What We’ve Said

What we’ve said about TMS

5 points from 5 episodes, newest first

Also searched as transcranial magnetic stimulation, rTMS, deep TMS

In short

TMS is one of the top-line interventions for treatment-resistant depression, better tolerated and far more available than ECT. It also helps bipolar depression once mood is stabilized, and for OCD only the specific cleared coil and protocol counts.

When we reach for it

  1. For treatment-resistant depression the best evidence goes to ECT, TMS, antipsychotics (aripiprazole most of all), lithium, thyroid supplement and the ketamines. Those are the top-line interventions.

    “The best evidence goes to ECT, TMS, TMS. antipsychotics, particularly aripiprazole has the best evidence and the biggest effect size, lithium, thyroid supplement, and the ketamines, esketamine and ketamine. So those would be our top line interventions”
    6:46The Deficit Model in Psychiatry & Difficult to Treat Depression with Dr. Chris Aiken | Episode 18Mar 2025Guest episode

  2. A great choice along with ECT for very serious cases. TMS is better tolerated, most people are less afraid of it, and it is probably far more available than ECT these days. Patients have had nice responses.

    “Great choice along with ECT for very serious cases. But TMS, of course, better tolerated. Most people aren't as afraid of it. Probably more available by far than ECT these days, I would think. Yeah, I've had patients who had nice response from TMS”
    55:14Treating Depression: Practical Tips & Pearls for Anti-Depressant MedicationsJan 2025

  3. In bipolar depression, TMS is showing a pretty good effect while the patient is mood stabilized.

    “wanted to mention also for the depression component beyond that, TMS, I am seeing some pretty good effect while your mood stabilized seems to be helpful. And you can consider esketamine for some patients”
    51:20The Best Bipolar Medication Review From The Best Bipolar ExpertJan 2025

TMS for OCD

  1. TMS itself is not approved for OCD. What is cleared is the BrainsWay H7 coil, used at a certain protocol together with an ERP intervention.

    “it's not that TMS is approved for OCD. It's actually a Brainsway H7 coil. that's used at a certain protocol with an ERP intervention”
    20:59Practical OCD Psychopharmacology: Evidence‑Based (& Non Evidence-Based) Medication ApproachAug 2025

How it might work

  1. TMS does not go deep enough to hit subcortical structures, but it speaks to the dynamic relationship between the cortex and the emotional systems, strengthening the top-down system.

    “TMS doesn't go deep enough to hit subcortical structures, but the That speaks to the relationship between the cortex or the fancy human part of the brain and these emotional systems. And it just speaks to the ongoing dynamic relationship and that strengthening that top-down system”
    51:39Affective Neuroscience: Understanding Patients Beyond DSM DiagnosesAug 2026Guest episode

From these episodes

Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.

Educational content only. Everything here is what was said on the Psychofarm podcast, for clinicians. It is not medical advice and not a substitute for clinical judgment, current labeling or guidelines. An episode reflects what we thought when we recorded it, so check anything before you rely on it.