Can transcranial magnetic stimulation produce durable improvements in real-world settings?

How long do TMS benefits last in everyday clinical practice?

The durability of TMS is well-documented, with most patients who respond to an initial course of treatment maintaining their gains for months to years. A large meta-analysis of 19 studies (732 patients) found that among initial responders, 66.5% sustained their response at 3 months, 52.9% at 6 months, and 50.6% at 12 months [4]. This means about half of people who get better with TMS are still better a full year later, even without ongoing maintenance treatment. The same analysis noted that maintenance TMS sessions (booster treatments) may further improve durability [4].

Real-world data from clinical practice confirms this. A study of 111 patients receiving accelerated deep TMS (multiple sessions per day) reported that 86.7% of those with follow-up data maintained their response at 60 days, and 92.9% at 180 days [1]. In a VA study of 217 veterans with treatment-resistant depression, 84.7% of responders had no severe relapse (defined as hospitalization, suicide attempt, or need for additional neuromodulation) for at least 2 years after treatment [7]. These figures come from routine clinical settings, not tightly controlled research labs, which strengthens their relevance to real-world patients.

Does TMS work for other conditions like long-COVID or chemo brain?

Emerging evidence suggests TMS may help with neuropsychiatric symptoms beyond depression, though the data is more preliminary. A pilot study of 23 patients with long-COVID (chronic fatigue, cognitive dysfunction, and mild depression) found that after TMS, depression scores improved by more than half (from 21.2 to 9.8 on the MADRS scale), fatigue scores improved, and cognitive function scores improved [2]. No serious side effects occurred. While this is a small, open-label study (not placebo-controlled), it suggests TMS could be a promising option for long-COVID brain fog and fatigue.

Similarly, a case report on a 58-year-old woman with chemotherapy-related cognitive impairment ('chemo brain') showed significant improvement in memory on neuropsychological testing after 10 TMS sessions. Remarkably, she was able to get a promotion at work 5-6 months after treatment, after 6 years of being unable to advance due to cognitive problems [8]. These are early findings, but they hint that TMS may help with cognitive symptoms that don't respond to medication.

What are the limitations and caveats?

While the evidence is strong, there are important caveats. First, durability figures are based on patients who initially responded to TMS — not everyone benefits. In real-world studies, response rates (meaning at least 50% improvement) range from about 31% to 53% immediately after treatment [3][5]. So about a third to half of patients get significant benefit, and of those, roughly half to two-thirds maintain it long-term. Second, most real-world studies are observational, not randomized controlled trials, which means they can't fully rule out placebo effects or natural recovery. However, the consistency across many studies and settings (Japan, France, US, Israel) strengthens confidence [1][3][5][7].

Another limitation is that durability depends on how you measure it. The VA study found that 84.7% of responders avoided severe relapse for 2 years, but only 35.4% avoided any changes to their medication regimen [7]. This suggests that while TMS prevents major crises, many patients still need some ongoing medication adjustments. Finally, TMS is not a one-size-fits-all treatment: different protocols (e.g., 10 Hz, 20 Hz, theta burst, accelerated) all show similar effectiveness, but individual response varies [1][3][6]. Sex does not appear to affect outcomes [6], but patients with more severe depression at baseline tend to show greater improvement [3].

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This answer is built on 8 peer-reviewed studies — published from 2019 to 2026, 3 from 2024 or later, 3 in Q1 journals, collectively cited 83 times — selected as the most relevant from 9 studies that passed quality screening, drawn from 67 papers retrieved from a database of over 500 million.

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