For anyone preparing to start a TMS course, one question tends to surface early: if it works, will it keep working? It is a reasonable thing to ask. Depression can return, and after trying treatments that have lost effect over time, many people want an honest answer about durability before committing to another course of therapy.
The evidence on how long TMS results for depression last is encouraging, though not simple. Understanding what the research shows, and what influences longevity, helps patients set realistic expectations and make the most of treatment.
Response vs Remission: Why the Distinction Matters
Before looking at how long results last, it helps to understand what those results actually are. In clinical research, response and remission describe different outcomes. Response usually means a meaningful reduction in symptoms, often a 50% or greater improvement on a standard depression scale. Remission means symptoms have reduced to the point where the person no longer meets the usual threshold for a depressive episode.
What the Research Shows
Long-term studies suggest that many people who respond to TMS continue to feel better for months after treatment. In a large multisite follow-up study published in The Journal of Clinical Psychiatry, 257 patients with pharmacoresistant major depression were followed for 12 months after an acute TMS course. Among the 120 patients who met response or remission criteria at the end of acute treatment, 62.5% maintained response criteria across the full follow-up period. Among patients who entered follow-up in full remission, 70.5% did not relapse over 12 months.
A broader systematic review and meta-analysis also found that, among people who initially responded to rTMS, sustained response rates were 66.5% at 3 months, 52.9% at 6 months, and 46.3% at 12 months. Senova et al., 2019
| Time After Treatment | Approx. Response / Durability Finding |
Key Observation |
|---|---|---|
| End of acute course | 58.0% clinician-rated response; 37.1% remission | Real-world acute outcomes in 307 patients. Carpenter et al., 2012. |
| 3 months | 66.5% sustained response among initial responders | Meta-analysis of durability studies. Senova et al., 2019. |
| 6 months | 52.9% sustained response among initial responders | Benefit often persists, though some relapse occurs. Senova et al., 2019. |
| 12 months | 46.3% sustained response among initial responders | Around half of responders maintain meaningful benefit at one year. Senova et al., 2019. |
| 12 months, responder/remitter subgroup | 62.5% maintained response across follow-up | Large multisite naturalistic study. Janicak et al., 2014. |
| 12 months, full-remission subgroup | 70.5% did not relapse | Remission appears more durable than partial response. Janicak et al., 2014. |
These findings should not be read as a direct head-to-head comparison with ECT, because the studies differ in design and patient groups. However, relapse after ECT is also a known issue: a meta-analysis of post-ECT outcomes found that 51.1% of patients relapsed by 12 months despite continuation pharmacotherapy. Jelovac et al., 2013
What Affects How Long Results Last?
No two people respond identically to TMS. The strongest and most consistent signal is the depth of initial improvement: people who reach remission tend to hold their gains longer than those with partial improvement. The 2014 multisite follow-up study found that responders and remitters were more likely to maintain benefit, and that symptom return was most common in the first 6 months after treatment. Janicak et al., 2014
A systematic review of relapse predictors also found that residual symptoms, comorbid anxiety, and the strength of acute response may influence relapse risk, while noting that more research is needed. Yip et al., 2019
Practical relapse-prevention planning may include ongoing psychiatric review, continuing medications or psychotherapy where recommended, monitoring early warning signs, and considering booster or retreatment sessions if symptoms return. Lifestyle measures such as regular sleep, exercise, reduced alcohol or substance use, and a balanced diet support depression recovery generally, but the evidence that lifestyle alone extends TMS durability is limited.
Maintenance and Booster Sessions: Extending the Benefits
For patients whose symptoms begin to return, retreatment can be effective. In a 6-month multisite open-label study, patients who had benefited from TMS were monitored and offered additional TMS if symptoms worsened. Of those who needed reintroduction treatment, 84.2% regained symptomatic benefit. Janicak et al., 2010
Maintenance schedules vary, and the evidence is still developing. A systematic review of maintenance TMS protocols found that most maintenance approaches reduced relapse risk, but very infrequent schedules appeared less effective; protocols using more than two stimulations per month were more consistently associated with maintained benefit. Cotovio et al., 2023
| Approach | Typical Schedule | Benefit |
|---|---|---|
| Taper-off sessions | Gradual reduction after the acute course | May help transition out of daily treatment; used in several durability studies. |
| Clustered maintenance | Several sessions grouped over a few days, repeated periodically | Some studies suggest this may reduce relapse risk. |
| Booster course | Short course when early symptoms return | Can restore benefit without waiting for full relapse. |
| Full retreatment | A new acute course when symptoms have fully returned | Appropriate when relapse is more established. In Australia, Medicare covers up to 15 retreatment sessions for eligible patients who previously improved and later relapsed. |
Early intervention matters. Catching the first signs of returning symptoms and acting on them with a short booster course may be more efficient than waiting until symptoms are severe again.
Frequently Asked Questions
Is TMS a permanent cure for depression?
No. TMS is not considered a permanent cure, but it can produce long-lasting remission for many patients. Benefits can persist for months or longer, and if symptoms return, retreatment is often effective.
When do most patients start noticing improvement?
Improvement is usually gradual. Some people notice changes in sleep, energy, motivation, or mood during the first few weeks, while others improve later in the course. A recent trajectory study found that some patients have a delayed pattern of improvement across a 20-session course. Briley et al., 2024
What should I do if my symptoms start returning after TMS?
Contact your treating team promptly. Early action, before a full relapse, may allow for a shorter booster or retreatment plan rather than a full acute course.
Does a second course of TMS work as well as the first?
Many patients who respond to an initial course respond again. In a prospective 6-month study, 84.2% of patients who experienced symptom worsening and received adjunctive TMS regained symptomatic benefit. Janicak et al., 2010
Does lifestyle affect how long TMS results last?
Lifestyle can support depression recovery generally, especially regular sleep, exercise, healthy eating, reduced alcohol or substance use, and continued psychological support where recommended. However, direct evidence that lifestyle alone extends TMS results is limited, so it is best viewed as part of a broader relapse-prevention plan rather than a substitute for clinical follow-up.
How many sessions does a standard course involve in Australia?
Under the Medicare Benefits Schedule, eligible patients can access an initial rTMS treatment course of up to 35 sessions. The RANZCP notes that rTMS is usually delivered multiple times per week, most commonly 5 times weekly over 4 to 6 weeks.
Take the Next Step With Sydney TMS
At Sydney TMS, we understand that starting treatment is only part of the journey. Our psychiatrist-led team monitors your progress throughout your 35-session course and works with you to plan what comes next, whether that means watchful monitoring, a taper-off schedule, or booster sessions if symptoms return.
We can bulk-bill the initial assessment with a referral and Medicare card. Our outpatient suites in Bondi, Campbelltown, Castle Hill, and St Leonards are designed around your routine. If you have been living with treatment-resistant depression and want to understand whether TMS is right for you, get in touch with us or call 1300 177 144 to book your consultation.
