Deep TMS can stimulate brain tissue up to 6 centimeters beneath the skull. This FDA-cleared technology differs from standard TMS by using a specialized coil design that reaches deeper and stimulates broader brain regions simultaneously, expanding treatment options for conditions including major depressive disorder and obsessive-compulsive disorder.
What Makes Deep TMS Different
The key distinction between Deep TMS and standard TMS lies in coil design. Standard TMS uses a figure-8 coil that creates a focused, shallow magnetic field. Deep TMS employs an H-coil—a helmet-like device with multiple coil elements arranged in a specific pattern to generate magnetic fields that penetrate further into brain tissue. This design allows stimulation of deeper cortical and subcortical structures without requiring higher intensity levels that could cause discomfort.
Both technologies use electromagnetic induction—a process where changing magnetic fields create electrical currents—to generate brief magnetic pulses that pass through the skull. These pulses induce small electrical currents in targeted brain regions, either exciting or inhibiting neural activity depending on the stimulation frequency. The H-coil’s configuration produces a more diffuse field that affects larger volumes of tissue, potentially engaging broader neural networks involved in psychiatric conditions (Cohen et al., 2021). For a side-by-side look at how these two technologies compare clinically, see our post on comparing Deep TMS and traditional TMS.
Many people have concerns about brain stimulation safety. Deep TMS is non-invasive, meaning nothing enters your body or brain tissue. The magnetic fields used are similar to those in MRI machines. You remain fully awake and alert during treatment, and the procedure doesn’t require anesthesia or sedation. The most common side effect is mild scalp discomfort or headache.
Deep TMS received FDA clearance through the 510(k) pathway in 2013 for major depressive disorder, specifically for patients who have not achieved satisfactory improvement from previous antidepressant medication. The FDA clearance followed clinical trials demonstrating efficacy in treating depression that hadn’t responded adequately to 1–4 antidepressant trials.
Catalyst Psychiatry is the only Deep TMS provider in the Willamette Valley, offering this advanced technology to patients throughout Corvallis and the mid-Willamette region. The practice’s board-certified psychiatrists have specialized training in Deep TMS administration and patient selection.
Brain Regions Targeted in Depression Treatment
For major depressive disorder, Deep TMS targets the left dorsolateral prefrontal cortex, a region involved in executive function, decision-making, and mood regulation. Research using functional brain imaging has shown that this area typically shows reduced activity in people with depression. By delivering repetitive magnetic pulses to this region, Deep TMS aims to normalize activity patterns and strengthen connections with other mood-regulating brain areas.
The magnetic field generated by the H-coil doesn’t stop at the prefrontal cortex. These areas form interconnected networks that regulate emotional responses, motivation, and reward processing—functions frequently disrupted in depression.
Stimulation uses high-frequency pulses (typically above 1 Hz), which tend to increase cortical excitability—the readiness of brain cells to fire and transmit signals. This differs from low-frequency stimulation, which generally inhibits neural activity. The specific stimulation parameters—frequency, intensity, and number of pulses—follow protocols established through clinical research.
A typical Deep TMS session for depression lasts about 20 minutes. During treatment, you sit comfortably while wearing the H-coil helmet. The device delivers thousands of magnetic pulses in a patterned sequence. Most people describe feeling tapping sensations on the scalp with each pulse. Treatment typically occurs five days per week for 6 weeks with an additional three weeks for taper, though protocols may vary based on individual response.
Deep TMS for Obsessive-Compulsive Disorder
The FDA cleared Deep TMS for OCD treatment in 2017 with a new helmet called the H7 coil, making it the first brain stimulation device approved for this condition. OCD treatment targets different brain regions than depression treatment—specifically the anterior cingulate cortex and medial prefrontal cortex, areas that show abnormal activity patterns in people with OCD (Carmi et al., 2023).
Deep TMS for OCD uses higher frequency stimulation than depression treatment and includes a unique component: symptom provocation. During treatment, you’re asked to engage with triggers related to your specific obsessions and compulsions while receiving magnetic stimulation. This approach, based on principles similar to exposure therapy, aims to modify the brain’s response to OCD triggers.
Clinical trials showed that 38% of people receiving active Deep TMS for OCD experienced significant symptom reduction compared to 11% receiving sham treatment. Response was defined as at least 30% reduction in OCD symptoms measured by the Yale-Brown Obsessive Compulsive Scale (Carmi et al., 2023). Results vary by individual, and not everyone achieves meaningful improvement.
Deep TMS for OCD works as an adjunct or co-adjuvant to existing treatments. In clinical trials, patients continued their stable medication regimens and could maintain ongoing psychotherapy during Deep TMS treatment. The technology doesn’t replace evidence-based OCD treatments but offers an additional option when standard approaches haven’t provided adequate relief.
How Deep TMS Sessions Work
Before starting Deep TMS, your psychiatrist will conduct a comprehensive psychiatric evaluation to confirm you’re an appropriate candidate. This includes reviewing your diagnosis, treatment history, current medications, and medical conditions. Some people cannot receive TMS due to metallic implants in the head or neck, history of seizures, or certain neurological conditions.
Your first session includes mapping your brain and determining your motor threshold—the minimum stimulation intensity needed to cause a visible finger twitch when the coil targets the motor cortex. This individualized measurement guides treatment intensity for your therapeutic sessions. Mapping your brain and finding your motor threshold takes about 20–30 minutes and is typically well tolerated.
During treatment sessions, you’ll sit in a comfortable chair while the treatment technician positions the H-coil helmet on your head. The device is adjusted to ensure proper placement over the target brain region. You’ll wear earplugs to protect your hearing from the clicking sound the machine makes during stimulation.
Treatment involves alternating periods of stimulation and rest. For depression, a typical protocol delivers short bursts of magnetic pulses followed by brief pauses, repeated for about 20 minutes. You remain awake and alert throughout the session. Most people read, play on their phone, or simply rest during treatment.
The most common side effect is mild scalp discomfort or headache during or shortly after treatment, typically resolving within hours. Serious side effects are rare but can include seizures, occurring in approximately 0.1% of treatments. Your treatment team monitors for any concerning responses throughout the procedure.
Treatment Schedule and Duration
Standard Deep TMS protocols involve daily sessions Monday through Friday for 6 weeks, totaling 30 sessions with an additional 6 sessions used over three weeks as a taper. Recently, the FDA cleared an accelerated Deep TMS protocol that delivers similar outcomes with fewer treatment days. A multicenter randomized controlled trial showed accelerated treatment produced results comparable to standard protocols but compressed the timeline to approximately six days of intensive sessions (Psychiatric Times, 2025).
Many people notice some improvement within 2–3 weeks, though maximum benefit often occurs after completing the full treatment course. If you respond positively to the initial treatment series, your psychiatrist may recommend maintenance sessions—typically one session weekly, biweekly, or monthly—to sustain improvements.
Treatment decisions should be individualized based on your symptom patterns, response to initial treatment, and practical considerations like schedule flexibility. If you achieve improvement or remission with Deep TMS, the benefit may last from 3 months to a year or longer. If your depression returns you may undergo another full treatment series.
Catalyst Psychiatry offers both standard and accelerated Deep TMS protocols. The practice works with each patient to determine the most appropriate treatment approach based on clinical presentation, schedule, and insurance coverage.
Insurance Coverage and FDA Clearances
Many insurance plans cover Deep TMS for FDA-cleared indications when prior treatments haven’t provided adequate benefit. Coverage requirements vary by plan but typically require documentation of inadequate response to multiple medication trials. Your treatment team can verify your insurance coverage and help navigate prior authorization requirements before you start treatment.
Beyond depression and OCD, Deep TMS has received FDA clearances for other conditions including smoking cessation and migraine headaches. The device is also cleared for adolescents ages 15–21 with depression. Research continues investigating Deep TMS for additional psychiatric and neurological conditions, though treatment for conditions without FDA clearance is considered off-label. Even FDA-cleared conditions may not be covered by your insurance, so please contact your insurance company if you are interested in these other indications.
The American Psychological Association notes that Deep TMS can stimulate deeper and wider brain areas than initial TMS technology, potentially offering advantages for certain patients or conditions (American Psychological Association, 2025). However, whether this broader, deeper stimulation produces clinically superior outcomes compared to focused stimulation remains an active area of research.
FAQ Section
Q: Does Deep TMS hurt?
A: Most people describe feeling tapping sensations on their scalp during treatment. Some experience mild discomfort or headache, but Deep TMS generally doesn’t cause significant pain. Intensity can be adjusted if sensations become uncomfortable or are intolerable.
Q: How long do Deep TMS benefits last?
A: Response duration varies considerably. Some people maintain improvement for many months after treatment, while others notice symptoms returning sooner. Your psychiatrist will monitor your symptoms and recommend appropriate follow-up.
Q: Can Deep TMS damage the brain?
A: Deep TMS uses magnetic fields similar in strength to those used in MRI machines and has been extensively studied for safety. The treatment doesn’t damage brain tissue. Serious side effects are rare when treatment follows established protocols and safety guidelines.
Q: Will I be able to drive after Deep TMS treatment?
A: Yes, unlike SPRAVATO® or ECT, Deep TMS doesn’t cause sedation or cognitive impairment. Most people drive themselves to and from appointments and return to normal activities immediately after sessions.
Q: Can I receive Deep TMS if I have dental implants?
A: Dental fillings and typical dental work don’t prevent Deep TMS treatment. However, certain metallic implants in the head or neck may be contraindications. Your psychiatrist will review your complete medical history to determine safety.
Conclusion
Deep TMS uses specialized H-coil technology to reach deeper brain structures than standard TMS, with FDA clearances for treating major depressive disorder and obsessive-compulsive disorder. The treatment works by stimulating broader neural networks involved in these conditions, offering an option for people who haven’t achieved adequate improvement with medications alone. As with any medical treatment, results vary by individual, and careful patient selection helps ensure appropriate use.
As the only Deep TMS provider in the Willamette Valley, Catalyst Psychiatry offers this advanced treatment to patients throughout Corvallis and the surrounding region. If you’re interested in learning whether Deep TMS might be appropriate for your situation, complete our online self-assessment or contact us to schedule a consultation.
References
- American Psychological Association. (2025). Transcranial magnetic stimulation (TMS). American Psychological Association. https://www.apa.org/topics/therapy/tms
- Carmi, L., Tendler, A., Bystritsky, A., Hollander, E., Blumberger, D. M., Daskalakis, J., Ward, H., Lapidus, K., Goodman, W., Casuto, L., Feifel, D., Barnea-Ygael, N., Roth, Y., Zangen, A., & Del Dosso, C. (2023). Efficacy and safety of deep transcranial magnetic stimulation for obsessive-compulsive disorder: A prospective multicenter randomized double-blind placebo-controlled trial. Frontiers in Psychiatry, 14. https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2023.1148258/full
- Cohen, R. B., Boggio, P. S., & Fregni, F. (2021). Risk factors for relapse after remission with repetitive transcranial magnetic stimulation for the treatment of depression. Brain Stimulation, 14(5), 1258–1268. https://pmc.ncbi.nlm.nih.gov/articles/PMC8380670/
- FDA 510(k) Clearance. (2013). BrainsWay Deep TMS System K122288. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K122288
- Psychiatric Times. (2025). Accelerated deep TMS protocol for depression. Psychiatric Times. https://www.psychiatrictimes.com/view/accelerated-deep-tms-protocol-depression