Transcranial Magnetic Stimulation (TMS) for PTSD: Is it Effective?

What Is PTSD?

Post-traumatic stress disorder (PTSD) is a mental health condition some people develop after experiencing, witnessing, or hearing about a traumatic event. Associated stress can limit their ability to cope with the event, causing lasting negative impacts on mental health.

PTSD symptoms begin after a traumatic event and persist for longer than one month. PTSD-induced night terrors, vivid PTSD flashbacks, and recurring memories about the trauma are common and cause significant distress or impairment. These experiences can also lead survivors to avoid people, places, and things that remind them of the trauma. 

Common symptoms of PTSD include:⁴

• Intrusive thoughts, memories, flashbacks, or nightmares of the trauma
• Dissociation
• Efforts to avoid trauma reminders
• An inability to recall key details
• Negative beliefs about self, others, or the world
• Exaggerated self-blame for the trauma
• Reduced interest in activities
• Feelings of loneliness or isolation
• Trouble accessing or experiencing positive emotions
• Increased irritability or aggression
• Risky or destructive behavior
• Trouble sleeping
• Hypervigilance
• Trouble concentrating/focusing

What Is Transcranial Magnetic Stimulation?

Transcranial magnetic stimulation (TMS) is an outpatient treatment involving devices that use magnetism to generate electrical pulses to stimulate the brain. Depending on the type, such as deep TMS, the machine can deliver these currents at different frequencies and speeds to generate specific responses in the brain. TMS targets certain nerve cells involved with emotion regulation that may help reprogram parts of the brain.^2,3,5

The FDA approved TMS for depression in 2008, and many studies have demonstrated its effectiveness in improving symptoms. Since then, TMS has shown promising results for several other mental health conditions, including OCD, schizophrenia, and PTSD.^1,2,3 Proponents of TMS emphasize the potential for rapid and significant improvements using this relatively safe and noninvasive treatment.^3,7,8

Does TMS Work for PTSD?

According to several studies, four to six weeks of TMS can lead to significant and lasting improvements in PTSD that continue for two to four weeks after the last session.^2.3.7 Researchers believe TMS can decrease PTSD symptoms by helping retrain areas of the brain impacted by trauma, such as the fear response.^2,6

TMS can be a good option for those who do not respond to regular trauma-informed therapies or medications. However, people can also benefit from TMS in combination with these other treatment approaches.^{3, 5}

How Long Does TMS for PTSD Last?

Most TMS treatment plans include four to six weeks of sessions, generally administered several times per week. While individual responses vary, most people notice improvements in symptoms and functioning after about two weeks of treatment.^2,6,7 TMS therapy for PTSD can also be individualized, with adjustments made to the treatment plan if clients do not see the desired results.¹

Is TMS for PTSD FDA-Approved?

TMS for PTSD is not FDA-approved, but most people can still access the treatment at specific clinics. A growing number of studies suggest TMS can help people with PTSD, meaning this therapy will likely receive FDA approval in the future.

How Effective Is TMS for PTSD?

Approximately 50-75% of people with PTSD who receive TMS therapy see a significant improvement in their symptoms. While the results are not immediate, they usually occur within two weeks of beginning TMS sessions.^6,7 Everyone will respond differently to treatment, meaning not everyone with PTSD will benefit from this approach.

Who Should Avoid TMS for PTSD?

Because TMS involves strong magnetic pulses, professionals advise against use for people with metal implants. Additionally, those with epilepsy or a history of seizures may not be appropriate candidates because of the slight risk of seizures. Some TMS clinics also do not allow older adults, people with severe and persistent mental illness, or those on multiple medications to receive the treatment. Because of a potential increase in suicidality, people struggling with suicidal thoughts should consult their physician before exploring TMS.^5,8

Can TMS Make PTSD Worse?

TMS therapy is unlikely to worsen PTSD symptoms, and no recent studies have reported a negative change after treatment. TMS can also be combined with other treatments like medication and therapy for added benefits.^1,5,7

Is TMS for PTSD Painful?

Many people may not know what to expect from TMS. Some view sending electrical currents into the brain as painful, dangerous, or both. The reality is that TMS therapy is almost always painless and unlikely to cause serious side effects. In fact, most people report no discomfort and find the clicking sound of the TMS machine to be the most irritating part of the process.^3,5

While TMS is generally considered safe, some people do experience side effects. Only about 7% of people report mild headaches or pain in the scalp. Because of this, those with frequent migraines may want to consult a doctor before considering TMS therapy.⁸

Potential side effects associated with TMS for PTSD include:^1,5,7,8

• Headache, scalp pain or discomfort
• Dizziness or feeling lightheaded
• A tingling feeling in your face or head
• Tinnitus (ringing sound in the ears)
• Retinal tears or detachment
• Vision problems
• Increased sensitivity to light or sound
• Muscle twitches or tics
• Increased risk for seizures
• Increased suicidal thoughts

What to Expect From TMS for PTSD

During a TMS for PTSD session, providers position a machine near the head to target specific brain areas while the patient sits or lies down. Most protocols for TMS involve 30 sessions throughout four to six weeks.^1,5,6 Each appointment will last 20-60 minutes in an outpatient clinic or office setting.

A trained technician, nurse, or doctor will be present during the appointment and answer any questions you might have. All TMS clinics conduct initial screenings and assessments before treatment to ensure patients are a good fit.

Here is what to expect during a typical TMS for PTSD appointment:^1,5

• Starting treatment: A technician will take you to a private room to sit or lie down. They may take your vitals before beginning and ask you to remove anything metal (glasses, jewelry, etc.) before the treatment begins.
• Positioning the machine: The technician will position the machine arm (which looks similar to a dental X-ray machine) in a specific spot on your head or face. They will hand you a pair of earplugs or headphones to protect your ears from the loud sounds made by the machine. Depending on the type of machine, you may wear a helmet or chin strap to hold the machine in place.
• Sessions begin: You can expect to hear loud knocking sounds when the machine starts. You may feel a tapping sensation but should not experience any pain. The magnetic pulses may cause a strange tingling sensation or muscle twitch, which is normal and not a cause for concern. The technician may make some early adjustments to the machine placement or strength/frequency of pulses used.
• Ending the session: Once the technician identifies the appropriate frequency and position, they may place the machine on a timer that delivers the pulses automatically for the remainder of the appointment. This TMS session could be just a few minutes or up to an hour long. Afterward, you can leave the site and continue normally with your routine until the next appointment.

How Much Will TMS for PTSD Cost?

The cost of TMS for PTSD can be a barrier or drawback for some, especially when insurance does not cover treatment. Coverage will depend on the state and specific details and exclusions in your policy. If you are paying out of pocket for TMS PTSD treatment, costs can range between $6,000-$12,000 for a 30-session course. If you have depression, your chances of receiving insurance coverage for TMS therapy may be better.

How to Find a TMS Therapist for PTSD

If you are interested in finding a TMS clinic near you, a quick online search is often the best way to determine whether you can access local treatment. Once you find a provider, you can call to ask more questions about sessions specifically for PTSD, potential costs, and insurance coverage. The next step would be to contact your insurance provider for more information about the copay and steps for getting the treatment covered.

Alternative Treatments for PTSD

TMS therapy can be a good option for people struggling with PTSD. However, many other effective treatments are available. While the FDA has not approved specific medications for PTSD, some people with other co-occurring disorders like depression and anxiety benefit from finding a psychiatrist to explore these options.^6,9

An online therapist directory is a great way to find a therapist specializing in PTSD treatment. Alternatively, online therapy services can be beneficial for individuals whose schedules do not permit in-person therapy or whose PTSD makes leaving their homes difficult.

Additional treatments for PTSD include:^6,9

• Eye movement desensitization and reprocessing (EMDR): EMDR for PTSD helps people access and reprocess traumatic memories by using rapid eye movements or bilateral ‘tapping’ until they become desensitized.
• Accelerated resolution therapy (ART): ART is a new evidence-based practice for trauma that involves the use of imagery, eye movement, and other exercises to recondition trauma responses in the brain.
• Cognitive processing therapy (CPT): CPT helps people change how they understand traumatic events by adjusting their perspective on what happened, why it happened, and what it means for them and their lives.
• Cognitive behavioral therapy (CBT): CBT for PTSD involves a structured approach to modifying patterns of thinking and behaving to trigger mood, functioning, and symptom improvements.
• Prolonged exposure therapy: Prolonged exposure therapy is a form of exposure therapy that helps people gradually desensitize themselves to traumatic memories and reminders while using relaxation skills to remain calm.