Standard transcranial magnetic stimulation helps many people with depression — but for patients with treatment-resistant depression (TRD), a form that has not responded to at least two antidepressant trials, standard TMS may not go deep enough to reach the brain structures most involved in their symptoms. That gap is exactly what Deep TMS was designed to address. At the Houston Center for Advanced Psychiatric Treatment, we use the BrainsWay Deep TMS system specifically because it reaches further than conventional TMS coil technology — and for our patient population, that distinction matters.
What Makes Treatment-Resistant Depression Different
Treatment-resistant depression (TRD) is not a failure of effort or willpower. Clinically, it refers to major depression that has not responded adequately to at least two antidepressant medications taken at therapeutic doses for a sufficient duration. For patients in this category, the biology of their depression may involve neural circuits that oral medications do not reliably reach — which is why interventional approaches like Deep TMS exist.
The prefrontal cortex — the brain region most associated with mood regulation, decision-making, and emotional processing — is a primary target in depression treatment. In many people with TRD, this region is underactive, and standard pharmacological approaches produce limited effect on it. Magnetic stimulation applied directly to these circuits offers a different mechanism of action entirely, one that does not depend on systemic medication absorption or neurotransmitter metabolism. Our post on 4 Things We Now Know About Treatment-Resistant Depression explores the neuroscience behind TRD in greater depth.
Standard TMS vs. Deep TMS: What the Difference Means Clinically
Conventional TMS systems use a figure-8 coil that stimulates cortical tissue to a depth of roughly 1.5 to 2 centimeters below the skull. For many patients with depression, that depth is sufficient. For others — particularly those with TRD or co-occurring anxiety — the relevant circuits sit deeper, and surface stimulation may not engage them effectively.
The BrainsWay Deep TMS system, which we use at our practice, employs a patented H-coil integrated into a padded helmet. This coil design penetrates up to 4 centimeters beneath the skull, reaching the anterior cingulate cortex and other structures involved in mood regulation that are less accessible to standard coils (BrainsWay). Research on Deep TMS demonstrates its effectiveness in reaching deeper brain structures, and it holds FDA clearances for both major depressive disorder and OCD (BrainsWay). Clinical data cited by BrainsWay shows that Deep TMS combined with medication produces significantly higher remission rates than medication alone — 60% versus 11% respectively.
For patients who have completed a standard TMS course without adequate response, this difference in reach is clinically meaningful, not just technical. The broader stimulation pattern also reduces the focal discomfort some patients experience with figure-8 coils, which can affect tolerability across a full treatment course. You can learn more about what our TMS Therapy in Houston, TX program involves and how we approach patient care.
How Deep TMS Works at Our Practice
At the Houston Center for Advanced Psychiatric Treatment, Deep TMS sessions take place in a private treatment room. During each session, a helmet equipped with the H-coil is placed on the head and delivers magnetic pulses to targeted brain regions. Most patients describe the sensation as a light tapping on the scalp. There is no anesthesia, no sedation, and no recovery period — patients can drive themselves to and from appointments and return to their normal routine the same day.
A standard Deep TMS course for depression runs four to six weeks, with sessions five days per week. Each session takes approximately 20 minutes, with the total visit including paperwork and any additional steps running 30 to 40 minutes. Research consistently demonstrates that TMS promotes neuroplasticity — the brain’s capacity to form and strengthen new neural connections — which is the underlying mechanism for its lasting antidepressant effects (PMC: TMS Therapy and Neuroplasticity).
We also offer combination treatment for patients for whom Deep TMS alone may not be sufficient. The ONE-D TMS: One-Day Depression Treatment protocol, for patients with significant anxiety alongside depression or those who have not previously responded to either modality alone, delivers multiple theta burst treatments on the same day as an IV ketamine infusion. This approach is synergistic: ketamine enhances neuroplasticity, creating conditions that may allow Deep TMS to produce more durable effects. Results vary by individual, and Dr. Prashad evaluates each patient’s history carefully before recommending a combination approach.
What the Evidence Shows
Deep TMS has been evaluated in more than 60 clinical studies at institutions worldwide, with results published in peer-reviewed journals. The BrainsWay system received FDA clearance for depression in 2013 and for OCD in 2018. These are not experimental designations — they reflect a substantial evidence base that has been reviewed by the FDA and replicated across multiple centers (BrainsWay). Independent research further supports TMS’s role in strengthening neural pathways associated with mood regulation, providing a biological rationale for why the effects persist beyond the treatment course itself (PMC: TMS Therapy and Neuroplasticity).
For patients with TRD, the comparison to standard rTMS is particularly relevant. Data from BrainsWay’s multicenter trials shows superior depression relief and greater symptom reduction with Deep TMS than with standard figure-8 coil stimulation — findings that directly inform why we invested in this system for our practice. Results vary by individual, and not every patient will achieve the same degree of response. For additional context on how Deep TMS compares to standard approaches, see our coverage of how ‘Deep’ TMS Beats Standard TMS, Meds for Severe Depression.
Addressing Two Common Barriers
Insurance and cost. Deep TMS for major depressive disorder is covered by Medicare and most major private insurance providers when prior treatments have been unsuccessful. At our practice, we handle insurance verification and prior authorization before treatment begins, so patients are not left to navigate that process alone. For conditions or protocols not covered by insurance, we discuss self-pay options during consultation. We are transparent about cost before any commitment is made.
The fear that nothing will work. Patients who come to us after a failed standard TMS course often arrive with a reasonable degree of skepticism. That skepticism is understandable — and we take it seriously. What we can offer is a genuine clinical distinction: Deep TMS reaches brain structures that standard TMS does not. That is not a marketing claim; it is a function of coil geometry and the physics of magnetic field penetration. Whether that distinction translates to meaningful improvement for any individual patient depends on factors we assess at evaluation. We do not offer guarantees, but we do offer an honest conversation about what Deep TMS can and cannot do.
Frequently Asked Questions
How is Deep TMS different from the TMS I already tried? Standard TMS uses a figure-8 coil that stimulates cortical tissue at a relatively shallow depth. Deep TMS uses a patented H-coil that penetrates up to 4 centimeters beneath the skull, reaching structures like the anterior cingulate cortex that are involved in mood regulation and are less accessible to conventional coils. If your prior TMS course used a figure-8 coil, Deep TMS may engage different circuits. We review your full treatment history during consultation to assess whether Deep TMS is an appropriate next step.
Will I need to stop my current medications to do Deep TMS? No. Deep TMS is safe to combine with psychiatric medications and psychotherapy. It does not require stopping antidepressants and is often used alongside existing medication management. Dr. Prashad reviews your full medication regimen as part of the evaluation process.
How soon do patients notice a difference? Response timelines vary considerably by individual. Most patients in clinical trials showed meaningful improvement by the end of the standard 4–6 week course, with some noting changes earlier. Results vary, and we discuss realistic expectations during your consultation rather than offering a fixed timeline.
Is Deep TMS covered by my insurance? Deep TMS for major depressive disorder is covered by Medicare and most major private insurance providers when prior treatments have been unsuccessful. Coverage for OCD and off-label protocols varies by insurer. We verify your specific coverage before treatment begins so there are no surprises.
What happens if Deep TMS doesn’t produce enough improvement? For patients who do not achieve adequate response with Deep TMS alone, we may discuss combination approaches — including the IV Ketamine + Deep TMS protocol — or other interventional options available at our practice. We do not treat a single treatment as the only path forward, and we stay engaged with you across your care. Learn more about Ketamine Treatment in Houston, TX as one such option.
Key Takeaways
- Deep TMS uses a patented H-coil that stimulates up to 4 centimeters beneath the skull, reaching brain structures involved in mood regulation that standard TMS coils do not reliably engage.
- The BrainsWay system we use holds FDA clearances for both major depressive disorder and OCD, with an evidence base across more than 60 clinical studies.
- Deep TMS produces lasting effects through neuroplasticity — the strengthening of neural pathways associated with mood — not through systemic medication.
- For patients who have not responded to standard TMS, the added depth of Deep TMS represents a clinically meaningful difference, not a marketing distinction.
- Deep TMS for MDD is covered by Medicare and most major private insurers; our team handles prior authorization before treatment begins.
For patients in Houston who have already tried standard TMS without sufficient relief, there is a specific clinical reason to consider what Deep TMS offers differently. We review every patient’s full treatment history before making any recommendation — because the right next step depends on what has already been tried and why it may not have worked. Call us at 832-436-4055 or schedule a consultation online to discuss whether Deep TMS is an appropriate option for you. We will give you a direct answer.
References
BrainsWay Deep TMS Device. BrainsWay. https://www.brainsway.com/
Deep TMS. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC10523198/
TMS Therapy and Neuroplasticity. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC9313265/
Medical Disclaimer
The information in this blog is for educational purposes only and does not constitute medical advice. Deep TMS and other interventional treatments for depression should only be pursued under the supervision of a licensed psychiatric provider who is familiar with your full medical and psychiatric history. Individual results vary. If you are experiencing a mental health crisis or thoughts of self-harm, please call or text 988 to reach the Suicide and Crisis Lifeline or go to your nearest emergency room.