TMS therapy uses focused magnetic pulses to stimulate underactive brain circuits linked to depression and OCD — without medication or anesthesia. Most patients complete 36 outpatient sessions over four to six weeks and experience significant symptom relief with minimal side effects.
What Is TMS Therapy?
Transcranial Magnetic Stimulation (TMS) is a non-invasive, FDA-cleared treatment for major depressive disorder (MDD) and obsessive-compulsive disorder (OCD). It works by delivering brief magnetic pulses through the scalp to targeted regions of the brain. Unlike antidepressants, TMS does not circulate through the bloodstream, which means it produces no systemic side effects such as weight gain, sexual dysfunction, or sedation.
TMS was first cleared by the FDA for treatment-resistant depression in 2008. Since then, it has helped hundreds of thousands of patients across the United States — including many right here in New Jersey — achieve meaningful, lasting relief when medications alone have fallen short.
At Hamilton Psychiatric Services in Hamilton, NJ, Dr. Mirza uses the BrainsWay Deep TMS system, the most clinically validated form of TMS available, to deliver personalized care for depression and OCD. Learn more about our TMS therapy services.
How TMS Works in the Brain
To understand why TMS works, it helps to know what happens in the brains of people with depression. Research consistently shows that depression is associated with reduced activity in the left dorsolateral prefrontal cortex (DLPFC) — the part of the brain responsible for regulating mood, motivation, and emotional responses.
TMS therapy targets this exact area. Each magnetic pulse creates a small electrical current in the underlying brain tissue, which activates neurons that have become underactive. Over the course of a full treatment course, this repeated stimulation produces neuroplastic changes — essentially re-training the brain's mood-regulation circuits to function more normally.
Key mechanisms include:
- Neuronal activation: Magnetic pulses depolarize neurons in the DLPFC, increasing their firing rate.
- Neuroplasticity: Repeated sessions strengthen synaptic connections in mood-regulating circuits over time.
- No systemic effects: The magnetic field acts only on the targeted brain region — it does not enter the bloodstream or affect other organs.
- OCD circuitry: For OCD, TMS targets the anterior cingulate cortex and related prefrontal regions that drive obsessive-compulsive loops.
This targeted, drug-free mechanism is why TMS is such a compelling option for patients who have not found adequate relief from antidepressants or who cannot tolerate medication side effects.
BrainsWay Deep TMS vs. Standard TMS
Not all TMS systems are the same. The two primary types are standard (figure-8 coil) TMS and BrainsWay Deep TMS, which uses a patented H-coil technology.
- Standard TMS: Uses a figure-8 coil that stimulates a relatively shallow and narrow area of cortex (approximately 0.7 cm depth). Effective for depression but limited in its ability to reach deeper brain structures.
- BrainsWay Deep TMS: The H-coil reaches deeper brain tissue (up to 4 cm) and activates a broader cortical volume. This allows for more comprehensive stimulation of the neural circuits involved in both depression and OCD. BrainsWay Deep TMS is the only TMS system FDA-cleared for both MDD and OCD, and it holds the largest body of peer-reviewed clinical evidence of any TMS device.
At Hamilton Psychiatric Services, we specifically chose the BrainsWay system because of this superior depth of penetration, its dual FDA clearances, and its strong real-world outcomes data.
What a Typical TMS Treatment Course Looks Like
A standard TMS treatment course for depression consists of 36 sessions delivered over four to six weeks, with five sessions per week. Each session lasts approximately 20 minutes. For OCD, the protocol may differ slightly based on clinical guidelines.
Here is what the typical progression looks like:
- Weeks 1–2: Initial sessions. Some patients begin noticing subtle improvements in sleep, energy, or concentration.
- Weeks 3–4: Many patients report the first meaningful lift in mood, reduced anxiety, or greater motivation.
- Weeks 5–6: Full therapeutic effect develops. The majority of responders experience significant symptom reduction by the end of the course.
- After treatment: Many patients maintain their improvement for months or longer. Some return for periodic maintenance sessions.
TMS does not require any time off work. Patients drive themselves to and from appointments and resume normal activities immediately after each session.
What a Single TMS Session Feels Like
Many patients are understandably curious — or nervous — about what TMS actually feels like. Here is what to expect at a typical session at Hamilton Psychiatric Services:
- Arrival: You check in and sit in a comfortable reclining chair. No sedation, no IV, no preparation needed.
- Positioning: The TMS technician places the BrainsWay helmet-style coil on your head, calibrated to your unique brain anatomy.
- During stimulation: You will hear a series of clicking sounds and feel a light tapping or knocking sensation on your scalp where the coil is positioned. Most patients describe it as a mild, rhythmic pressure.
- Duration: The active stimulation portion lasts approximately 20 minutes. You remain fully awake and alert throughout.
- After the session: You get up, collect your belongings, and go about your day. There is no recovery period.
The most commonly reported sensation during early sessions is mild scalp discomfort or a slight headache, both of which typically diminish after the first few treatments as patients habituate to the stimulation.
Who Is a Good Candidate for TMS?
TMS is particularly well-suited for adults who:
- Have been diagnosed with major depressive disorder (MDD) or OCD
- Have tried two or more antidepressant medications without adequate relief (treatment-resistant depression)
- Cannot tolerate the side effects of antidepressants
- Prefer a non-medication approach
- Are pregnant or planning to become pregnant and wish to avoid psychiatric medications
- Have experienced depression alongside anxiety (anxious depression)
TMS is not appropriate for everyone. Patients with certain metallic implants in or near the head (such as cochlear implants or certain aneurysm clips), a history of seizures, or other specific medical conditions may not be eligible. Dr. Mirza conducts a thorough evaluation before recommending TMS to ensure it is safe and appropriate for each individual patient.
To learn more about the full range of conditions we treat, visit our mood disorder treatment page.
Frequently Asked Questions About TMS Therapy
Is TMS painful?
TMS is not painful for most patients. The most common sensation is a mild tapping or knocking on the scalp during stimulation. Some patients experience a temporary headache after early sessions, which typically resolves on its own and improves as treatment continues.
How long does it take for TMS to work?
Most patients begin noticing improvements within two to four weeks of starting treatment. Full results are typically seen by the end of the six-week course. A minority of patients are slow responders and may notice benefits several weeks after treatment concludes.
Does TMS work for everyone?
TMS is not a universal cure, but the evidence base is strong. Approximately 50–60% of patients with treatment-resistant depression respond to TMS, and about one-third achieve full remission. For OCD, response rates are also clinically meaningful.
Can I take antidepressants while doing TMS?
In most cases, yes. Many patients continue their current medications during TMS. Dr. Mirza will review your complete medication history and advise on the optimal approach for your situation.
Will I need TMS again after my first course?
Some patients maintain their improvement without further TMS. Others benefit from periodic maintenance sessions — typically monthly or as needed — to sustain results. Dr. Mirza will work with you to develop a long-term plan based on your response.
Ready to Learn If TMS Is Right for You?
Hamilton Psychiatric Services offers BrainsWay Deep TMS in Hamilton, NJ, serving patients from Trenton, Mercer County, and throughout Central New Jersey. Dr. Mirza is a board-certified psychiatrist with specialized expertise in TMS therapy for depression and OCD.
Call 609-631-7770 or schedule online to request a TMS consultation. We will verify your insurance benefits, answer your questions, and help you decide if TMS is the right next step.