Depression is one of the most common and debilitating mental health conditions in the world, affecting hundreds of millions of people. For many, standard treatments, such as antidepressant medications, therapy, or a combination of both, provide meaningful relief. But for a significant subset of patients, depression persists despite multiple medication trials, adequate therapy, and genuine effort. This is called treatment-resistant depression, and it has historically left patients with limited options and diminishing hope.
Transcranial magnetic stimulation (TMS) therapy has emerged as a powerful, FDA-cleared alternative for this population, offering clinically proven results without the systemic side effects that make medication intolerable for many. At NeoPsych in Los Angeles, Dr. Thomas Hughes and the team provide state-of-the-art TMS therapy that has helped numerous patients reclaim their lives from treatment-resistant depression.
What Is TMS Therapy?
Transcranial magnetic stimulation is a non-invasive brain stimulation therapy that uses precisely targeted magnetic pulses similar in strength to those used in MRI machines to stimulate nerve cells in the regions of the brain associated with mood regulation. The primary target for depression treatment is the dorsolateral prefrontal cortex (DLPFC), a region of the frontal brain that shows decreased activity in patients with depression.
TMS is administered through a device placed on the scalp. The magnetic pulses pass painlessly through the skull and stimulate the underlying cortical tissue, inducing small electrical currents that activate neurons in the target region. Over the course of treatment, this stimulation is thought to produce neuroplastic changes that literally rewire the brain’s patterns of activity toward healthier functioning.
The procedure is:
- Non-invasive: No surgery, no anesthesia, no implants
- Outpatient: Performed in a clinic setting; patients drive themselves to and from appointments
- Non-systemic: The magnetic fields act locally on the brain and don’t circulate through the body, avoiding the systemic side effects of medications
- FDA-cleared: The FDA cleared TMS for treatment-resistant major depressive disorder in 2008, and subsequent clearances have expanded its approved applications
Who Is a Candidate for TMS Therapy?
TMS at NeoPsych in Los Angeles is most commonly considered for:
Patients with treatment-resistant depression (TRD): Defined as depression that has not responded adequately to at least one (and typically two or more) antidepressant medications at adequate doses and durations. This represents approximately one-third of all patients with major depressive disorder.
Patients who cannot tolerate antidepressant medications: Side effects of antidepressants, including weight gain, sexual dysfunction, sedation, emotional blunting, and gastrointestinal symptoms, cause many patients to discontinue medication before it can work, or to decline medication trials entirely. TMS offers these patients an effective alternative path.
Patients who want to avoid systemic treatment: Some patients, including pregnant women, nursing mothers, or those with medical conditions that make medication problematic, prefer or require a non-pharmacological approach. (TMS safety in pregnancy is still being studied; this should be discussed with Dr. Hughes.)
Patients seeking an adjunct to current treatment: TMS can be used alongside ongoing psychotherapy and, when appropriate, in combination with medication.
The TMS Treatment Experience at NeoPsych
The first step is a comprehensive evaluation with Dr. Thomas Hughes to review the patient’s psychiatric history, previous treatments, current symptoms, and appropriateness for TMS. Medical history is reviewed to ensure there are no contraindications (such as metallic implants in or near the head, a history of seizures, or other relevant factors).
Mapping Session
Before the first treatment, a mapping session is conducted to identify the exact location and intensity of stimulation to be used for the patient. The motor threshold, the minimum magnetic intensity needed to produce a visible twitch in the thumb, is determined and used to calibrate the treatment intensity.
Treatment Sessions
A standard TMS course for depression consists of daily sessions (Monday through Friday) for approximately six weeks, typically 30 to 36 treatment sessions total. Each session lasts between 20 and 40 minutes, depending on the protocol used.
During the session, patients sit in a comfortable chair while the TMS coil is positioned over the scalp at the treatment site. The device delivers rapid sequences of magnetic pulses. Patients hear clicking sounds during stimulation and feel a tapping sensation on the scalp. Reading, listening to music, or simply resting are all fine during treatment. At NeoPsych, patients report that Dr. Hughes and the clinical team create a welcoming, unhurried atmosphere that makes the treatment experience genuinely comfortable.
Advanced TMS Protocols
In addition to conventional TMS, NeoPsych offers access to newer protocols that have expanded the speed and efficacy of treatment:
Theta Burst Stimulation (TBS): An FDA-cleared TMS protocol that delivers the same stimulation as conventional TMS in a significantly shorter session, often just three minutes. Theta burst stimulation has equivalent efficacy to standard TMS and allows for greater flexibility in scheduling.
Accelerated TMS / SAINT Protocol: Pioneered at Stanford, the Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) protocol involves multiple TMS sessions per day over five days, using individualized targeting based on neuroimaging. This accelerated approach has shown remarkable results in research settings, with many patients experiencing rapid and profound improvements in depressive symptoms.
What Results Can Patients Expect?
TMS is not a magic cure, and realistic expectations are an important part of the treatment planning process at NeoPsych. That said, the clinical evidence for TMS in treatment-resistant depression is genuinely compelling:
- In clinical trials, approximately 50% to 60% of patients experience a significant reduction in depressive symptoms (defined as a 50% or greater reduction on validated rating scales)
- Approximately 30% to 35% of patients achieve full remission (symptoms return to normal range)
- Response rates in real-world clinical settings are consistent with these trial findings
- Most patients who respond do so by the fourth to sixth week of treatment; some begin to notice changes earlier
These numbers are particularly meaningful in the context of treatment-resistant depression, where previous medication trials have failed to provide relief.
How Long Do TMS Results Last?
The durability of TMS response is a common and important question. Research shows that response to TMS is generally sustained:
- Many patients maintain significant improvement for six months or longer following a course of treatment
- Some patients experience full, sustained remission
- Those who experience recurrence of depression often respond to subsequent courses of TMS (“re-treatment”), which is an important option
At NeoPsych, maintenance TMS protocols, including periodic single sessions or brief re-treatment courses, are available to help patients preserve their gains over the long term.
Side Effects and Safety Profile
One of the most significant advantages of TMS for patients who have struggled with medication side effects is its favorable safety profile. The most common side effects of TMS are:
- Headache: Mild to moderate headache, particularly after early sessions, affects some patients and typically resolves within an hour. Over-the-counter analgesics are generally effective.
- Scalp discomfort: A tapping or discomfort sensation at the treatment site during stimulation; this typically diminishes as patients adapt to the sensation over several sessions.
- Rare risk of seizure: The risk of a seizure during TMS is very low (less than 1 in 10,000 treatment sessions) and appropriate patient screening significantly minimizes this risk.
TMS does not cause memory problems, cognitive impairment, sedation, weight gain, sexual dysfunction, or any of the systemic side effects commonly associated with antidepressant medications. Patients leave their TMS sessions able to drive, work, and go about their day without impairment.
Combining TMS with Psychotherapy
TMS is most effective when integrated with appropriate psychiatric care and psychotherapy. At NeoPsych, Dr. Thomas Hughes takes a comprehensive approach that considers the full picture of each patient’s mental health, not just the neurobiological dimension addressed by TMS, but the psychological, relational, and behavioral factors that also contribute to depression.
Patients undergoing TMS are encouraged to continue or begin psychotherapy (particularly cognitive behavioral therapy, which has robust evidence for depression) alongside their TMS treatment course.
Taking the Next Step
If you or someone you love has been living with depression that hasn’t responded to multiple treatments, TMS therapy at NeoPsych in Los Angeles may represent the breakthrough that has been missing. Dr. Thomas Hughes and the NeoPsych team combine clinical expertise with genuine compassion for patients who have often spent years struggling. Contact NeoPsych today to schedule a TMS evaluation and learn whether this innovative, evidence-based treatment is the right next step for you.