Deep TMS vs TMS: What Are the Differences?
Transcranial magnetic stimulation (TMS) is a non-invasive neuromodulation therapy that uses magnetic fields to stimulate nerve cells in specific regions of the brain. By delivering rapid magnetic pulses through a coil positioned against the scalp, TMS is designed to modulate neural activity associated with mood regulation and other cognitive functions. Unlike medications, TMS does not require anesthesia and does not produce systemic side effects.
To learn more about conditions that may benefit from TMS, see Conditions Treated.
Deep TMS, or dTMS, is an advanced form of TMS that utilizes unique coil designs, most notably the patented H-coil, to deliver magnetic stimulation to deeper and broader brain regions compared to standard TMS. The H-coil is configured as a helmet-like apparatus, allowing magnetic fields to penetrate up to 4-6 cm beneath the skull, compared to the 1-2 cm reach of traditional TMS coils.
For a detailed comparison of TMS types, see Types of TMS.
For depression treatment, both rTMS and deep TMS generally require a series of treatment sessions spread over several weeks. A standard course of TMS therapy often involves daily sessions, five days a week, for four to six weeks, totaling about 20 to 30 treatments. Deep TMS follows a similar schedule, though the exact number of sessions may vary depending on individual response and clinical recommendations. Consistency is key, as the cumulative effect of repeated stimulation helps reinforce changes in brain activity.
Accelerated TMS protocols are designed to shorten the overall treatment timeline while maintaining effectiveness. One common approach utilizes intermittent theta burst stimulation (iTBS), which delivers magnetic pulses more rapidly and efficiently. Instead of daily sessions over weeks, iTBS protocols may involve 10 shorter treatments within a single day, compressing the entire course into just a week. This method is particularly appealing for patients seeking quicker relief without compromising therapeutic outcomes.
Implication: Deep TMS may be preferable for conditions involving deeper or more widely distributed brain circuits, whereas traditional TMS is suited for disorders associated with specific cortical areas.
See more information about TMS mapping.
| Feature | Traditional TMS | Deep TMS |
|---|---|---|
| Coil Type | Figure-8/Circular | H-Coil |
| Stimulation Depth | 1–2 cm | 4-6 cm |
| Coverage Area | Focal | Broad |
| Targeting Precision | High | Moderate |
| FDA Approvals | Depression, OCD, smoking cessation, and adolescent depression | Depression, OCD, smoking cessation, anxious depression, and late-life depression |
When considering deep TMS vs TMS, one of the most pressing questions is: which is more effective? Both have demonstrated efficacy in large clinical studies, particularly for treatment-resistant depression.
Traditional TMS: Response rates for depression typically range from 50-60%, with remission rates between 30-40%.
Deep TMS: Studies suggest similar or slightly higher response and remission rates in some populations, such as older people.
However, direct comparisons are complex, as protocols, patient populations, and outcome measures can vary.
Depression: Multiple randomized controlled trials have shown both treatments to be significantly more effective than placebo (sham stimulation), with some studies suggesting modestly higher efficacy for deep TMS in specific subgroups.
OCD: Deep TMS received FDA clearance for OCD based on large trials showing significant symptom reduction. Traditional TMS is also used for OCD due to its effectiveness.
Both traditional and deep TMS are generally well tolerated. The most common side effects include:
Mild scalp discomfort or headache at the stimulation site
Tingling or tapping sensations during treatment
Transient lightheadedness
Muscle twitching in the face or scalp
These effects are usually temporary and resolve shortly after the session.
Cognitive Effects: Neither traditional nor deep TMS is associated with cognitive impairment.
Serious Adverse Events: Uncommon but may include seizures without proper screening. Deep TMS’s broader stimulation field is not associated with higher rates of adverse effects in clinical trials.
For more information about side effects, visit the following pages:
Traditional TMS: Widely available in mental health centers, hospitals, and outpatient clinics.
Deep TMS: Availability is growing, but it remains more limited due to the specialized equipment and training required.
To explore treatment options in your area, visit TMS Therapy Near Me.
Our experienced providers treat a wide range of mental health conditions, tailoring each treatment plan to ensure optimal stimulation parameters are used for the best possible results. To explore therapies, conditions, and providers in your area, we encourage you to visit our online directory and connect with the right specialist for your needs.
Major depressive disorder is one of the most common reasons patients seek TMS therapy. By stimulating specific brain regions involved in mood regulation, TMS and deep TMS can help reduce depressive symptoms in individuals who have not fully responded to medication or psychotherapy. Regular sessions can provide long-lasting improvements in mood, daily functioning, and overall quality of life.
Anxious depression presents a unique challenge, as patients experience both depressive and anxiety-related symptoms. Deep TMS has received FDA clearance for this condition, and both TMS and deep TMS are used to regulate neural circuits linked to mood and anxiety. The broader coverage of deep TMS may be particularly helpful for patients whose symptoms involve overlapping brain regions.
OCD is associated with dysfunctional activity in brain circuits that regulate intrusive thoughts and repetitive behaviors. Deep TMS, specifically with the H-coil, has been FDA cleared for OCD, demonstrating significant reductions in symptom severity. Traditional TMS may also be applied for OCD treatment, though protocols differ from those used for depression.
TMS and deep TMS have been FDA-approved for addressing smoking addiction. By delivering repeated magnetic pulses to regions of the brain involved in craving and reward, these therapies can reduce the urge to smoke and improve quit rates. Clinical studies have demonstrated that targeting these neural pathways offers a safe, non-invasive approach for individuals struggling to overcome nicotine dependence.
Beyond depression, anxiety, OCD, and smoking, TMS research has expanded to other psychiatric disorders. By targeting deeper brain structures, deep TMS in particular has been investigated for certain mental health conditions, such as bipolar disorder. Studies suggest that the use of magnetic energy in these treatments may improve treatment outcomes across a broader spectrum of psychiatric illnesses. While more research is ongoing, the potential for broader clinical application continues to grow.
When weighing deep TMS vs TMS, several factors come into play:
Diagnosis: Deep TMS is FDA-cleared for a wider array of conditions (including MDD and OCD).
Treatment History: If traditional TMS has not produced results, deep TMS may be the next step.
Depth of Brain Target: Certain patients may benefit from deeper or broader stimulation.
Provider Expertise and Device Availability: Not all clinics offer deep TMS.
Personal Preference and Comfort: Some patients may prefer the helmet-like feel of the H-coil, while others may opt for the targeted approach of traditional TMS.
Traditional TMS is often recommended as a first-line neuromodulation treatment for major depression, especially if medications have failed or caused adverse effects.
Deep TMS may be suggested for patients with complex or refractory conditions, those seeking treatment for FDA-cleared indications like OCD, or individuals who did not respond to traditional TMS.
For additional guidance, see TMS vs rTMS.
In comparing deep TMS and traditional transcranial magnetic stimulation, it becomes clear that both approaches are valuable brain stimulation therapies with proven ability to treat depression symptoms and address other mental health conditions. Repetitive transcranial magnetic stimulation (rTMS) utilizes a magnetic coil to deliver focused stimulation to cortical regions. In contrast, deep TMS provides deeper and more extensive stimulation that can reach subcortical areas of the central nervous system. Both treatments are generally mild in terms of side effects, making them a safe alternative to more invasive options.
When considering treatment efficacy, it is essential to remember that TMS belongs to a broader family of interventions that includes electroconvulsive therapy (ECT) and vagus nerve stimulation (VNS). Each has distinct mechanisms, safety profiles, and clinical applications. Patients with devices such as cochlear implants or other implanted electronics may not be candidates for TMS due to magnetic interference, so thorough screening is always necessary. Ultimately, the choice between rTMS, deep TMS, or another form of therapy should be guided by individual needs, medical history, and professional recommendations.
