Finishing a course of TMS and feeling like yourself again brings a new worry: will it hold? How long do TMS results last, and what happens if the depression comes back? The research is more encouraging than many people expect. Among people who respond to a course, roughly half to nearly two-thirds are still responding a year later, and when symptoms do return, restarting TMS brought back the improvement for most people in the research.
None of that predicts any one person's course. It does show what tends to help results last, and why the months after treatment deserve a plan of their own.
What "Lasting" Means: Response vs. Remission
Two terms do most of the work in durability research. A person has responded when their depression scores fall by at least half on a standard rating scale. They're in remission when scores drop low enough that the depression is largely gone.
Durability studies then ask a narrower question than the original trials did: of the people who responded or reached remission by the end of a course, how many were still doing well months later? That framing matters when you read the numbers. A result such as 62.5% of people keeping their response for a year describes people who had already responded, not everyone who started TMS. Those follow-up checks happen at set points, typically three, six, and 12 months after a course, so durability is reported as the share of people still responding at each checkpoint.
What the Research Shows About Durability
The most direct data come from a 2014 study in The Journal of Clinical Psychiatry that followed people with medication-resistant major depression for a year after they finished TMS at 42 U.S. clinical practices. Of the 257 people who completed a course and agreed to follow-up, 120 had responded or reached remission by the end of treatment. Of those 120, 75 (62.5%) kept meeting response criteria through the full 12 months.
Two details shape that result. The study used a practical approach after the course: continued antidepressant medication, plus access to more TMS if symptoms returned. And over the year, 93 participants (36.2%) had TMS reintroduced at some point, averaging about 16 treatment days. So the 62.5% reflects TMS inside ongoing care, not a single course left to stand on its own.
A 2019 meta-analysis in Brain Stimulation pooled 19 studies of people who had responded to a TMS course. About two-thirds were still responding at three months, about 53% at six months, and about 46% at one year. The authors' summary: roughly half of responders keep their response for up to a year after a successful course.
Read together, the two studies give a realistic range of around half to nearly two-thirds of responders still doing well a year out. The other side of those numbers matters just as much. A meaningful share of people see symptoms return within the first year, and planning for that possibility is part of good care, not a sign that treatment failed.
Factors That Influence How Long Results Last
The research has identified a few patterns, mostly at the level of groups rather than individuals:
- Maintenance treatment. In the 2019 meta-analysis, studies that included maintenance treatment showed higher sustained response at some time points.
- The mix of people studied. Studies with a higher proportion of women also showed higher sustained response, a group-level pattern that says nothing reliable about any one person.
- Continued medication. The best-known durability results come from people who stayed on antidepressants after TMS, so those numbers describe that combination.
- A completed course. Durability figures come from people who finished a full acute course. They don't describe what happens after a partial one.
Clinicians also weigh a person's history when planning follow-up, such as how many depressive episodes they've had and how many treatments failed before TMS. The findings above don't establish how much those factors change the odds, so they inform a clinician's judgment rather than supply a number.
Maintenance TMS: What It Is and Who May Need It
TMS maintenance treatment means periodic sessions after the main course, scheduled to protect a response rather than to answer a relapse. Schedules vary between providers and between people, and no single schedule has become standard.
The evidence supports the idea without settling the details. The 2019 meta-analysis found maintenance associated with more durable response, and its authors suggested maintenance be considered in practice and tested in future trials. That's a promising signal, not a proven protocol. Maintenance TMS is also separate from staying on medication: in both the year-long and six-month studies, people continued antidepressants whether or not they received more TMS.
Not everyone needs it. Some people stay well for long stretches without it. Whether maintenance makes sense for a particular person is a judgment a psychiatrist makes from their history and how they're doing in the months after the course.
Can TMS Be Repeated If Symptoms Return?
Yes, and the research on restarting TMS is among the most reassuring parts of this topic. In a six-month study in Brain Stimulation, people whose depression had improved by at least a quarter with TMS stopped treatment gradually over three weeks while starting maintenance antidepressant medication. In that study, worsening had a specific meaning: a clinician-rated decline that held for two consecutive weeks, which triggered restarting TMS. Over the next 24 weeks, 38% had symptoms worsen enough to restart TMS, and 32 of those 38 people (84%) regained their improvement. Only 10% of the 99 people whose results were reported met the study's definition of relapse.
A repeat course is different from maintenance. Maintenance is planned in advance to hold a response; a repeat course starts because symptoms have come back. In the year-long study described above, about a third of participants had TMS reintroduced at some point. Whether and when to restart is a decision made with a psychiatrist, based on how symptoms are changing.
What Helps Results Last Longer
Beyond maintenance and continued medication, two more things help, though neither promises that results will last for a particular person:
- Catching changes early. In the six-month study, regular assessments flagged worsening symptoms, and most people who restarted TMS at that point regained their improvement.
- Staying connected to care. Therapy and regular psychiatric visits mean someone is watching for early changes between treatments.
Knowing what returning depression tends to look like makes early changes easier to catch: shifts in sleep or appetite, lower energy, less interest in usual activities, and a low mood that lingers instead of lifting after a few days. When those signs show up, reaching out sooner gives a care team more options, and our guide on how to ask for help when depressed covers how to start that conversation.
These describe what research associates with better long-term results in groups of patients. They aren't instructions for any one person's treatment plan; that's a psychiatrist's call, made with the whole history in view.
Talking to a Psychiatrist About a Long-Term Plan
A TMS course is the start of a plan, not the end of one. The months afterward are when follow-up, medication decisions, and a clear plan for what happens if symptoms return matter most.
At Amae, TMS sits inside our integrated care model, where psychiatric care, therapy, primary care, and peer support stay linked after the course ends. We provide TMS therapy for major depressive disorder at our Los Angeles clinic and at our Bay Area clinics in Los Altos and San Mateo. Commercial insurance plans and cash pay are both accepted, and our intake team handles prior authorization. To map out what comes after a course, talk with an Amae psychiatrist about a long-term plan. Anyone in crisis can reach the 988 Suicide and Crisis Lifeline by call or text.
Frequently Asked Questions
How long do TMS results typically last?
For many people, months to a year or longer, though it varies. In a year-long study of people who responded to TMS, 62.5% kept meeting response criteria for the full 12 months. A 2019 meta-analysis found that about half of responders were still responding at one year.
What percentage of people relapse after TMS?
Some return of symptoms within a year is common. In the 2019 meta-analysis, roughly half of responders were no longer responding at one year. That isn't always a full relapse: in a six-month study, 38% had symptoms worsen enough to restart TMS, while 10% met the study's definition of relapse.
Can TMS be repeated if depression comes back?
Yes. In a six-month study, 84% of people whose symptoms worsened regained their improvement when TMS was restarted. A repeat course is different from ongoing maintenance sessions, and the decision is made with a psychiatrist based on individual history.
Do I need maintenance TMS sessions after my initial course?
Not necessarily. Some people stay well without them, and there is no standard maintenance schedule across providers. Research links maintenance with longer-lasting response, so whether it fits is a decision a psychiatrist makes based on your response and how closely symptoms are being monitored.
What can help TMS results last longer?
The research points to planned follow-up, continued medication when it's part of the plan, and catching symptom changes early. These are general findings from groups of patients, not instructions for any one person's treatment.
Is maintenance TMS covered by insurance?
It depends on the insurer and on whether sessions are billed as maintenance or as a new course for returning symptoms, since coverage can differ between the two. Ask the provider to verify benefits with your insurer before sessions begin.
Citations
- Dunner DL, Aaronson ST, Sackeim HA, et al. A multisite, naturalistic, observational study of transcranial magnetic stimulation for patients with pharmacoresistant major depressive disorder: durability of benefit over a 1-year follow-up period. Journal of Clinical Psychiatry. 2014;75(12):1394-1401. https://pubmed.ncbi.nlm.nih.gov/25271871/ (Tier 1)
- Senova S, Cotovio G, Pascual-Leone A, Oliveira-Maia AJ. Durability of antidepressant response to repetitive transcranial magnetic stimulation: systematic review and meta-analysis. Brain Stimulation. 2019;12(1):119-128. https://pubmed.ncbi.nlm.nih.gov/30344109/ (Tier 1)
- Janicak PG, Nahas Z, Lisanby SH, et al. Durability of clinical benefit with transcranial magnetic stimulation (TMS) in the treatment of pharmacoresistant major depression: assessment of relapse during a 6-month, multisite, open-label study. Brain Stimulation. 2010;3(4):187-199. https://pubmed.ncbi.nlm.nih.gov/20965447/ (Tier 1)
- 988 Suicide and Crisis Lifeline. https://988lifeline.org (Tier 2)
