Transcranial Magnetic Stimulation: Clinical Use and Evidence
How transcranial magnetic stimulation is used in clinics, which U.S. devices the FDA has authorized for which uses, what trials show, and the safety limits.
Content last updated . This page has not been medically reviewed.
Urgent first
If you or someone you know is thinking about suicide, call or text 988 (the 988 Suicide and Crisis Lifeline in the United States), or call 911 in an emergency. [1] This page is education only. It is not a guide to getting or deciding on treatment.What it is
Transcranial magnetic stimulation (TMS) is a noninvasive method that uses an electromagnet to stimulate the brain. When the pulses are repeated it is called repetitive TMS (rTMS). The magnetic field is turned on and off very rapidly, which induces weak electrical currents that stimulate neurons and neural circuits. [1] The field is about the same strength as an MRI scanner, according to NIMH, and, unlike ECT, the stimulation is aimed at a specific brain site. [1] It is a clinical treatment given by trained staff. It should be prescribed and monitored by a health care provider with specific training and expertise. [1] For how it differs from other tools, see electrical and magnetic brain stimulation.Evidence labels used here (approved medicine, established, promising but limited, mixed, insufficient evidence) are explained in how we label evidence.
What the evidence shows
- Depression, adults: established as a clinical option for cleared uses; benefit varies between people. A sham-controlled trial of 190 people (intention-to-treat) with depression who were off antidepressants found remission in 14.1% with active rTMS and 5.1% with sham; the number needed to treat was 12. [4] Almost 30% of people remitted in the open-label follow-up whichever group they started in. [4] A network meta-analysis of 113 trials found several rTMS strategies linked to higher response than sham, with imprecise estimates. [5] NIMH says rTMS does not match the therapeutic effects of ECT. [1]
- OCD: one device, one randomized trial reviewed by the FDA. In the FDA's summary, 100 patients were randomized (49 to the Brainsway device, 51 to sham). [3] Response (more than a 30% drop on the YBOCS rating scale) was 38% with the device and 11% with sham. [3]
- Other uses: Only the uses above were reviewed here. Evidence for pain, stroke and cognition belongs to the pages on neuromodulation for pain and migraine, rehabilitation and cognitive research.
NIMH adds that there is not consensus on the best way to position the coil or deliver pulses. [1] This page does not describe treatment settings.
Frequently asked questions
Is TMS FDA approved?
Specific TMS devices have been authorized for specific uses. For example, one device's depression record is DEN070003 [2] and another device was permitted for OCD in 2018. [3] A device's status does not transfer to other devices.
Does TMS hurt or need anesthesia?
rTMS does not require anesthesia, and patients usually feel a slight knocking or tapping on the head. [1]
Is TMS as effective as ECT?
NIMH states that it does not match the therapeutic effects of ECT. [1]
Can TMS cause seizures?
It can, but a comprehensive review found the risk is low when expert guidelines are followed. [1]
Can I buy a TMS device for home?
This page covers clinical TMS only. See clinical vs consumer brain stimulation devices.
More details: evidence, limits and cautions
The details behind this page: cautions, limits of the evidence and where sources disagree. Open any note to read it.
Regulatory status: specific devices, specific uses (United States, read 2026-10-22)
| Device or record | What the regulator record says |
|---|---|
| NeuroStar TMS System | FDA De Novo record DEN070003, decision granted 10/07/2008 [2]. NIMH describes the first rTMS device cleared in 2008 for depression in people who did not respond to at least one antidepressant in the current episode. [1] |
| Brainsway Deep TMS System | Marketing permitted in August 2018 for obsessive compulsive disorder, through the De Novo pathway. [3] |
| TMS for migraine | The FDA's 2018 announcement says use expanded to pain associated with certain migraine headaches in 2013. [3] I did not read the individual migraine device record. |
NIMH's overview lists rTMS as FDA-cleared for treatment-resistant depression, OCD, migraines, anxiety with depression and smoking dependence, and says it cleared rTMS for adjunctive treatment of depression in adolescents 15 and older in March 2024. [1] Those are NIMH's summaries; which device carries which indication is a product-level question. Rules outside the U.S. were not verified for this page.
Risks and who should not have it
- Common effects: discomfort at the site, scalp or facial muscle tingling or contraction, mild headaches or brief lightheadedness. [1]
- Seizure: possible; a comprehensive review found the risk is low. [1] Expert consensus guidance says seizures have been extremely rare, with most cases following stimulation beyond earlier guidelines, often in people taking drugs that may lower seizure threshold. [6]
- Long term: long-term side effects have not been determined. [1]
- Metal and implants: the Brainsway device is contraindicated for people with metallic objects or implanted stimulators in or near the head, and people with a seizure history should discuss it with their provider first. [3]
More detail is on the contraindications and seizure considerations page.
Safety note
References
- National Institute of Mental Health. Brain Stimulation Therapies. Read 2026-10-22.
- U.S. Food and Drug Administration. De Novo database record DEN070003 (transcranial magnetic stimulator). Read 2026-10-22.
- U.S. Food and Drug Administration. FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder (August 17, 2018). Read 2026-10-22.
- George MS, et al. Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: a sham-controlled randomized trial. Arch Gen Psychiatry. 2010. Read 2026-10-22.
- Mutz J, et al. Comparative efficacy and acceptability of non-surgical brain stimulation for the acute treatment of major depressive episodes in adults: systematic review and network meta-analysis. BMJ. 2019. Read 2026-10-22.
- Rossi S, et al. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol. 2009. Read 2026-10-22.