How Long Do TMS Results Last? Durability and Relapse Data

For people whose depression responds to a course of TMS, the benefit often lasts many months, but it is not permanent for everyone. The best pooled estimate finds that about two-thirds of responders are still responding at 3 months, about half at 6 months and a little under half at 12 months. A large naturalistic study in which patients stayed on antidepressants and could return for extra TMS found that about 6 in 10 responders kept their response through a year. Across studies, a fair summary is that roughly half to about 6 in 10 initial responders are still doing well at one year.

Two other findings matter as much as those averages. When depression does come back, a second course of TMS works again for most people who responded the first time. And what happens after the acute course, including medication, psychotherapy and, in some cases, maintenance sessions, appears to change the odds.

What "lasting" means in these studies

Durability research follows people who already improved. It asks whether a responder (usually at least a 50% drop on a depression scale) or a remitter (a score in the near-normal range) stays that way over follow-up. Relapse means symptoms return to the level of a depressive episode. Researchers define it with a cut-off on a rating scale, and each study chooses its own cut-off, which is one reason figures differ.

The denominator matters too. A durability figure applies to people who responded, not to everyone who started treatment. If you want to understand how often the first course works in the first place, see how response and remission are measured; this page picks up where that one ends.

The main durability studies at a glance

None of these studies had a sham control during follow-up, and the two largest single studies were sponsored by or connected to industry. They are the best data available, but they describe what happened to treated patients, not what TMS alone caused.

How TMS durability compares with other treatments

Relapse after a successful acute treatment is a feature of recurrent depression in general, not something unique to TMS. In the STAR*D medication study, people who needed more treatment steps to get well had higher relapse rates during follow-up. After ECT, which the APA guideline calls the most effective form of therapy, recurrence is high: the CANMAT 2023 guideline puts it at 60% to 80% of patients by 6 months, and in the CORE trial more than half of remitters either relapsed or dropped out within 6 months even with continuation treatment.

Those numbers come from different populations and definitions, so they cannot be lined up in a league table. The useful point is that any acute treatment for treatment-resistant depression needs a plan for what comes next. The TMS vs ECT comparison covers the acute trade-offs in more detail.

What seems to help benefit last

The research on predictors of durability is thinner than the research on predictors of initial response, but a few signals recur.

• Maintenance treatment. In the Senova meta-analysis, receiving maintenance treatment predicted a higher rate of sustained response. A 2025 consensus review reported six-month sustained response of 61.1% in studies with a maintenance protocol against 38.5% in studies without one.
• Sex. A higher proportion of women in a study also predicted better durability in the same analysis. That is a group-level finding and says little about any one person.
• Continuing antidepressant treatment. The 62.5% one-year figure from Dunner and colleagues came from patients who stayed on continuation antidepressants and could have TMS reintroduced when symptoms returned. It is not evidence that medication alone kept them well, but it reflects the setting in which those results were achieved.
• Reaching remission rather than partial response. In STAR*D, after each of the first three treatment steps, people who entered follow-up in remission relapsed less than those who did not. That was a medication study, but the principle is widely applied to TMS: a course that ends with residual symptoms leaves less margin.

What predicts whether someone responds in the first place is a separate question, covered in who responds to TMS.

If depression comes back: retreatment

The most reassuring durability finding is about retreatment. In the largest real-world cohort, 82.5% of people who had responded to a first course responded again to a second, and 54.2% remitted. Response also came sooner the second time, at a median of session 13.5 compared with 22.5 on the BDI-II, and session 12 compared with 16 on the PHQ-9. A smaller chart review found that response to the first course correlated with response to the second.

Those are retrospective, open-label data, so they likely overstate what a controlled trial would show. Still, they are consistent with the 2010 follow-up in which 32 of 38 patients whose symptoms worsened improved again with added TMS. The Clinical TMS Society's 2016 consensus recommends that when someone who benefited from TMS relapses, TMS should be reintroduced until remission is achieved again.

Insurers generally treat retreatment differently from maintenance. New York's Medicare policy, for example, allows retreatment for a relapse in a patient who previously improved by more than 50%. The details for each payer are on the Medicare TMS coverage in New York page and the related insurer pages in this guide.

Maintenance TMS: what has been tested

Maintenance means scheduled TMS sessions after a successful course, given before symptoms return. It sounds logical, but the trials are small and their results are mixed.

The pattern across these trials is that clustered sessions look more promising than a single monthly session. The 2025 consensus review puts it this way: maintenance TMS is promising, but the frequency needed is unclear, clustered protocols may prolong remission, and monthly single sessions may not help. It also notes that the common end-of-course taper has little empirical support.

Guideline bodies rate the evidence as weak. CANMAT 2023 gives rTMS Level 1 evidence for acute efficacy but only Level 3 for maintenance, and NICE has asked for more evidence on maintenance and long-term outcomes. Claims that TMS results are permanent, or that maintenance TMS is proven to prevent relapse, go beyond the data.

Coverage follows the evidence. New York Medicare states that maintenance therapy is not considered reasonable and necessary, and at least one New York Medicaid plan says the evidence does not support maintenance rTMS. Because of that, the consensus review notes that many practitioners treat acutely, monitor for relapse and retreat when needed. For a patient-level view of how maintenance schedules work in practice, see the Mind Body Seven guide to TMS maintenance sessions.

Accelerated and newer protocols: durability is still unknown

Most of the durability data above come from standard once-daily courses. For accelerated protocols the follow-up is much shorter. The FDA summary for SAINT states that effectiveness was evaluated at four weeks after treatment and "has not been established beyond the timepoints evaluated." The 2025 consensus review likewise calls for more studies of long-term durability with SAINT. If you are weighing an accelerated course or the SAINT protocol, a faster course does not yet come with evidence that it lasts as long, or longer.

A practical plan for after the course

Because there is no single proven maintenance strategy, the consensus literature lists several options: repeat rTMS, medication, psychotherapy and others. In practice, a sound plan usually includes:

1. A baseline score. Keep the rating scale used during treatment, such as the PHQ-9, and repeat it at regular intervals so a slide is caught early rather than after weeks of decline.
2. Early warning signs written down in advance: sleep changes, withdrawal from people, loss of interest, or the particular thoughts that came first last time.
3. A decision about medication. Whether to continue, adjust or taper an antidepressant after TMS is an individual decision to make with your psychiatrist through medication management, not on your own.
4. Psychotherapy. Skills-based therapy can protect gains and is one of the listed continuation options; see how to choose a therapy for depression.
5. A retreatment path. Know in advance how quickly you can be re-evaluated, and whether your plan covers retreatment, so a relapse does not turn into months of waiting.

Clinical TMS Society members mainly consider scheduled maintenance for people with a history of frequent relapse, defined as two or more in a year. For others, watchful monitoring plus fast retreatment is a reasonable default.

If you are thinking about suicide or are in crisis, call or text 988 (the 988 Suicide & Crisis Lifeline) or go to the nearest emergency room.

The TMS guide collects the related evidence pages, and the TMS therapy page explains how evaluation for TMS works.

Frequently asked questions

Are TMS results permanent?

Not reliably. In pooled studies, a little under half of responders were still responding at 12 months. Some people stay well for a long time, while others relapse within months. Guidelines rate the evidence for long-term maintenance as weak.

Does a second course of TMS work as well as the first?

In the largest real-world study, about 8 in 10 people who responded to a first course responded again to a second, and response came sooner. That study was retrospective, so the true figure may be lower, but retreatment is a well-supported option.

Should I stay on my antidepressant after TMS?

That depends on your history, side effects and how you responded. The one-year studies with the best durability involved patients who continued antidepressants, but there is no single rule. Decide with your psychiatrist rather than stopping on your own.

Is maintenance TMS covered by insurance?

Usually not. New York Medicare does not cover maintenance TMS, though it does allow retreatment after a relapse in someone who responded before. Commercial plans vary; see the Aetna and other insurer pages in this guide.

How soon would I know if depression is coming back?

Repeating the same rating scale used during treatment, such as the PHQ-9, every few weeks is the simplest way to see a trend before it becomes a full relapse. Agree on a score that should prompt a call to your psychiatrist.

Sources

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Educational information, not medical advice. Whether TMS or any treatment fits you is a decision to make with a psychiatrist who knows your history.