Who is most likely to benefit from transcranial magnetic stimulation?

Who benefits most from TMS?

The strongest evidence points to people with treatment-resistant major depression. A meta-analysis of 12 sham-controlled studies found that TMS was statistically superior to placebo, with a moderate-to-large effect size of 0.81 [1]. In a randomized crossover trial of 38 patients with treatment-resistant depression, 63% responded to active TMS and 42% achieved remission [6]. Similarly, a study of treatment-resistant bipolar depression found a 55.7% response rate and no serious side effects like manic switches [10]. So if you have depression that hasn't improved with medication, TMS is a well-supported option.

TMS also helps people with obsessive-compulsive disorder (OCD), especially those with co-occurring depression. A meta-analysis of 25 randomized controlled trials (860 participants) found a moderate therapeutic effect (g=0.65) and a three-fold increase in the likelihood of treatment response compared to sham [12]. The authors noted that greater improvement in comorbid depression predicted better OCD outcomes, suggesting patients with both conditions may benefit most.

For anorexia nervosa, TMS appears effective for increasing body mass index (BMI) and reducing eating disorder symptoms. A meta-analysis of nine studies found a significant increase in BMI and a large decrease in Eating Disorder Examination Questionnaire scores (SMD=0.634) after TMS [5]. The effect was stronger when sessions lasted more than 20 minutes.

TMS may also help with post-stroke cognitive impairment. A retrospective cohort study found that stroke patients who received TMS combined with reminiscence therapy had significantly higher scores on cognitive tests (MMSE: 27.42 vs. 25.18) and functional independence measures compared to routine treatment [3]. Another study suggested TMS can improve consciousness in stroke-induced disorders of consciousness [14].

Who may not benefit—or needs a tailored approach?

Not everyone responds equally. A 2024 study of 124 veterans found that while TMS worked well for depression overall, those with chronic low back pain had significantly lower response rates [8]. The authors recommended adjunctive pain treatment for this group. Similarly, a 2024 study found that patients with a slower individual alpha frequency (around 9 Hz) showed the least improvement with standard 10 Hz TMS, suggesting that brainwave-based personalization could improve outcomes [7].

For epilepsy, the evidence is weaker. A Cochrane review of eight randomized trials (241 participants) found that only two studies showed a significant reduction in seizure frequency, while six showed no difference [9]. The authors concluded that evidence for seizure reduction is lacking, though TMS did reduce epileptiform discharges in some studies. Side effects were generally mild (headache, dizziness), but a small number of patients experienced increased seizures.

For disorders of consciousness (e.g., coma or vegetative state), a retrospective study found no overall benefit on the Glasgow Coma Scale, though a subgroup analysis suggested improvement in stroke-induced cases [14]. The authors called for larger randomized trials.

For geriatric depression, results are mixed. A systematic review of seven randomized trials (260 participants) found response rates ranging from 6.7% to 54.3%, highlighting the need for optimized dosing protocols for older adults [2]. Age-related brain changes may require different stimulation parameters.

What about adolescents and combination therapies?

In adolescents with first-episode depression, a 2025 study of 100 patients found that TMS combined with sertraline was most effective for improving subjective mood symptoms (effect size d=2.41) but less effective for somatic concerns (d=0.59) [13]. This suggests TMS may work best for emotional rather than physical symptoms in younger patients.

Combining TMS with other therapies may boost results. A pilot study adding rhythmic breathing yoga (SKY) to TMS found no significant improvement in depression scores compared to TMS alone, but the sample was small (10 patients) [4]. The authors speculated that yoga might help with maintenance rather than acute treatment. For stroke patients, combining TMS with reminiscence therapy (discussing past experiences) improved cognitive outcomes more than routine care [3].

A wearable TMS device has been developed that weighs only 3 kg and uses 10% of the power of commercial devices, potentially enabling home or community use [11]. This could expand access, but its effectiveness in real-world settings hasn't been tested yet.

About These Sources

This answer is built on 14 peer-reviewed studies — published from 2021 to 2026, 8 from 2024 or later, 6 in Q1 journals, collectively cited 423 times — selected as the most relevant from 15 studies that passed quality screening, drawn from 91 papers retrieved from a database of over 500 million.

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