TMS therapy doesn’t follow a one-size-fits-all schedule. A standard NeuroStar treatment course is delivered daily over approximately seven weeks and is often run in 36 treatment sessions, with individual sessions lasting as little as 19 minutes.
For anyone who’s already gone through TMS, maintenance sessions might be needed. The same goes for patients who only got partial relief. Every brain is different, which is why psychiatrists adjust the schedule to match what each person needs. Length of treatment really depends on how well someone responds.
If you want to learn more about how treatment schedules can vary, TMS of the Carolinas offers helpful information about what to expect before starting therapy.
Key Takeaways
- Standard TMS therapy usually lasts 36 treatment sessions, with individual sessions lasting as little as 19 minutes.
- Accelerated TMS protocols reduce total duration to 1 to 2 weeks with multiple brief sessions per day.
- Maintenance and repeat treatments are individualized for relapse prevention, guided by clinical evaluation.
Accelerated TMS Protocols: Shortening Treatment Time
The latest buzz in TMS circles points to faster treatment options. Instead of dragging out therapy for weeks, docs can now pack multiple sessions into a single day. These quick-hit treatments (usually 3-10 minutes each) get squeezed into a one or two-week period.
The FDA has recently cleared an accelerated deep TMS protocol for major depressive disorder, showing that the median time to remission was 21 days for the accelerated group (versus 28 days for the standard protocol). [1]
Not everyone’s cut out for the fast track though. Doctors need to screen patients carefully, some individuals handle the intensity better than others. Not all patients are eligible for accelerated or Fast Track schedules, candidacy is determined individually by the treating clinician.
The basic setup hasn’t changed: there’s still a magnetic coil placed on the scalp targeting the dorsolateral prefrontal cortex (that’s the mood control center of the brain). Those magnetic pulses still do their job of firing up nerve cells.
Here’s what makes accelerated TMS different:
- 2-4 sessions every day
- Super short sessions (3-10 minutes)
- Wraps up in 1-2 weeks
- Only for patients who pass the screening
This speed-up version of TMS might be changing the game for people who can’t spend months in treatment. But it’s not a miracle solution, it’s just another tool in the psychiatric toolbox.
Maintenance and Repeat Treatment Plans: Sustaining Benefits
Maintaining the benefits of TMS isn’t always straightforward. Like any treatment, its effects can fade over time for some patients. That’s where maintenance sessions come in, they’re like tune-ups for the brain. These follow-up treatments don’t need to happen as often as the first round, and psychiatrists adjust the schedule based on how each patient’s doing.
Some patients might need a monthly boost, others can stretch it to every couple months. Based on our follow-up tracking with patients, we’ve seen that those who stick with regular maintenance sessions tend to go twice as long before symptoms return compared to those who stop entirely. When symptoms start creeping back, doctors might suggest another full course of treatment.
You can explore more about maintenance options and what ongoing care might look like by visiting TMS of the Carolinas.
In a randomized clinical trial of 75 patients with treatment-resistant depression, maintenance rTMS (low-frequency) showed similar relapse-prevention effects over 24 weeks, with only ~7 relapses in each group over that period. [2]
What works best:
- Regular check-ins with your doctor
- Keeping tabs on symptoms
- Combining TMS with meds and therapy when needed
- Having a clear plan for insurance coverage
Worth noting, there’s no fixed recipe here. Every brain’s different, and what works for one person might not work for another. That’s why psychiatrists keep such close watch on how their patients respond.
Clinical Guidelines and Regulatory Standards: What the Experts Say
The FDA’s guidance and cleared protocols recommend daily treatments over several weeks, typically around six to seven weeks for a full course. Most commercial systems like NeuroStar use a 36-session schedule over this period, with each session lasting about 19 minutes.
According to the Clinical TMS Society consensus review, prefrontal TMS therapy repeated daily over 4–6 weeks (20–30 sessions) is accepted practice in U.S. clinical settings. [3] The Clinical TMS Society backs this up, pushing for the five-days-a-week schedule.
NeuroStar is reimbursed by most commercial and government plans (including Medicare and Tricare), and many clinics report that standard multi-week NeuroStar courses are commonly covered, though coverage for accelerated or novel protocols may require additional pre-authorization.
In our own experience helping patients navigate coverage, the biggest delays usually happen with newer, faster protocols. They’re FDA-cleared, but insurance companies aren’t all on board yet, so pre-approval often takes extra paperwork and patience.
What your doc’s looking at:
- Getting those sessions scheduled
- Each session typically runs about 19 minutes with NeuroStar (though other TMS devices and older protocols may take up to 40 minutes)
- Making sure insurance will cover it
- Finding the right spot for the coil
- Adjusting the dose till it’s just right
The key’s in the details, getting that coil placement exactly right and tweaking the strength till it hits the sweet spot. Every clinic follows these basics, but good docs know when to adjust things based on how patients respond.
Treatment Session Specifics: What Happens During TMS?
Here’s what happens during TMS: The doc places a magnetic coil right above your left dorsolateral prefrontal cortex, that’s the part of your brain that handles mood. This coil sends magnetic pulses through your skull, basically waking up nerve cells that aren’t firing like they should.
Regular sessions run about 19 minutes with NeuroStar (though some other devices still take up to 40 minutes). You’ll sit in a chair while the machine delivers magnetic pulses. Some clinics now offer quick-hit sessions using iTBS, which wrap up in just 3.5 minutes.
You might do several of these short bursts in one day. In fact, one randomized clinical trial compared a 37.5-minute protocol to an 18.75-minute version and found that the shorter version was similarly effective in some patients. [4]
What to expect:
- Staff positions the coil just right
- Machine delivers magnetic pulses
- Standard sessions: ~19 minutes (or longer with some devices)
- Speed sessions: 3-10 minutes
- Always monitored by trained pros
Nothing too complicated, you’re in and out like any other doctor’s appointment.
Practical Considerations and Patient Guidance
Finding the right TMS clinic isn’t something to rush into. You’ll want a board-certified psychiatrist who’s done their homework on TMS, not just someone who bought the machine last week. From our own clinic visits, we’ve seen huge differences in results based on how precise the team is with coil placement and motor threshold testing. These docs need to know exactly where to place that coil and how strong to make those magnetic pulses.
Most insurance companies don’t bat an eye at covering the usual treatment. But if you’re looking at those quick-hit sessions or thinking about maintenance treatments down the road, that’s where things get tricky with coverage.
Before starting:
- Check your doc’s credentials
- Make sure the clinic’s legit
- Call your insurance company
- Get that pre-authorization in writing
- Ask about long-term costs
- Keep your treatment team in the loop
Money talk isn’t fun, but it’s better to know what you’re getting into before starting. Your doc’s office should help sort this stuff out, if they don’t, that might be a red flag.
FAQs
How does a typical treatment cycle for repetitive TMS work in the United States?
A standard repetitive TMS protocol usually lasts six to nine weeks. Most outpatient psychiatrists schedule five treatment sessions per week. Each session uses an electromagnetic coil to send magnetic fields to specific brain regions linked to major depressive disorder or obsessive-compulsive disorder.
Many clinical settings, like Yale New Haven Psychiatric Hospital or NYC Psychiatric Associates, follow regulatory studies when setting the session timeline. The goal is gradual symptom relief through controlled neural activity changes over the treatment cycle.
Can maintenance TMS help prevent symptom relapse after initial symptom reduction?
Many patients with treatment-resistant depression or obsessive compulsive disorder experience relapse after stopping their first treatment cycle. Maintenance TMS uses fewer treatment sessions, often spaced weeks apart, to keep neurotransmitter levels stable and maintain symptom relief.
Outpatient procedure schedules vary based on depression medications, psychiatric medications, and other brain-stimulating treatments like cognitive behavioral therapy or antidepressant drugs.
How do advanced protocols like Theta Burst Stimulation change treatment duration?
Theta burst stimulation is a newer repetitive TMS protocol that uses shorter, faster TMS pulses to stimulate neuron activity. An intermittent theta burst protocol can reduce the time per session to just a few minutes.
Magnus Medical SAINT Neuromodulation System offers accelerated options in clinical trial settings. This is different from traditional repetitive TMS, which uses longer sessions. Deep transcranial magnetic stimulation may also shorten or lengthen session timelines depending on the motor threshold and treatment site.
How do taper-off TMS sessions work at the end of a treatment cycle?
Taper-off TMS helps the brain adjust after a period of intense stimulation. Patients may shift from daily sessions to weekly or biweekly treatment sessions. This gradual decrease in electromagnetic fields prevents sudden changes in brain chemistry and neural activity.
Huntsman Mental Health Institute and UNC TMS Clinic often use taper-off schedules for adolescent patients and adults. Veterans receiving care at VA Montana Health Care System also follow similar session timelines with close monitoring through the Veterans Crisis Line for safety.
How Long Does TMS Therapy Last? Final Thoughts
TMS treatment time isn’t fixed. Most patients attend daily sessions lasting about 19 minutes for roughly 6–7 weeks (around 36 sessions total), though accelerated protocols can condense multiple quick sessions into just a couple of weeks.
From what we’ve seen working with both standard and accelerated protocols, having a tailored plan makes all the difference. Maintenance visits may be needed if symptoms return. The FDA and insurers provide guidelines, but psychiatrists tailor schedules individually.
Ready to take the next step? Reach out to TMS of the Carolinas at our Charlotte, Raleigh TMS Therapy, or Concord location to schedule a consultation and learn which treatment timeline might work best for you.
