This method uses short magnetic pulses, comparable in strength to a traditional MRI, to achieve precise neuromodulation of the brain’s bioelectrical activity.

A TMS coil is placed on the scalp, in the predefined location, for instance over the motor cortex. When electric current flows through the coil, it generates a magnetic field, which in turn induces an electric field in the brain – in accordance with Faraday's Law – stimulating neurons.

TMS devices produce impulses that penetrate the brain tissue to a depth of approximately 3–4 cm, triggering what is known as a depolarising current in the neurons. This stimulation directionally changes cortical activity in the targeted region, and through trans-synaptic modulation, it also influences surrounding brain structures.

TMS promotes neuroplasticity by stimulating the release of neuroprotective substances and neurotransmitters such as serotonin. It also supports the formation of new neural connections (neurogenesis).

Traditional treatments in neurology and psychiatry mainly rely on pharmacotherapy, i.e. administering substances that affect the nervous system and brain chemistry. TMS, in contrast, does not involve introducing external substances – it stimulates the body’s own production of neuroactive compounds, thereby promoting change.

These changes occur on three levels:

• Neuronal: TMS triggers neuronal activity – either suppressing overactive structures or activating underperforming regions.
• Synaptic: TMS sessions over time stimulate the production of neurotransmitters (e.g. dopamine) and growth factors such as BDNF.
• Network-level: These neurochemical changes promote broader neuroplasticity within brain structures, helping to repair or compensate for dysfunction in the brain’s neural networks.

TMS utilises neuroplasticity – the brain's natural ability to repair and reorganise itself – by stimulating and guiding this process. Learn more about neuroplasticity and how it is used in TMS therapy.

TMS - A safe and effective non-pharmacological option for your mental health.

TMS works where medication has failed or cannot be used – in some cases, TMS can completely replace pharmacotherapy. This is especially relevant for individuals for whom medication was ineffective or caused too many adverse effects.

TMS can enhance the effectiveness of medications – studies have shown that TMS can improve the outcomes of certain drugs, achieving better results than either treatment alone. TMS can help reduce medication dosage – it can be used to lower doses and minimise side effects.

TMS offers hope even in the most difficult cases where standard treatment has failed. Between 50% and 70% of people with treatment-resistant depression experience clinically significant improvement after TMS therapy. And it’s not just depression – TMS has a broader therapeutic potential. See below what conditions can be treated with TMS.

TMS is uniquely non-invasive.

While TMS is officially approved for treating depression in adults by the FDA, it is also safely used in children [1]. TMS for children is available worldwide, including at Cook Children's Medical Center.

At Magwise, we have extensive experience with TMS. For children, TMS is always administered by a qualified specialist in child and adolescent psychiatry.

“TMS therapy demonstrates a strong safety and efficacy profile in minors – with minimal side effects compared to antidepressants. Moreover, TMS does not negatively impact cognitive function, brain maturation, motor development, or neural activity (e.g. receptors or neurotransmitters).” [2]

Clinical Uses of TMS in Children

Numerous clinical studies have shown that TMS is safe and effective in treating various conditions in children, including:

• Depression
• Autism spectrum disorders (ASD)
• Attention deficit disorders (ADHD/ADD)
• Tourette's syndrome

As with adults, there are many other potential indications and protocols for paediatric TMS.

Proven Safety and Efficacy

The safety and efficacy of TMS in children has been confirmed in studies involving over 3.5 million stimulations [3]

References

• [1] Narang P, Madigan K, Sarai S, Lippmann S. Is Transcranial Magnetic Stimulation Appropriate For Treating Adolescents with Depression? Innov Clin Neurosci. 2019 Sep 1;16(9-10):33-35. PMID: 32082948; PMCID: PMC7009324.
• [2] Qiu H, Liang K, Lu L, Gao Y, Li H, Hu X, Xing H, Huang X, Gong Q. Efficacy and safety of repetitive transcranial magnetic stimulation in children and adolescents with depression: A systematic review and preliminary meta-analysis. J Affect Disord. 2023 Jan 1;320:305-312. doi: 10.1016/j.jad.2022.09.060. Epub 2022 Sep 27. PMID: 36174786.3.
• [3] Zewdie E, Ciechanski P, Kuo HC, Giuffre A, Kahl C, King R, Cole L, Godfrey H, Seeger T, Swansburg R, Damji O, Rajapakse T, Hodge J, Nelson S, Selby B, Gan L, Jadavji Z, Larson JR, MacMaster F, Yang JF, Barlow K, Gorassini M, Brunton K, Kirton A. Safety and tolerability of transcranial magnetic and direct current stimulation in children: Prospective single center evidence from 3.5 million stimulations. Brain Stimul. 2020 May-Jun;13(3):565-575. doi: 10.1016/j.brs.2019.12.025. Epub 2019 Dec 30. PMID: 32289678.

Currently, the most commonly used TMS protocols involve repeated magnetic pulses (rTMS) at frequencies of:

• 10 Hz – excitatory
• 1 Hz – inhibitory

Another form is theta-burst stimulation (TBS), where pulses are delivered in triplets at 50 Hz. TBS allows for significantly shorter treatment durations (e.g. accelerated iTBS or aiTBS), often completed over just a few days, and is generally better tolerated than standard protocols.

A variety of brain regions can be targeted during treatment. Common targets include:

• Bilateral prefrontal cortex
• Premotor cortex
• Motor cortex
• Broca’s area

The exact stimulation target and protocol details are determined during a qualifying consultation performed by a physician.

SAINT (Stanford Accelerated Intelligent Neuromodulation Therapy) is a modern, personalised protocol of TMS developed by Professor Nolan Williams and his team at the Brain Stimulation Lab at Stanford University, California.

Dr Nolan Williams, Professor of Psychiatry and Neurology at Stanford University and creator of the SAINT protocol: “It works quickly and it’s non-invasive.”

What is the SAINT protocol?

SAINT involves an intensive stimulation programme: the patient receives 50 sessions over 5 days (10 sessions per day, every 50 minutes), equivalent to six standard TMS courses in terms of pulse count. What sets SAINT apart is the precise targeting. Unlike conventional protocols, SAINT uses functional MRI (fMRI) to identify the exact location in the left dorsolateral prefrontal cortex (DLPFC) that is most anti-correlated with the subgenual anterior cingulate cortex (sgACC).

Why does this matter? A strong anti-correlation between the DLPFC and sgACC is key – DLPFC activity can inhibit the overactivity of the sgACC, which is linked to depressive symptoms. Targeting this specific site increases the likelihood of effectively “resetting” dysfunctional neural networks.

Advantages of the SAINT accelerated protocol

• Exceptional efficacy – clinical studies show that around 80% of patients with treatment-resistant depression achieved remission. This is among the highest success rates recorded in depression treatment.
• Rapid treatment – the full protocol lasts only 5 days, making SAINT one of the fastest available TMS therapies.
• Highly personalised – using fMRI and analysis of functional connectivity between DLPFC and sgACC, the stimulation is tailored to the individual neurobiology of each patient.
• FDA approval – in 2022, the SAINT® Neuromodulation System developed by Magnus Medical received official FDA clearance for the treatment of medication-resistant depression.

SAINT at Magwise

Since 2020, Magwise has been offering a 5-day SAINT-inspired protocol using craniometric targeting, with hundreds of satisfied patients.

We share this story to offer you an authentic patient’s perspective - showing how effective TMS therapy can be, addressing potential doubts you may have, and helping you make an informed decision about starting treatment.

1. Patient Preparation After the qualifying consultation and once a personalised treatment plan has been agreed, the patient comes to the clinic on the chosen day to start the therapy. On the first day, all details are discussed again, and preparations are made. The patient sits comfortably in a special treatment chair. Before starting, any magnetic or metal objects must be removed from the head and neck area (for example, earrings, hair clips or other metal jewellery). Patients who have tinnitus are given earplugs for comfort.

2. Identifying the Stimulation Site During the initial therapy session, the qualified physician carries out a calibration process, which involves precise measurements to determine the exact site for stimulation.

3. Measuring the Motor Threshold The power level of the stimulator is individually adjusted to ensure optimal stimulation tailored to the patient’s needs.

4. Therapy Sessions Subsequent sessions are conducted by qualified staff. During each session, the TMS coil is positioned against the patient’s head at the previously determined site, generating a series of magnetic pulses. These are perceived by the patient as a gentle tapping sensation and heard as clicking sounds. While seated in the chair, the patient may use their mobile phone, provided it is kept at a safe distance of approximately 50 cm from the head. At the end of each visit, the patient can return to their daily activities as usual.

5. Follow-up consultation After completing the full course of TMS therapy, a follow-up consultation—included in the cost of treatment—is carried out. During this final assessment, the doctor may recommend a further treatment plan, such as maintenance sessions to help sustain the effects of therapy. These sessions are typically scheduled once a month for a period of six months. Each maintenance session is conducted in the same way as a standard treatment day.

TMS therapy is a safe and non-invasive treatment method. Some patients may experience side effects – typically mild and temporary – such as discomfort at the site of stimulation (resulting from muscle tension), headaches, or, more rarely, nausea or fatigue. These symptoms usually subside as the therapy progresses.

In very rare cases, a seizure may be triggered by TMS, although the likelihood is exceptionally low – estimated at less than 0.002% in the general population. For individuals considered to be at higher risk – such as those with a history of epilepsy or previous strokes – the probability may range from approximately 0% to 4%. Nevertheless, such instances are uncommon, particularly when safety standards are strictly followed. It is also important to emphasise that the aforementioned risk refers to an isolated seizure episode, not the onset of epilepsy.

- Safe, non-invasive, and well-tolerated TMS does not require surgery or medication; it works externally by using magnetic stimulation to target specific areas of the brain. It is a non-invasive and well-tolerated method.

- Effectiveness supported by research Particularly beneficial for patients with treatment-resistant depression. Significant improvement is observed in 50–70% of patients.

- An alternative to medication TMS can be used as a stand-alone treatment or as an adjunct to medication, helping to reduce the need for drugs and their side effects.

- Long-term effectiveness Studies show that in the depressed patients who respond to TMS therapy, improvement in mood and daily functioning can last for at least 12 months.

- Targeted and selective action TMS can be used to target specific brain regions, such as the prefrontal cortex, without affecting the entire body.

- Improved cognitive functioning Some patients report better concentration, improved mood, and better sleep quality.

- Quick return to daily life A session lasts around 20–40 minutes and does not require a recovery period — patients can immediately return to work or other responsibilities.

- Compatibility with other therapies TMS complements and enhances other therapeutic approaches, such as psychotherapy, rehabilitation, or pharmacological treatment.

TMS Therapy vs Electroconvulsive Therapy (ECT) and Vagus Nerve Stimulation (VNS)

TMS stimulation differs significantly from electroconvulsive therapy (ECT) and vagus nerve stimulation (VNS).

TMS Therapy vs Electroconvulsive Therapy (ECT)

Unlike electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS) does not require hospitalisation or general anaesthesia, nor is there any recovery period necessary following the procedure. After TMS session the patient can follow directly with daily activities. TMS is a non-invasive, safe, and well-tolerated treatment. It does not cause cardiovascular or respiratory complications, nor cognitive side effects — which may occur with ECT. The two methods also differ in their mechanisms of action: TMS uses magnetic pulses to gradually and precisely modulate activity in targeted areas of the brain, while ECT induces seizures using electrical currents.

TMS Therapy vs Vagus Nerve Stimulation (VNS)

Both TMS (transcranial magnetic stimulation) and VNS (vagus nerve stimulation) are neuromodulation techniques used in the treatment of depression, but they differ significantly. VNS, which has been approved by the FDA for treating depression, requires a surgical procedure involving the implantation of a device and works indirectly—via stimulation of the vagus nerve. In contrast, TMS, approved by the FDA for treating depression, is a non-invasive, outpatient procedure. As a result, TMS is associated with a lower risk of systemic side effects.