Response vs Remission: How TMS Success Is Measured

In TMS research, "response" usually means depression scores fell by at least 50% from where they started, and "remission" means the score dropped below a low cutoff that signals minimal symptoms, such as under 10 on the 21-item Hamilton scale or under 5 on the PHQ-9. There is no single TMS success rate. Sham-controlled trials, open-label clinic data and company registries use different patients, scales and counting rules, so reported figures range from about 14% remission in a strict NIMH trial to over 80% response in open-label registries.

Knowing how each number was produced is the only way to compare them. This page explains the definitions, the scales, and the questions that expose an inflated success rate.

Response, remission and the words around them

• Response: a reduction of at least 50% in a depression rating score from baseline, the definition used across most TMS trials.
• Remission: a score at or below a scale-specific cutoff that indicates minimal residual symptoms. Remission is the stricter and more meaningful target.
• Recovery: an expert task force convened by the American College of Neuropsychopharmacology recommended reserving this term for at least 4 months of remission without relapse, and defining remission itself as minimal symptoms maintained for 3 consecutive weeks. Most TMS trials measure remission at a single end-of-treatment visit, which is a looser standard.
• Relapse and recurrence: a return of the episode after remission (relapse) or a new episode after recovery (recurrence), as the same task force defines them. Durability data are covered in how long TMS results last.

The task force also noted a weakness of "response": because it is a percentage of the starting score, it depends heavily on a single baseline measurement. Someone who starts very severe can "respond" while still quite depressed.

The scales and the cutoffs TMS studies use

The PHQ-9 is worth knowing because many clinics track it session by session. It scores each of nine symptoms from 0 to 3, and scores of 5, 10, 15 and 20 mark mild, moderate, moderately severe and severe depression. A remission cutoff of under 5 therefore means landing below the mild range. The MADRS was designed in 1979 specifically to be sensitive to change with treatment.

For OCD, a different convention applies: TMS trials have defined response as at least a 30% drop on the Y-BOCS.

Beyond the 50% line

Response and remission are yes-or-no labels laid over a continuous change, and they hide a lot. A person who improves by 45% counts as a non-responder, even though that change may feel substantial. For this reason some studies also report the size of change or a threshold for clinically meaningful improvement. A 2025 NeuroStar registry analysis of adolescents and young adults, for example, used a drop of at least 6 points on the PHQ-9 as meaningful improvement: about 70% met it, and fewer than 1% reported meaningful worsening. That analysis was retrospective and open-label, so it shares the limits described below.

Speed is another dimension the labels miss. In a 2026 retreatment cohort, patients who had responded to TMS before responded again earlier in the second course, at a median of session 13.5 instead of 22.5 on the BDI-II, and 12 instead of 16 on the PHQ-9. In a 2026 deep TMS trial, an accelerated schedule reached remission in 21 days versus 28 with the standard schedule, while overall change at week 6 was similar. Two treatments can have the same remission rate and still differ in how quickly people feel better.

Finally, the categories say nothing about function: work, relationships, sleep and energy. The ACNP task force called day-to-day functioning and quality of life important secondary end points, even though they were left out of its formal definitions. In practice, a good outcome is one you notice in your life, not only on a questionnaire.

Why TMS success rates vary so much

1. Was there a sham comparison?

People treated with sham TMS improve a lot. A meta-analysis of 61 trials found a within-group sham effect size of about 0.8, and in the adolescent NeuroStar trial, 36.4% of the sham group met response criteria. A clinic's 70% response rate includes that placebo share. In sham-controlled trials, the remission advantage of active TMS over sham has typically been about 9 to 18 percentage points.

2. Who was counted?

Intent-to-treat (ITT) analyses include everyone who started; completer or per-protocol analyses drop people who stopped early or lacked follow-up data. The SAINT open-label study shows the effect on a small scale: 19 of 21 completers (90.5%) remitted, versus 19 of 22 (86.4%) when everyone enrolled is counted. In Levkovitz 2015, deep TMS remission was 32.6% per-protocol and 30.4% ITT. In a large BrainsWay post-marketing analysis, the widely quoted 65.3% remission counted only patients who had data on at least one scale at 30 sessions.

3. Which scale, and who filled it in?

The same patients can produce different numbers on different scales. In Carpenter 2012, clinician-rated (CGI-S) remission was 37.1%, while patient-rated remission was 28.7% on the PHQ-9 and 26.5% on the IDS-SR. In the BrainsWay analysis, remission was highest when measured with the clinician-rated HDRS (72%). Some analyses use whichever scale was "most rated" for each patient, which mixes measures.

4. When was it measured?

Outcomes at week 4, week 6, after a taper, or months later are not interchangeable. In the BrainsWay data, response was 73.6% after 20 sessions and 81.6% after 30. Durability falls over time: among initial responders in a 2019 meta-analysis, sustained response was 66.5% at 3 months and 46.3% at 12 months.

5. Who was treated?

Less treatment-resistant patients do better; in the NIMH trial, most remitters had low levels of prior resistance. In the ONE-D single-day series, 40.6% of patients had previously responded to TMS, a group in which higher remission would be expected. Registry data come from sites that choose to report.

6. Who analyzed the data?

Many real-world reports are written by device companies or clinic operators. That does not make them wrong, but it is a reason to look for independent, blinded data. In ONE-D, a single unblinded rater employed by the companies involved did every clinician rating.

Same treatment, very different numbers

None of these is "the" TMS success rate. They measure different things in different people. The registry range in particular is open-label, mostly self-report and partly completers only, and should not be presented next to RCT rates as if comparable. The trials behind these numbers are summarized in the landmark TMS trials.

How to read a clinic's success rate

When a clinic or advertisement quotes a percentage, these questions reveal what it means:

1. Is it response or remission?
2. Which scale, and was it clinician-rated or self-reported?
3. Does it include everyone who started, or only those who finished?
4. At what point was it measured: end of treatment, or months later?
5. Is it from the clinic's own patients, a company registry or a published trial? If a trial, was there a sham arm?
6. Were patients new to TMS, or did the sample include previous responders?

A trustworthy answer will be specific. A single headline number with no scale, denominator or time point tells you very little. The same logic applies to newer protocols; see one-day TMS and the SAINT guide for worked examples.

Putting it in context

For comparison, in the STAR*D medication study, remission on the QIDS-SR16 was 36.8% at the first treatment step and fell to 13.0% by the fourth. A later reanalysis using the protocol-specified blinded scale put cumulative remission at 35.0% rather than the originally reported 67%, a figure the original investigators disputed. The lesson is the same as for TMS: definitions change results. The STAR*D page covers that debate.

For an individual, the most useful measure is your own scores over time. Many teams use the PHQ-9 or a clinician scale at regular points through the course, which also helps decide whether to extend, stop or change treatment; the patient side of this is covered in tracking progress during TMS. Whether early change predicts the final result is discussed in who responds to TMS.

The TMS guide links every evidence page in this series, and the TMS therapy page explains how to start a conversation about whether TMS is an option.

Frequently asked questions

What is a realistic TMS success rate?

It depends on the definition. Guideline summaries put response at roughly 25% to 50% depending on the population and how trials are pooled, while open-label clinic data report higher figures. Ask which definition and which population a number refers to.

Is response or remission more important?

Remission. Response means meaningful improvement, but people who respond without remitting often have lingering symptoms. Remission, ideally sustained over weeks, is the better treatment goal.

Why do clinics use the PHQ-9?

It is short, self-administered and can be repeated each week, which makes it practical for tracking change. Clinician-rated scales such as the HAM-D or MADRS are more common in trials.

If I respond but do not remit, what happens next?

Options include extending the course, adjusting medication or psychotherapy, or considering other treatments. The decision depends on how much you improved and how long it took. See what if TMS does not work.

Can I compare one clinic's success rate with another's?

Only if they use the same scale, the same definition, the same time point and the same way of counting dropouts. In practice that is rare, so direct comparisons are usually misleading.

Sources

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23. VA/DoD Clinical Practice Guideline for the Management of Major Depressive Disorder. U.S. Department of Veterans Affairs / Department of Defense, 2022. healthquality.va.gov
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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.