Transcranial magnetic stimulation (TMS) has been FDA-cleared for major depressive disorder since 2008, yet most people encountering it for the first time have never heard of it. That gap between clinical credibility and public awareness matters, because for the roughly one in three people with depression who don’t find adequate relief from antidepressant medications, TMS may represent a meaningful path forward (Mayo Clinic). At WHOA Wellness in Richmond, VA, we use Brainsway Deep TMS therapy specifically because the science behind how it works is both well-established and worth understanding before you commit to a course of treatment.
What TMS Actually Does to the Brain
Depression is not simply a matter of low serotonin. Research has consistently shown that people with major depressive disorder — a condition characterized by persistent low mood, loss of interest, disrupted sleep, and difficulty functioning — often have measurably reduced activity in the left dorsolateral prefrontal cortex, a region of the brain responsible for mood regulation, executive function, and emotional processing (Mayo Clinic). Antidepressant medications attempt to address depression by altering neurotransmitter availability throughout the entire brain and body. TMS works differently: it delivers focused magnetic pulses to that specific underactive region, stimulating neurons directly.
During a TMS session at our Richmond practice, a cushioned helmet containing an electromagnetic coil is positioned comfortably over your head. The device generates brief magnetic fields — comparable in strength to those used in MRI machines — that pass through your scalp and skull without any cuts, injections, or anesthesia. Those fields create small electrical currents in the targeted neurons, encouraging them to fire more regularly. You remain fully awake throughout. Most people describe the sensation as rhythmic tapping on the scalp, and you can drive yourself home immediately after each session.
The Neuroplasticity Mechanism
A single TMS session does not rewire the brain. The therapeutic effect builds through repetition. Research on TMS and neuroplasticity — the brain’s capacity to form and strengthen new neural connections — shows that repeated stimulation over multiple sessions gradually reinforces the pathways involved in mood regulation (PMC). Think of it as physical therapy for neural circuitry: the consistent, targeted activation prompts the brain to sustain healthier patterns of activity over time.
This is why the standard course at WHOA Wellness runs 30 to 36 sessions, scheduled five days per week over six to eight weeks. Each session, lasting 20 to 40 minutes, builds on the one before it. Patients often begin noticing shifts in energy and motivation before emotional symptoms fully lift — a pattern consistent with how the neuroplastic changes accumulate rather than arrive all at once.
Why Brainsway Deep TMS Specifically
Not all TMS devices deliver the same treatment. Standard TMS systems use a figure-8 coil that targets a relatively shallow, narrow area of the cortex. At WHOA Wellness, we use Brainsway’s patented H-Coil technology, which reaches deeper brain structures and covers a broader stimulation area per pulse. This distinction matters clinically: greater depth and breadth means more neurons are activated with each session, reducing the chance of subtherapeutic targeting and increasing the cumulative effect of treatment.
Brainsway Deep TMS has been studied in over 60 clinical trials and holds multiple FDA clearances — including for major depressive disorder, reduction of anxiety symptoms in patients with depression, obsessive-compulsive disorder, and smoking cessation (PMC). It is also the only Deep TMS system FDA-cleared for treating depression in adults up to age 86, which makes it a viable option for older patients who have struggled with medication tolerability for years. You can review a full list of facts about TMS therapy on our dedicated page.
What the Evidence Shows
The clinical evidence behind TMS is the reason major insurance carriers cover it. Peer-reviewed research confirms TMS’s FDA clearance status and established clinical evidence base as a treatment for depression, particularly for patients who have not responded to prior antidepressant trials (PMC). In real-world clinical practice with Brainsway Deep TMS specifically, data from over 1,000 patients shows that approximately four in five patients who completed at least 30 sessions achieved a meaningful response, and approximately two in three achieved remission — meaning their depression symptoms resolved substantially or completely.
Results vary by individual, and we discuss realistic expectations openly with every patient before treatment begins. TMS does not work for everyone, and response is not always complete remission. What the research consistently shows is that for patients who have tried medications without sufficient relief, TMS offers a different mechanism of action that reaches brain systems antidepressants may not adequately address.
How TMS Fits Into a Comprehensive Approach
TMS is a powerful clinical tool, and it works best when it is part of a broader care picture. Many patients continue psychotherapy during their TMS course — and often find that as the cognitive fog of depression begins to lift, they can engage more fully with therapeutic work. Some continue existing antidepressant medications alongside TMS; others work with their prescribing provider to reassess their medication plan as symptoms improve. Those decisions are made collaboratively, based on your history and response to treatment.
At WHOA Wellness, our integrated model means TMS doesn’t exist in isolation from the rest of our services. Patients who are also working with our massage therapists or acupuncturist find that addressing the physical symptoms of depression — tension, fatigue, disrupted sleep — complements the neurological work TMS is doing. The two tracks reinforce each other in ways that a single-treatment approach simply cannot replicate.
Insurance and Getting Started
Cost is one of the first questions people ask, and it deserves a direct answer. Most major insurance plans cover TMS therapy for qualified patients — including Aetna, United Healthcare, Cigna, Medicare, Anthem, and many Medicaid plans. Eligibility typically requires a diagnosis of major depressive disorder and documentation of prior antidepressant trials that were either ineffective or poorly tolerated. Our team handles prior authorization and coverage verification before treatment begins, so there are no surprises once you’ve decided to move forward.
If you’re uncertain whether your insurance covers TMS, or what out-of-pocket costs might look like, we walk through all of that during your initial consultation. No pressure, no obligation — just a clear picture of what treatment would involve and what it would cost.
Frequently Asked Questions
Is TMS the same as electroconvulsive therapy (ECT)? They are both brain stimulation treatments for depression, but they work very differently. ECT requires general anesthesia, involves inducing a brief seizure, and can cause temporary memory problems. TMS requires no anesthesia, causes no seizures under normal clinical use, and has no known impact on memory or cognitive function. You can drive yourself to and from TMS sessions and continue your normal daily routine throughout.
How quickly do patients typically notice results? Most patients don’t notice dramatic changes in the first two weeks. Energy and motivation often return before mood fully lifts, typically around weeks three and four. Emotional symptoms — the persistent sadness, the inability to feel pleasure — generally begin to ease in weeks four through six. Some patients continue to improve for several weeks after their final session as the neuroplastic changes consolidate.
Does TMS hurt? TMS is not painful. Most people feel a rhythmic tapping or pulsing sensation on the scalp during treatment. Some find the first few sessions mildly uncomfortable as they adjust, but that typically resolves within the first week. The most common side effect is temporary scalp tenderness or a mild headache after early sessions. Serious side effects, including seizures, occur in less than 0.01% of sessions.
Can I receive TMS if I’m currently taking antidepressants? Many patients receive TMS while continuing antidepressant medications. Whether to maintain, adjust, or taper your medications during treatment is a decision made with your prescribing provider, not something we change unilaterally. Discuss your current medication plan with your provider before starting TMS.
What disqualifies someone from TMS? TMS is not appropriate for patients who have certain metal implants in or near the head — cochlear implants, deep brain stimulators, or aneurysm clips. A history of seizures or epilepsy is also a contraindication. During your consultation at WHOA Wellness, we conduct a thorough screening to confirm TMS is safe for your specific situation.
Key Takeaways
- TMS uses focused magnetic pulses to directly stimulate the underactive brain regions associated with depression — a fundamentally different mechanism from antidepressant medications.
- The therapeutic effect builds through repetition over a standard course of 30 to 36 sessions, as repeated stimulation promotes neuroplasticity in mood-regulating neural pathways.
- Brainsway Deep TMS reaches deeper brain structures than standard TMS devices, and holds multiple FDA clearances including for major depressive disorder and comorbid anxiety symptoms.
- Most major insurance plans cover TMS for qualified patients; our team handles verification and prior authorization before treatment begins.
- Results vary by individual, and TMS works best as part of a comprehensive care approach that may include therapy, medication review, and holistic wellness support.
The science behind TMS is straightforward: target the right brain region, stimulate it consistently, and give the brain the repeated signal it needs to rebuild healthier patterns of activity. At WHOA Wellness in Richmond, VA, we use the most advanced TMS technology available because the mechanism matters — and so do the outcomes. To explore whether TMS is right for you, request a consultation with our team. We will review your history, verify your coverage, and give you a clear picture of what treatment would look like.
References
- Mayo Clinic. Transcranial magnetic stimulation. https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625
- PMC. TMS therapy and neuroplasticity. https://pmc.ncbi.nlm.nih.gov/articles/PMC9313265/
- PMC. TMS FDA approval — general. https://pmc.ncbi.nlm.nih.gov/articles/PMC8864803/
Medical Disclaimer
The information in this blog is for educational purposes only and does not constitute medical advice. TMS therapy should only be pursued under the supervision of a licensed provider familiar with your full medical and psychiatric history. Individual results vary. If you are experiencing a mental health crisis or thoughts of self-harm, please call or text 988 to reach the Suicide and Crisis Lifeline or go to your nearest emergency room.