How Does TMS Work? Deep TMS Explained - Louisville, KY

How Does TMS Work?

TMS works by sending focused magnetic pulses through the scalp into a specific region of the brain. Those pulses pass painlessly through the skull and induce a small electrical current in the tissue underneath, causing neurons to fire in the dorsolateral prefrontal cortex, the area that regulates mood and is measurably underactive in people with depression.

The BrainsWay Difference

At Bluegrass Advanced Mental Health, we use the  BrainsWay H1 coil, which reaches deeper and across a broader area than the figure-8 coils used in conventional rTMS. A single session does little on its own.


Repeated stimulation across a full course strengthens that circuit through neuroplasticity, the brain's own capacity to rebuild connections, which is why the benefit holds after treatment ends.


You stay awake the whole time in your regular clothes, with no anesthesia and no sedation. Active stimulation runs about 19 minutes, and you drive yourself home and go back to your day.


How Does BrainsWay TMS Work

Three Step Process

01 / TARGET

Positioning the H-Coil over the prefrontal cortex.


02 / STIMULATE

Magnetic pulses safely activate underactive neurons.


03 / RESTORE

Standard sessions rebuild healthy brain pathways.





TMS vs. ECT

What's actually different


TMS and ECT are often confused, but only one of them involves anesthesia and an induced seizure. ECT (electroconvulsive therapy) deliberately triggers a brief, controlled seizure while you're under general anesthesia.


TMS uses focused magnetic pulses to stimulate a specific brain region while you sit awake in a chair. That single difference drives almost everything else: the setting, the recovery, the side effects, and whether you can drive yourself home.

TMS (Deep TMS) ECT
What it does Magnetic pulses stimulate the dorsolateral prefrontal cortex Electrical current induces a brief, controlled seizure
Anesthesia None General anesthesia and a muscle relaxant, every session
Seizure induced No Yes, intentionally, under medical supervision
Where it happens Outpatient clinic chair Hospital or surgical suite with an anesthesiologist
Session length About 18 minutes of active stimulation About 5 to 10 minutes of treatment, plus 1 to 2 hours for prep and recovery
Course Standard course of TMS is 36 sessions over 12 weeks Typically 6 to 12 treatments, 2 to 3 times per week
Effect on memory No documented memory loss. Some patients report better concentration as depression lifts Memory effects are common, usually temporary, sometimes involving gaps around the treatment period
Common side effects Scalp discomfort, mild headache, jaw or eye twitching, typically fading after the first week Confusion after waking, headache, muscle aches, nausea, memory effects
Drive Immediately after session No. You need a driver and generally a day of rest
Time off work The first treatment is typically an hour and subsequent sessions are ~ :30 mins Usually significant, often weeks
Effectiveness Roughly 80% of patients improve; about two-thirds reach remission 50-60% response rate
Best suited to Depression or OCD that hasn't responded to two or more medications, in patients who want to keep working and living normally Severe, psychotic, or catatonic depression; acute suicidal risk; when previous treatments including TMS haven't worked
Insurance Covered by most insurance plans when criteria are met and with prior authorization Covered by most plans

Could TMS Be a Fit for Me?

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TMS MAY Be Appropriate if You:

  • Have depression that hasn't improved after trying 2+ antidepressants at full dose and duration.
  • Have severe treatment-resistant depression and have been unable to tolerate the side effects of antidepressants (2 or more).
  • Have OCD or another specific diagnosis where TMS is an evidence-based option and other treatments haven't helped.
Yellow warning triangle with an exclamation mark on a white background

Talk to Us First if You:

  • Have a history of uncontrolled seizures or active epilepsy.
  • Have metal implants or devices in or near the head that are incompatible with TMS, dental fillings and implants are safe.
  • Have an unstable medical condition (e.g., uncontrolled hypertension).



How Bluegrass Advanced Mental Health decides between options?

If many of the “may be appropriate” items fit, TMS is worth a clinical screen. If you endorsed one or more of "may not be recommended" items, you’ll need to discuss this with your physician during your intake evaluation review. In some cases, TMS can still be done safely with precautions, but in other cases, it’s not recommended.


All safety items are reviewed during our clinical screen and again before the first TMS session.


During the Evaluation

  • Safety & Medical History
  • Prior Treatments
  • Speed of Relief Needed
  • Patient Preference & Logistics
  • Evidence & Clinician Judgement


Mental Health Care That Works With Your Insurance


TMS and Spravato (esketamine nasal spray) are covered by most major health insurance plans when criteria are met. For patients who are out-of-network or who want accelerated TMS treatment, third-party financing may be available.


A 5-minute screening tells you if TMS or Spravato may be a fit, verifies your insurance coverage, and connects you with our Patient Care Team to schedule your first appointment.


How Does TMS Work - Frequently Asked Questions

  • How does TMS work in the brain?

    A. TMS uses a magnetic coil placed against your scalp to generate rapidly changing magnetic fields. Those fields pass painlessly through the skull and induce a small electrical current in the brain tissue underneath, which causes neurons in that region to fire. TMS for depression targets the dorsolateral prefrontal cortex, an area involved in mood regulation that is typically underactive in people with depression. Repeated sessions over several weeks strengthen activity in that circuit, a process called neuroplasticity, which is why the benefit persists after treatment ends.

  • What is the difference between Deep TMS and regular TMS?

    A. Conventional rTMS uses a figure-8 coil that stimulates a relatively shallow, focal area of cortex. BrainsWay's Deep TMS uses an H-coil, which produces a broader field that reaches deeper brain structures. Bluegrass Advanced Mental Health uses the BrainsWay H1 coil, which is FDA-cleared for major depressive disorder, treatment-resistant depression, and OCD.

  • How is TMS different than ECT ( shock therapy)?

    A. They are different treatments. ECT deliberately induces a brief seizure under general anesthesia and requires recovery time and a driver; it can cause memory effects. TMS uses focused magnetic pulses, does not induce a seizure, requires no anesthesia or sedation, has no documented memory effects, and you drive yourself home and return to your day. ECT remains a valuable treatment for severe cases; TMS is a first-line option for most people whose depression has not responded to medication.

  • Why does TMS take 36 sessions?

    A. The therapeutic effect of TMS is cumulative. A single session produces a temporary change in neural activity; repeated daily stimulation over weeks drives lasting change in how the targeted circuit functions. Standard protocols were established at roughly 36 sessions because that is where clinical trials found durable benefit. The BrainsWay SWIFT accelerated protocol delivers a comparable session count compressed into six days by running five sessions per day.

  • Is TMS FDA-approved or FDA-cleared, and what is the difference?

    A. TMS devices are FDA-cleared, not FDA-approved. Clearance applies to medical devices demonstrated substantially equivalent to an existing legally marketed device; approval applies to drugs and certain high-risk devices. Both require FDA authorization to market. BrainsWay Deep TMS is FDA-cleared for major depressive disorder, treatment-resistant depression, and OCD. Spravato, being a drug, is FDA-approved.

  • Does TMS work for anxiety?

    A. BrainsWay Deep TMS is FDA-cleared for major depressive disorder and OCD, not as a standalone treatment for generalized anxiety disorder. That said, anxiety very commonly occurs alongside depression, and many patients whose depression responds to TMS report their anxiety improves as well. If anxiety is your primary diagnosis, Bluegrass Advanced Mental Health treats it through psychiatric evaluation and medication management.

Compare Treatments

A side-by-side look at TMS, Spravato, medication, and therapy - who they help, how fast they work, and what to expect.

Is TMS Right For Me?

A quick self-screen to see if TMS might fit your symptoms, prior treatments, & medical profile.