What is TMS, and why isn't it already widely used in mental health care?
Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation technique that uses magnetic pulses to modulate activity in specific brain regions. It is approved for treatment-resistant depression and has strong evidence for efficacy, especially in younger adults [2]. Yet despite this, it is not widely available in public mental health systems. A 2025 survey of nearly 500 Norwegian psychiatrists found that 49% were not familiar with TMS at all, and 87% attributed its limited use to the method being relatively unknown [1]. In Spain, a 2024 survey of 219 mental health professionals found that while nearly 100% correctly understood the theory behind TMS, only 55% believed it was effective, and many viewed it as a last resort [4]. The core problem is not that TMS doesn't work—it's that clinicians lack hands-on training and clear guidelines for when and how to use it.
What would it take to make TMS a scalable treatment?
Scalability requires three things: trained clinicians, standardized protocols, and integration into public health systems. The Norwegian survey is clear: 80% of psychiatrists said national clinical guidelines are needed, and 81% wanted more training for doctors [1]. The Spanish survey echoed this: 85% believed neuromodulation training should be increased during residency, and 73% demanded TMS be included in public hospitals [4]. Without these steps, TMS will remain a niche treatment available only in specialized private clinics. A 2023 review of personalized TMS targeting notes that while the science is advancing rapidly—allowing millimeter-precision targeting based on individual brain scans—large randomized trials are still needed to prove that personalization improves outcomes enough to justify the extra cost and complexity [5]. So the path to scalability is clear, but it requires investment in training, infrastructure, and large-scale clinical trials.
Can digital tools help make TMS more scalable?
One promising approach is combining TMS with digital mental health coaching, which could reduce the need for in-person therapist time and make the overall treatment package more scalable. A 2026 pilot randomized controlled trial tested whether adding coach-supported digital cognitive behavioral therapy (iCBT) or digital narrative stories of hope to TMS improved outcomes for 36 adults with depression [3]. The study found that both digital adjuncts led to steeper symptom reduction compared to a benchmarking sample of patients who received TMS alone. However, the two digital approaches did not differ from each other, and the sample was small (36 participants), so the results are preliminary. This suggests that digital coaching could be a scalable way to enhance TMS, but larger trials are needed to confirm the effect and determine which type of coaching works best.
About These Sources
This answer is built on 5 peer-reviewed studies — published from 2021 to 2026, 3 from 2024 or later, 2 in Q1 journals, collectively cited 171 times — selected as the most relevant from 5 studies that passed quality screening, drawn from 66 papers retrieved from a database of over 500 million.
Sources used in this answer
Transcranial magnetic stimulation in mental health care
In a 2025 survey of 481 Norwegian psychiatrists, 49% were unfamiliar with TMS, 87% said limited use was due to it being unknown, and 80% called for national guidelines and training before wider implementation.
Transcranial magnetic stimulation (TMS) for geriatric depression
A 2021 systematic review of 7 RCTs and 7 uncontrolled trials on TMS for geriatric depression found large variability in clinical response (6.7% to 54.3%), highlighting the need for optimized, standardized protocols tailored to older adults.
Does mental health coaching improve efficacy of transcranial magnetic stimulation for major depression? A pilot randomized controlled trial and benchmarking study.
A 2026 pilot RCT with 36 depressed adults found that adding digital coaching (iCBT or narrative stories) to TMS led to steeper symptom reduction versus TMS alone, but the two digital groups did not differ; the small sample limits generalizability.
Opinion, Use and Knowledge About Transcranial Magnetic Stimulation in Spain: A National Survey of Mental Health Professionals.
A 2024 survey of 219 Spanish mental health professionals found that while 80% would refer patients for TMS if available, only 55% considered it effective, and 73% demanded its inclusion in public hospitals.
Personalized and Circuit-Based Transcranial Magnetic Stimulation: Evidence, Controversies, and Opportunities
A 2023 review argues that personalized TMS targeting based on individual brain connectivity is promising for improving outcomes, but large randomized trials are still needed to confirm its value over standard targeting.