Major depressive disorder is the leading cause of disability worldwide, according to the World Health Organization, yet a substantial percentage of the people it affects will not achieve full remission from the antidepressant medications that are almost universally offered as first-line care. Deep TMS — Deep Transcranial Magnetic Stimulation — is an FDA-cleared treatment for major depressive disorder that has been available for over a decade, but many patients in the Houston area have never been referred to it, and many who have heard of it carry significant misconceptions about what it involves and how it works. At our Bellaire practice, we want to address that gap directly.
What Is Deep TMS and How Does It Work?
Deep TMS is a non-invasive brain stimulation technology that uses magnetic pulses — similar in principle to those used in MRI machines — to stimulate neurons in targeted regions of the prefrontal cortex associated with mood regulation and depression. Unlike electroconvulsive therapy (ECT), Deep TMS does not require anesthesia, does not induce a seizure, and does not produce the memory disruption that leads many patients to hesitate before brain stimulation therapies. The patient sits in a chair, wears a helmet-like device that delivers the magnetic pulses, and remains awake and conscious throughout the session. Each session typically lasts approximately 20 minutes, and patients can drive themselves to and from appointments.
The specific technology at our practice uses an H-coil — the “deep” in Deep TMS refers to this coil’s ability to stimulate neurons at greater depth and breadth within the prefrontal cortex compared to conventional figure-eight coil TMS devices. This broader, deeper stimulation field is one of the reasons BrainsWay’s Deep TMS received FDA clearance for both depression and OCD, and it is one of the clinical rationales cited in the published literature for its efficacy in patients whose cortical anatomy makes standard TMS stimulation less reliable. FDA clearance for major depressive disorder is based on multiple randomized controlled trials, including pivotal studies demonstrating significantly greater response and remission rates compared to sham treatment.
Deep TMS for Depression in Houston, TX: What to Expect
The standard treatment course for depression involves daily sessions, Monday through Friday, over a period of typically four to six weeks. This schedule — approximately 20 to 36 sessions — may feel demanding when first presented to a patient who is already fatigued by depression. We address this honestly: the time commitment is real, and we structure our scheduling around what patients can realistically manage. The good news is that each session is brief, requires no recovery time, and most patients are able to continue their regular routines — including work — throughout the treatment course. Many patients find that the routine of daily appointments, with the associated daily contact with our clinical team, provides a structure that is itself therapeutically helpful during a period when depression undermines self-organization.
One barrier we work through with patients is the misconception that Deep TMS is only for patients who have exhausted every other option. In reality, the FDA clearance for major depressive disorder does not require prior medication failures — the indication is MDD, not strictly treatment-resistant MDD (though TMS does have a separate clearance pathway for that population as well). Many patients pursue Deep TMS after experiencing intolerable side effects from antidepressants, or simply because they prefer a non-pharmacological approach to their depression treatment in Houston. We discuss candidacy openly and without gatekeeping, because we believe patients deserve to understand all of their options, not just the ones their previous providers happened to mention.
What the Research Says About Deep TMS Response Rates
The second barrier is uncertainty about whether TMS will work for them specifically. This is a legitimate scientific question, not anxiety. Clinical trial response rates for Deep TMS hover in the 60 to 70 percent range for patients with MDD, and remission rates — the threshold most patients actually care about — are typically in the 30 to 40 percent range, consistent with what is seen in many other established psychiatric treatments. We are honest about these numbers because informed patients make better treatment decisions. Results vary by individual, and the factors that predict TMS response — including depression subtype, prior treatment history, and neuroimaging findings — are areas of active research. At Dr. Prashad’s practice, the evaluation process includes a careful review of the clinical features most associated with TMS response, and we share that assessment candidly with every patient.
For patients at our Bellaire practice whose depression co-occurs with treatment resistance, the combination of Deep TMS alongside IV ketamine treatment in Houston is also available and may be considered when clinically appropriate. SPRAVATO® — FDA-approved for treatment-resistant depression and MDD with acute suicidal ideation or behavior — is a third distinct option. These treatments are not mutually exclusive and can, in some cases, be combined under a protocol designed by Dr. Prashad to address the specific neurobiological profile driving a patient’s illness. Discuss with your provider which path, or combination of paths, makes the most sense for your clinical picture.
Frequently Asked Questions
Does Deep TMS hurt?
Most patients experience a tapping or knocking sensation on the scalp during the session, which some find mildly uncomfortable in the first sessions but typically habituate to within a few visits. Serious adverse events are rare; the most common side effect is a headache during or after early sessions, which typically diminishes as treatment progresses. Deep TMS does not require sedation, anesthesia, or any recovery period.
Is Deep TMS covered by insurance for depression?
Deep TMS for major depressive disorder has FDA clearance, which provides a pathway for insurance coverage. Many commercial plans cover TMS for MDD following documentation of prior antidepressant trials, and Medicare also covers TMS under specific criteria. Prior authorization is typically required. Our team assists patients with insurance verification and prior authorization paperwork so that coverage questions do not become a barrier to treatment.
How does Deep TMS differ from ECT (electroconvulsive therapy)?
Deep TMS and ECT both use electromagnetic energy to affect brain activity, but they are fundamentally different. ECT induces a controlled seizure under general anesthesia and is associated with some degree of temporary memory disruption. Deep TMS is non-invasive, does not induce a seizure, does not require anesthesia, and does not produce the memory effects associated with ECT. Patients remain awake and alert throughout TMS sessions.
Can I take my antidepressants while doing Deep TMS?
In most cases, yes. Deep TMS for depression is commonly used alongside antidepressant medications. Dr. Prashad reviews your current medication regimen during the initial evaluation to identify any concerns and to determine whether the combination is appropriate for your specific situation.
What happens after the initial TMS treatment course?
After the initial course of four to six weeks, patients who respond are typically monitored for durability of response. Some patients maintain their improvement for extended periods; others benefit from periodic maintenance sessions. Research suggests that a retreatment protocol can recapture response for patients who relapse after initial improvement. We discuss the maintenance picture during the course itself so patients are prepared for what the longer-term approach looks like. For a deeper look at the published evidence, see our post on Deep TMS for Treatment-Resistant Depression in Houston TX.
Key Takeaways
- Deep TMS is FDA-cleared for major depressive disorder and is available at Dr. Prashad’s Bellaire practice.
- Unlike ECT, Deep TMS is non-invasive, does not require anesthesia, and does not produce memory disruption.
- The standard treatment course involves daily sessions over four to six weeks — each session lasts approximately 20 minutes with no required recovery time.
- Insurance coverage pathways exist for Deep TMS for MDD; our team assists with prior authorization.
- Results vary by individual; clinical response and remission rates, as well as factors that predict response, are discussed candidly during the evaluation.
Major depressive disorder does not have to mean indefinitely cycling through medications that are not working. Deep TMS offers a non-pharmacological, evidence-based, FDA-cleared path forward — one that many patients in the Houston area have not yet been offered, and that our Bellaire practice is equipped to provide. If you are living with depression that has been inadequately controlled, we encourage you to contact us to schedule a consultation and take the first step toward finding out whether Deep TMS, or one of our other available interventional treatments, belongs in your care plan.
References
FDA — BrainsWay Deep TMS Clearance for MDD: https://www.fda.gov/medical-devices/neurological-devices/transcranial-magnetic-stimulation-tms-devices
National Institute of Mental Health — TMS for Depression: https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies
American Psychiatric Association — Depression Treatment: https://www.psychiatry.org/patients-families/depression
JAMA Psychiatry — TMS Clinical Trials: https://jamanetwork.com/journals/jamapsychiatry
World Health Organization — Depression Fact Sheet: https://www.who.int/news-room/fact-sheets/detail/depression
About Dr. Sandhya Prashad
Dr. Sandhya Prashad, MD, is a board-certified psychiatrist who has been treating patients in the Houston area since 2011, specializing in treatment-resistant depression and interventional psychiatric care. She has personally administered over 9,000 treatments for patients whose depression has not responded to traditional antidepressants, developing deep expertise in the neurobiological factors — including seasonal triggers, environmental stressors, and genetic predisposition — that shape treatment response. Dr. Prashad’s practice offers IV ketamine therapy, SPRAVATO® (esketamine), and comprehensive psychiatric evaluation, with a commitment to finding a path forward even for the most complex and long-standing cases.
Medical Disclaimer
The information provided in this article is intended for educational purposes only and does not constitute medical advice. It is not a substitute for professional psychiatric evaluation, diagnosis, or treatment. Results vary by individual, and not all patients will experience the same outcomes from Deep TMS therapy. Always discuss your treatment options with a qualified medical provider before making any changes to your care plan. If you are experiencing a psychiatric emergency or thoughts of self-harm, please call 988 (Suicide and Crisis Lifeline) or go to your nearest emergency room immediately.