From the Guidelines
Typically, a patient receives TMS treatments five days per week for four to six weeks, totaling 20-30 sessions in an acute treatment course, as supported by recent guidelines 1. The standard protocol involves daily treatments during the initial phase, as consistent stimulation is necessary to achieve therapeutic effects on brain circuitry. After completing the initial course, some patients may benefit from maintenance treatments, which can vary from once weekly to once monthly depending on individual response. The frequency and duration are determined by the treating physician based on the patient's diagnosis, symptom severity, and response to treatment. TMS works by using magnetic pulses to stimulate nerve cells in brain regions involved in mood regulation, particularly the dorsolateral prefrontal cortex. This stimulation helps normalize activity in neural circuits that may be underactive or overactive in conditions like depression, gradually producing cumulative therapeutic effects that require regular sessions to establish and maintain. Some studies have explored the use of TMS in addiction medicine, including a multisite RCT evaluating deep TMS as an aid to smoking cessation, which involved 10 Hz, 120% RMT, 1800 pulses per daily session for 3 weeks, with maintenance once a week for an additional 3 weeks 1. However, the primary recommendation for TMS treatment frequency is based on its use in major depressive disorder, as outlined in the 2022 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline 1. Key points to consider when determining TMS treatment frequency include:
- The patient's diagnosis and symptom severity
- The patient's response to treatment
- The treating physician's professional judgment
- The standard protocol of daily treatments for four to six weeks
- The potential need for maintenance treatments after the initial course. It is essential to prioritize the patient's individual needs and response to treatment when determining the frequency and duration of TMS sessions.
From the Research
TMS Treatment Frequency
- The frequency of TMS treatments can vary depending on the specific treatment protocol and the individual patient's needs 2.
- Typically, TMS therapy is repeated daily over 4-6 weeks, with 20-30 sessions 2.
- Some studies have used a flexible dosing schedule, with up to 30 sessions, adjunctive to current medications 3.
- Maintenance TMS treatment may be given over a period of 6 months, with sessions spaced out over time 3.
Treatment Duration
- The duration of TMS treatment can range from several weeks to several months 3, 2.
- Acute treatment phases typically last 4-6 weeks, with daily sessions 2.
- Maintenance treatment phases can last up to 6 months, with less frequent sessions 3.
Number of Sessions
- The number of TMS sessions can vary, but typical treatment protocols involve 20-30 sessions 3, 2.
- Some studies have used fewer or more sessions, depending on the specific treatment protocol and patient needs 3, 4.
- The number of sessions may be adjusted based on the patient's response to treatment and their individual needs 3.