture TMS Therapy system|url=https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K193006|publisher=Food and Drug Administration|access-date=18 January 2026|archive-url=https://web.archive.org/web/20230320170837/https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K193006|archive-date=20 March 2023|url-status=live}} * {{cite web|title=Product Classification: Transcranial Magnetic Stimulation System For Obsessive-Compulsive Disorder|url=https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpcd/classification.cfm?id=4130|publisher=Food and Drug Administration|access-date=18 January 2026}}</ref>

In May 2022, the FDA cleared the NeuroStar Advanced Therapy for the adjunctive treatment of OCD in response to a PMN by Neuronetics, Inc.<ref>Multiple sources: * {{Cite web |date=13 June 2023|title=FDA clears OCD motor threshold cap for transcranial magnetic stimulation system |url=https://www.healio.com/news/neurology/20230613/fda-clears-ocd-motor-threshold-cap-for-transcranial-magnetic-stimulation-system|publisher=www.healio.com|access-date=18 January 2026|archive-url=https://web.archive.org/web/20250828042139/https://www.healio.com/news/neurology/20230613/fda-clears-ocd-motor-threshold-cap-for-transcranial-magnetic-stimulation-system|archive-date=28 August 2025|url-status=live}} * {{cite web|title=510(k) Premarket Notification: NeuroStar Advanced Therapy for adjunctive treatment of OCD|url=https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K212289|publisher=Food and Drug Administration|access-date=18 January 2026|archive-url=https://web.archive.org/web/20250403185613/https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?ID=K212289|archive-date=3 April 2025|url-status=live}} * {{cite web|title=Product Classification: Transcranial Magnetic Stimulation System For Obsessive-Compulsive Disorder|url=https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpcd/classification.cfm?id=4130|publisher=Food and Drug Administration|access-date=18 January 2026}}</ref>

In October 2023, in response to a PMN by The Magstim Company Ltd., the FDA cleared the Horizon 3.0 TMS Therapy System for the treatment of MDD in adult patients who have failed to achieve satisfactory improvement from prior antidepressant medication in the current episode, as well as an adjunct for the treatment of adult patients suffering from OCD.<ref>Multiple sources: * {{cite web|first=Pamela|last=Scott|date=25 October 2023|title=Letter: 510(k) Premarket Notification: Horizon 3.0 TMS Therapy System|publisher=Food and Drug Administration|url=https://www.accessdata.fda.gov/cdrh_docs/pdf23/K232235.pdf|access-date=20 January 2026|archive-url=https://web.archive.org/web/20240724174006/https://www.accessdata.fda.gov/cdrh_docs/pdf23/K232235.pdf|archive-date=24 July 2024|url-status=live}} * {{cite web|title=510(k) Premarket Notification: Magstim Horizon 3.0 TMS Therapy System, Horizon 3.0 System, Horizon 3.0, H3.0, Horizon 3.0 with StimGuide+|publisher=Food and Drug Administration|url=https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K222171|access-date=20 January 2026|archive-url=https://web.archive.org/web/20250104163143/https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K222171|archive-date=4 January 2025|url-status=live}} * {{cite web|title=Product Classification: Transcranial Magnetic Stimulation System For Obsessive-Compulsive Disorder|url=https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpcd/classification.cfm?id=4130|publisher=Food and Drug Administration|access-date=18 January 2026}}</ref>

===Psychiatric disorders and conditions=== In August 2018, in response to a request by Brainsway Ltd., the FDA classified under its ''de novo'' classification pathway the generic type of device transcranial magnetic stimulation system for neurological and psychiatric disorders and conditions as a Class II medical device that is identified as a prescription, non-implantable device that uses brief duration, rapidly alternating, or pulsed, magnetic fields to induce neural activity in the cerebral cortex.<ref>{{cite journal|first=Lowell J.|last=Schiller|date=14 March 2019|title=Medical Devices; Neurological Devices; Classification of the Transcranial Magnetic Stimulation System for Neurological and Psychiatric Disorders and Conditions, Food and Drug Administration, HHS: Final order|url=https://www.govinfo.gov/content/pkg/FR-2019-03-14/pdf/2019-04709.pdf|journal=Federal Register|volume=84|issue=50|pages=9228–9230|id=FR Doc. 2019–04709|access-date=19 January 2026|archive-url=https://web.archive.org/web/20250206210025/https://www.govinfo.gov/content/pkg/FR-2019-03-14/pdf/2019-04709.pdf|archive-date=6 February 2025|url-status=live}}</ref>

===Smoking cessation=== In August 2020, the FDA cleared the Brainsway Deep TMS System for use as an aid in short term smoking cessation in adults in response to a PMN by Brainsway Ltd.<ref>{{cite web|url=https://www.scribd.com/document/646209545/FDAnicotine|title=510(k) Premarket Notification: Brainsway Deep TMS System for short term smoking cessation in adults|publisher=Food and Drug Administration|via= Scribd| access-date=19 January 2025|archive-url=https://web.archive.org/web/20260119202554/https://www.scribd.com/document/646209545/FDAnicotine|archive-date=19 January 2026|url-status=live}}</ref>

===Criticism of FDA regulatory procedures for medical devices=== In 1993, the US House of Representatives' Subcommittee on Oversight and Investigations of its Committee on Energy and Commerce issued a report entitled "Less Than The Sum Of Its Parts". The report identified a number of continued organizational and structural weaknesses that had made the FDA Center for Devices and Radiological Health unable to either adequately protect the public from unsafe devices or to approve useful and safe devices in a reasonable period of time.<ref>{{cite book|title=Subcommittee on Oversight and Investigations of the Committee on Energy and Commerce, U.S. House of Representatives |chapter=Less than the Sum of its Parts: Reforms Needed in the Organization, Management, and Resources of the Food and Drug Administration's Center for Devices and Radiological Health|date=May 1993|id=103d Congress, 1st Session: Committee Print 103-N|location=Washington, D.C.|publisher=United States Government Printing Office|chapter-url=https://babel.hathitrust.org/cgi/pt?id=pst.000021238543&seq=4|access-date=3 February 2026|isbn=0-16-040891-1|oclc=974422237|via=HathiTrust Digital Library|quote=A series of subcommittee hearings and investigations have documented a number of instances in which the FDA approved devices that proved unsafe in use. In every case that the subcommittee examined, personnel within the FDA were aware of problems with the device at the time of approval. The subcommittee also found systemic defects within the FDA: excessive delays in the review and approval process of device applications; low morale and productivity among staff within the office of Device Evaluation (ODE); inadequate use of science; poor or nonexistent communications between the device industry and the Agency; and organizational laws that have made the whole of the Center less than the sum of its parts. Thus, CDRH has problems at both ends of the approval spectrum: it has approved devices that have safety and effectiveness concerns, yet it also has been slow to approve potentially very beneficial devices.}}</ref> A 2010 review of the FDA's regulatory procedures subsequently contended that, among other things, the agency's reviews of medical devices had a lower approval standard than their drug counterparts, excessively relied upon a fast-track process, and failed to conduct Congressionally-mandated device classifications.<ref>{{cite journal|last1=Hines|first1=Jonas Zajac|last2=Lurie|first2=Peter|last3=Yu|first3=Eunice|last4=Wolfe|first4=Sidney|author4-link=Sidney M. Wolfe|title=Left to Their Own Devices: Breakdowns in United States Medical Device Premarket Review|journal=PLOS Med|year=2010| volume=7|issue=7|article-number=e1000280 |doi=10.1371/journal.pmed.1000280|doi-access=free|pmc=2903853|pmid=20634922}}</ref>

====Other areas==== In the European Economic Area, various versions of deep TMS H-coils have CE marking for Alzheimer's disease,<ref name=OCD/> autism,<ref name=OCD/> bipolar disorder,<ref name=Chronicpain/> epilepsy,<ref>{{cite journal | vauthors = Gersner R, Oberman L, Sanchez MJ, Chiriboga N, Kaye HL, Pascual-Leone A, Libenson M, Roth Y, Zangen A, Rotenberg A | display-authors = 6 | title = H-coil repetitive transcranial magnetic stimulation for treatment of temporal lobe epilepsy: A case report | journal = Epilepsy & Behavior Case Reports | volume = 5 | issue = Supplement C | pages = 52–56 | date = 2016-01-01 | pmid = 27114902 | pmc = 4832041 | doi = 10.1016/j.ebcr.2016.03.001 }}</ref> chronic pain,<ref name=Chronicpain/> MDD,<ref name=Chronicpain/> Parkinson's disease,<ref>Multiple sources: * {{cite journal | vauthors = Chou YH, Hickey PT, Sundman M, Song AW, Chen NK | title = Effects of repetitive transcranial magnetic stimulation on motor symptoms in Parkinson's disease: a systematic review and meta-analysis | journal = JAMA Neurology | volume = 72 | issue = 4 | pages = 432–440 | date = April 2015 | pmid = 25686212 | pmc = 4425190 | doi = 10.1001/jamaneurol.2014.4380 }} * {{cite journal | vauthors = Torres F, Villalon E, Poblete P, Moraga-Amaro R, Linsambarth S, Riquelme R, Zangen A, Stehberg J | display-authors = 6 | title = Retrospective Evaluation of Deep Transcranial Magnetic Stimulation as Add-On Treatment for Parkinson's Disease | journal = Frontiers in Neurology | volume = 6 | page = 210 | date = 2015-10-26 | pmid = 26579065 | pmc = 4620693 | doi = 10.3389/fneur.2015.00210 | doi-access = free }}</ref> PTSD,<ref name=Chronicpain/><ref name=TMSPTSD>{{cite journal |title= Transcranial magnetic stimulation for post-traumatic stress disorder |pmid= 34733479 |doi= 10.1177/20451253211049921 | doi-access = free |first1= Nicholas J. |last1= Petrosino |first2= Camila |last2= Cosmo |first3= Yosef A. |last3= Berlow |first4= Amin |last4= Zandvakili |first5= Mascha |last5= van 't Wout-Frank |first6= Noah S. |last6= Philip |journal= Therapeutic Advances in Psychopharmacology |date= 2021 |volume= 11 |article-number= 20451253211049921 |pmc= 8558793 }}</ref> schizophrenia (negative symptoms)<ref name=Chronicpain>{{cite web |url=http://www.medgadget.com/2012/07/brainsways-deep-tms-eu-cleared-for-neuropathic-chronic-pain.html|title= Brainsway's Deep TMS EU Cleared for Neuropathic Chronic Pain|work= Medgadget|date= July 3, 2012 |access-date=December 16, 2013}}</ref> and to aid smoking cessation.<ref name=OCD>{{cite news |url=http://www.medicaldevice-network.com/news/newsbrainsway-reports-positive-deep-tms-system-trial-data-ocd|archive-url=https://web.archive.org/web/20131104100829/http://www.medicaldevice-network.com/news/newsbrainsway-reports-positive-deep-tms-system-trial-data-ocd|archive-date=November 4, 2013|title= Brainsway reports positive Deep TMS system trial data for OCD|newspaper= Medical Device Network|date= September 6, 2013 |publisher= Medicaldevice-network |access-date= December 16, 2013}}</ref> One review found tentative benefit for cognitive enhancement in healthy people.<ref>{{cite journal | vauthors = Luber B, Lisanby SH | title = Enhancement of human cognitive performance using transcranial magnetic stimulation (TMS) | journal = NeuroImage | volume = 85 Pt 3 | issue = 3 | pages = 961–970 | date = January 2014 | pmid = 23770409 | pmc = 4083569 | doi = 10.1016/j.neuroimage.2013.06.007 }}</ref>

===Coverage by health services and insurers===

==== United Kingdom ==== The United Kingdom's NICE issues guidance to the National Health Service (NHS) in England, Wales, Scotland, and Northern Ireland. NICE guidance does not address whether the NHS should fund a procedure. Local NHS bodies (primary care trusts and hospital trusts) make decisions about funding after considering the clinical effectiveness of the procedure and whether the procedure represents value for money for the NHS.<ref>NICE [https://www.nice.org.uk/about/what-we-do About NICE: What we do]</ref>

NICE evaluated TMS for severe depression in 2007, finding that TMS was safe, but with insufficient evidence for its efficacy.<ref name=TMSdepress>{{cite web|url=https://www.nice.org.uk/guidance/ipg242|title=Transcranial magnetic stimulation for severe depression|id=IPG242|location=London|publisher=National Institute for Health and Clinical Excellence|date=2011-03-04}}</ref> Guidance was updated and replaced in 2015, concluding that evidence for short‑term efficacy of rTMS for depression was adequate, although the clinical response is variable, and ruling that rTMS for depression may be used with arrangements for clinical governance and audit.<ref>{{cite web | title=Repetitive transcranial magnetic stimulation for depression|publisher=National Institute for Health and Clinical Excellence| date=16 December 2015|id=IPG542| url=https://www.nice.org.uk/guidance/ipg542|access-date=11 January 2025}}</ref>

In January 2014, NICE reported the results of an evaluation of TMS for treating and preventing migraine (IPG 477). NICE found that short-term TMS is safe but there is insufficient evidence to evaluate safety for long-term and frequent uses. It found that evidence on the efficacy of TMS for the treatment of migraine is limited in quantity, that evidence for the prevention of migraine is limited in both quality and quantity.<ref>{{cite web|url=https://www.nice.org.uk/guidance/ipg477|title=Transcranial magnetic stimulation for treating and preventing migraine|date=23 January 2014|location=London|publisher=National Institute for Health and Clinical Excellence|access-date=11 January 2025}}</ref>

{{As of|2025}}, use of rTMS in the UK was reported to have remained limited due to the cost of equipment and establishing treatment centres. Camilla Nord, head of the Mental Health Neuroscience Lab at the University of Cambridge said, "The NHS has unfortunately been far behind the US and Canada on rTMS, which is at least as effective as antidepressants, if not more".<ref>{{cite news| last=Cox | first=David | title=Is a brain-stimulation headset the answer to depression? | website=the Guardian | date=11 January 2025 | url=https://www.theguardian.com/society/2025/jan/11/is-a-brain-stimulation-headset-the-answer-to-depression }}</ref>

==== United States ==== {{Update|section|February 2014|date=September 2025}}

;Commercial health insurance In 2013, several commercial health insurance plans in the United States, including Anthem, Health Net, Kaiser Permanente, and Blue Cross Blue Shield of Nebraska and of Rhode Island, covered TMS for the treatment of depression for the first time.<ref>Multiple sources: * {{cite web| publisher = Anthem, Inc. |archive-url=https://web.archive.org/web/20130729015624/http://www.anthem.com/ca/medicalpolicies/policies/mp_pw_a047769.htm|archive-date=2013-07-29|url=http://www.anthem.com/ca/medicalpolicies/policies/mp_pw_a047769.htm|title=Medical Policy: Transcranial Magnetic Stimulation for Depression and Other Neuropsychiatric Disorders|work=Policy No. BEH.00002 |date=2013-04-16|access-date=2013-12-11}} * {{cite web|author=Health Net|archive-url=https://www.webcitation.org/6BLNdUZpk?url=https://www.healthnet.com/static/general/unprotected/pdfs/national/policies/Transcranial_Magnetic_Stimulation_Mar_12.pdf|archive-date=2012-10-11|url=https://www.healthnet.com/static/general/unprotected/pdfs/national/policies/Transcranial_Magnetic_Stimulation_Mar_12.pdf|title=National Medical Policy: Transcranial Magnetic Stimulation|work=Policy Number NMP 508|publisher=Health Net|date=March 2012|access-date=2012-09-05}} * {{cite web| archive-url=https://web.archive.org/web/20121028032816/https://www.nebraskablue.com/~/media/pdf/Provider/Policy%20Procedure%20Manuals/MedicalPolicies.pdf|archive-date=2012-10-28|work=Section IV.67|title=Medical Policy Manual|date=2011-05-18|publisher=Blue Cross Blue Shield of Nebraska|url=https://www.nebraskablue.com/~/media/pdf/Provider/Policy%20Procedure%20Manuals/MedicalPolicies.pdf}} * {{cite web |archive-url=https://web.archive.org/web/20130526210811/https://www.bcbsri.com/sites/default/files/polices/TranscranialMagneticStimulationasaTreatmentofDepressionandOtherPsychiatricNeurologicDisorders_0.pdf|archive-date=2013-05-26|url=https://www.bcbsri.com/sites/default/files/polices/TranscranialMagneticStimulationasaTreatmentofDepressionandOtherPsychiatricNeurologicDisorders_0.pdf|title=Medical Coverage Policy: Transcranial Magnetic Stimulation for Treatment of Depression and Other Psychiatric/Neurologic Disorders|publisher=Blue Cross Blue Shield of Rhode Island|date=2012-05-15|access-date=2012-09-05}}</ref> In contrast, UnitedHealthcare issued a medical policy for TMS in 2013 that stated there is insufficient evidence that the procedure is beneficial for health outcomes in patients with depression. UnitedHealthcare noted that methodological concerns raised about the scientific evidence studying TMS for depression include small sample size, lack of a validated sham comparison in randomized controlled studies, and variable uses of outcome measures.<ref>{{cite web|author=UnitedHealthcare|archive-url=https://web.archive.org/web/20130520172341/https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Transcranial_Magnetic_Stimulation.pdf|archive-date=2013-05-20|url=https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Transcranial_Magnetic_Stimulation.pdf|title=Transcranial Magnetic Stimulation|date=2013-12-01|publisher=UnitedHealthCare|page=2|access-date=2013-12-11|author-link = UnitedHealthcare}}</ref> Other commercial insurance plans whose 2013 medical coverage policies stated that the role of TMS in the treatment of depression and other disorders had not been clearly established or remained investigational included Aetna, Cigna and Regence.<ref>Multiple sources: * {{cite web|author=Aetna|archive-url=https://web.archive.org/web/20131022055505/http://www.aetna.com/cpb/medical/data/400_499/0469.html|archive-date=2013-10-22|url=http://www.aetna.com/cpb/medical/data/400_499/0469.html|title=Clinical Policy Bulletin: Transcranial Magnetic Stimulation and Cranial Electrical Stimulation|date=2013-10-11|work=Number 0469|publisher=Aetna|access-date=2013-12-11|author-link = Aetna}} * {{cite web|author=Cigna|archive-url=https://web.archive.org/web/20170204194830/https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0383_coveragepositioncriteria_transcranial_magnetic_stimulation.pdf|archive-date=2017-02-04|url=http://www.cigna.com/assets/docs/health-care-professionals/coverage_positions/mm_0383_coveragepositioncriteria_transcranial_magnetic_stimulation.pdf|title=Cigna Medical Coverage Policy: Transcranial Magnetic Stimulation|date=2013-01-15|work=Coverage Policy Number 0383|publisher=Cigna|access-date=2013-12-11|author-link = Cigna}} * {{cite web|archive-url=https://web.archive.org/web/20141209145816/http://blue.regence.com/trgmedpol/medicine/med148.pdf|archive-date=2014-12-09|author=Regence|url=http://blue.regence.com/trgmedpol/medicine/med148.pdf|title=Medical Policy: Transcranial Magnetic Stimulation as a Treatment of Depression and Other Disorders|work=Policy No. 17|date=2013-06-01|publisher=Regence|access-date=2013-12-11|author-link=The Regence Group}}</ref>

;Medicare Policies for Medicare coverage vary among local jurisdictions within the Medicare system,<ref>{{cite web|url=https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/MedicareAdministrativeContractors.html|archive-url=https://web.archive.org/web/20140214094931/http://cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/MedicareAdministrativeContractors.html|archive-date=2014-02-14|title=Medicare Administrative Contractors|publisher=Centers for Medicare and Medicaid Services|date=2013-07-10|access-date=2014-02-14}}</ref> and Medicare coverage for TMS has varied among jurisdictions and with time. For example: * In early 2012 in New England, Medicare covered TMS for the first time in the United States.<ref>Multiple sources: * {{cite web|author=NHIC, Corp.|url=http://coverage.cms.fu.com/mcd_archive/viewlcd.asp?lcd_id=32228&lcd_version=5&basket=lcd%3A32228%3A5%3ARepetitive+Transcranial+Magnetic+Stimulation+%28rTMS%29%3AMAC+%2D+Part+B%3ANHIC%7C%7C+Corp%2E+%2814202%29%3A|archive-url=https://archive.today/20140217152734/http://coverage.cms.fu.com/mcd_archive/viewlcd.asp?lcd_id=32228&lcd_version=5&basket=lcd:32228:5:Repetitive+Transcranial+Magnetic+Stimulation+(rTMS):MAC+-+Part+B:NHIC%7C%7C+Corp.+(14202):|archive-date=2014-02-17|title=Local Coverage Determination (LCD) for Repetitive Transcranial Magnetic Stimulation (rTMS) (L32228)|publisher=Centers for Medicare and Medicaid Services|date=2013-10-24|access-date=2014-02-17}} * {{cite web|archive-url=https://web.archive.org/web/20130405070836/http://www.pbn.com/Important-Treatment-Option-for-Depression-Receives-Medicare-Coverage,66462|archive-date=2013-04-05|access-date=2012-10-11|url=http://www.pbn.com/Important-Treatment-Option-for-Depression-Receives-Medicare-Coverage,66462|title=Important Treatment Option for Depression Receives Medicare Coverage|work=Press Release|date=2012-03-30|publisher=PBN.com: Providence Business News}} * {{cite web|author=The Institute for Clinical and Economic Review|date=June 2012|archive-url=https://web.archive.org/web/20131213211022/http://cepac.icer-review.org/wp-content/uploads/2012/07/rTMS-Coverage-Policy-Analysis.pdf|archive-date=2013-12-13|url=http://cepac.icer-review.org/wp-content/uploads/2012/07/rTMS-Coverage-Policy-Analysis.pdf|title=Coverage Policy Analysis: Repetitive Transcranial Magnetic Stimulation (rTMS)|publisher=The New England Comparative Effectiveness Public Advisory Council (CEPAC)|access-date=2013-12-11}} * {{cite web|archive-url=https://web.archive.org/web/20120325091400/http://www.cvmc.org/news/2012-theresa-fama-cepac|archive-date=2012-03-25|url=http://www.cvmc.org/news/2012-theresa-fama-cepac|title=Transcranial Magnetic Stimulation Cites Influence of New England Comparative Effectiveness Public Advisory Council (CEPAC)|date=2012-02-06|location=Berlin, Vermont|publisher=Central Vermont Medical Center|access-date=2012-10-12}}</ref> However, that jurisdiction later decided to end coverage after October, 2013.<ref>{{cite web|author=National Government Services, Inc. |url=http://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=32038&ContrId=178&&bc=IAAAABAAAAAAAA%3d%3d&|date=2013-10-25|title=Local Coverage Determination (LCD): Transcranial Magnetic Stimulation (L32038)|publisher= Centers for Medicare and Medicaid Services |access-date=2014-02-17}}</ref> * In August 2012, the jurisdiction covering Arkansas, Louisiana, Mississippi, Colorado, Texas, Oklahoma, and New Mexico determined that there was insufficient evidence to cover the treatment,<ref>{{cite web |author=Novitas Solutions, Inc. |date=2013-12-04 |title=LCD L32752 – Transcranial Magnetic Stimulation for Depression |url=https://hwscenter.com/treatments/#neuropsychology |access-date=2014-02-17 |work=Contractor's Determination Number L32752 |publisher=Centers for Medicare and Medicaid Services}}</ref> but the same jurisdiction subsequently determined that Medicare would cover TMS for the treatment of depression after December 2013.<ref>{{cite web|url=http://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33660&ContrId=259&bc=IAAAAAgAAAAAAA%3d%3d&|title=LCD L33660 – Transcranial Magnetic Stimulation (TMS) for the Treatment of Depression|author=Novitas Solutions, Inc.|work=Contractor's Determination Number L33660|publisher= Centers for Medicare and Medicaid Services|date=2013-12-05|access-date=2014-02-17}}</ref>

== Limitations ==

There are serious concerns about stimulating brain tissue using non-invasive magnetic field methods such as uncertainty in the dose and localisation of the stimulation effect.<ref>Multiple sources: * {{cite journal |last1=Benussi|first1=A|last2=Pascual-Leone|first2=A|author2-link=Alvaro Pascual-Leone|last3=Borroni|first3=B|title=Non-Invasive Cerebellar Stimulation in Neurodegenerative Ataxia: A Literature Review |journal=Int J Mol Sci |volume=21 |issue=6 |page=1948 |date=March 2020 |pmid=32178459 |pmc=7139863 |doi=10.3390/ijms21061948 |doi-access=free}} * {{cite journal |vauthors=Grimaldi G, Argyropoulos GP, Boehringer A, Celnik P, Edwards MJ, Ferrucci R, Galea JM, Groiss SJ, Hiraoka K, Kassavetis P, Lesage E, Manto M, Miall RC, Priori A, Sadnicka A, Ugawa Y, Ziemann U |title=Non-invasive cerebellar stimulation—a consensus paper |journal=Cerebellum |volume=13 |issue=1 |pages=121–38 |date=February 2014 |pmid=23943521 |doi=10.1007/s12311-013-0514-7 |url=https://research.birmingham.ac.uk/portal/en/publications/noninvasive-cerebellar-stimulation(1e9aaf7a-42a6-4879-a0cf-31742a773386).html}} * {{cite journal |vauthors=Siebner HR, Hartwigsen G, Kassuba T, Rothwell JC |title=How does transcranial magnetic stimulation modify neuronal activity in the brain? Implications for studies of cognition |journal=Cortex |volume=45 |issue=9 |pages=1035–42 |date=October 2009 |pmid=19371866 |pmc=2997692 |doi=10.1016/j.cortex.2009.02.007 }} * {{cite journal |vauthors=Sparing R, Mottaghy FM |title=Noninvasive brain stimulation with transcranial magnetic or direct current stimulation (TMS/tDCS)-From insights into human memory to therapy of its dysfunction |journal=Methods |volume=44 |issue=4 |pages=329–37 |date=April 2008 |pmid=18374276 |doi=10.1016/j.ymeth.2007.02.001 }}</ref>

== See also == {{col div|colwidth=30em}} * Cortical stimulation mapping * Cranial electrotherapy stimulation * Electrical brain stimulation * Electroconvulsive therapy * Low field magnetic stimulation * My Beautiful Broken Brain * Neuromodulation * Neurostimulation * Neurotechnology * Non-invasive cerebellar stimulation * Transcranial alternating current stimulation * Transcranial direct-current stimulation * Transcranial random noise stimulation * Vagus nerve stimulation {{colend}}

== References == {{reflist}}

<!--US FDA approved-->

Category:Diagnostic neurology Category:Physical psychiatric treatments Category:Electrotherapy Category:Magnetic devices Category:Neurophysiology Category:Neuropsychology Category:Neurotechnology Category:Treatment of bipolar disorder Category:Treatment of depression Category:Medical devices Category:1985 introductions<!--1st stable TMS devices--> Category:2008 introductions Category:Bioelectromagnetics