Transcranial Magnetic Stimulation (TMS) for Depression and Bipolar

Transcranial Magnetic Stimulation (TMS) is a noninvasive neuromodulation therapy used primarily for depression. It delivers brief magnetic pulses via a coil placed on the scalp, stimulating brain regions involved in mood regulation. Patients remain awake during treatment, with no anesthesia needed. TMS is FDA‑cleared for major depressive disorder (MDD) when other treatments have failed. In practice, a TMS session typically lasts 20–50 minutes, given 5 days per week for about 4–6 weeks. For example, Mount Sinai’s program notes that “we generally provide TMS every day for four to six weeks…usually 20 to 30 sessions”.

Figure: Conceptual illustration of brain stimulation. TMS uses a magnetic coil to create pulses that modulate neural circuits involved in mood (image: Neurotherapeutics NYC).

How TMS Works

During a session, an electromagnetic coil is positioned against the patient’s head. The coil generates a rapidly changing magnetic field that penetrates the skull and induces small electrical currents in targeted brain regions. In depression treatment, TMS typically targets the left dorsolateral prefrontal cortex – a region with reduced activity in many depressed patients. These magnetic pulses “stimulate nerve cells in the region of your brain involved in mood control and depression”. Over multiple sessions, this stimulation is thought to normalize brain activity and improve mood. Deep TMS devices use specialized coils to reach deeper brain areas, but the basic principle remains the same. Importantly, TMS is not invasive: no surgery or anesthesia is required, and patients can drive themselves home after each visit.

TMS for Depression and Bipolar Disorder

Depression (MDD)

TMS is FDA-approved for treatment-resistant depression (TRD), meaning patients with major depression who have not responded to several medication trials. Research shows TMS can provide meaningful relief for many such patients. Harvard Medical School notes that “approximately 50%–60% of people with depression who have tried and failed to receive benefit from medications experience a clinically meaningful response with TMS. About one-third of these individuals experience a full remission”. These response rates, while not 100%, make TMS a valuable option for patients who have “not found medication to be a helpful resource”. After a course of treatment, most patients feel better for many months, although depression can recur and maintenance treatments are sometimes needed.

Mount Sinai and ColumbiaDoctors (both in New York City) highlight that TMS is a cutting-edge, FDA-approved treatment for medication-resistant depression. For instance, Columbia notes that “TMS was first FDA approved in 2008 for depression” and that treatments are “typically covered by insurance” for this indication. In practice, a TMS regimen is individualized: Columbia’s program delivers daily sessions (each up to one hour) for about six weeks, while some clinics offer accelerated protocols (e.g. 19-minute sessions over 3–4 weeks).

Bipolar Depression

TMS is not formally FDA-approved for bipolar disorder, but it is often used off-label for bipolar depression (the depressive phase of bipolar I or II) in consultation with a psychiatrist. Patients with bipolar depression typically try medications and psychotherapy first; if those fail, TMS may be considered. The U.S. FDA granted “Breakthrough Device” status in 2020 to a TMS system for bipolar depression, indicating growing evidence and interest. A recent JAMA Network review notes that this designation “indicates interest, is generally supported by evidence, and provides an expedited path for FDA review”.

Clinical studies on bipolar disorder are still emerging. A review by Weill Cornell (NY) concluded that current data on TMS in bipolar disorder are “preliminary but intriguing,” suggesting possible benefit especially as an adjunct to medication. In practice, some providers may try TMS for bipolar depression when episodes are not well-controlled by drugs. However, patients with a history of mania or seizures require careful evaluation, as any brain stimulation carries some risk of inducing mania or seizures in rare cases.

Benefits and Limitations of TMS Therapy

Pros (Benefits): TMS offers several advantages over other treatments. It is completely noninvasive, with no need for anesthesia or sedation. Unlike electroconvulsive therapy (ECT), TMS has minimal cognitive side effects (no memory loss). Sessions are short and painless; “the pulses are not painful and have few side effects”. The most common complaints are mild scalp discomfort or headache during or after treatment. Because patients stay awake, life disruption is minimal: most return to work or daily activities immediately after a session.

In terms of effectiveness, TMS has a solid evidence base for depression. As noted, about half of medication-resistant patients improve significantly. TMS has FDA clearance and insurance coverage for MDD, meaning it meets rigorous safety standards. In clinical settings, positive results can often be seen after a few weeks of treatment (many centers report improvement after 4–6 weeks). TMS can be a lifeline for TRD patients who have exhausted other options: it’s a proven alternative to further medication or invasive therapies.

Cons (Limitations): TMS also has drawbacks. The time commitment is substantial: standard protocols involve daily (weekdays) visits for 4–6 weeks. This can be challenging for patients with busy schedules or mobility issues. Insurance coverage usually requires documentation of “treatment resistance” – for example, history of failed antidepressant trials. Insurers like Medicare, United Healthcare, Aetna, Cigna and others cover TMS for MDD/TRD, but typically after meeting specific criteria (e.g. documented medication failures). Patients should confirm coverage and any out-of-pocket costs before starting.

Another limitation is that TMS is not effective for everyone. Some patients do not respond even after a full course. And its benefits may wane over time; many patients find their mood stabilizers for about a year on average after treatment, but then may need repeat sessions or maintenance. Because it's only FDA-approved for depression (and OCD/migraine/smoking), using TMS for other conditions (like bipolar depression) is considered off-label. In bipolar cases, the evidence is still emerging, so it is usually offered only when traditional treatments have failed, and often in a research or specialized setting. Finally, there is a very low risk of serious side effects: seizures are rare, but TMS is generally avoided in people with epilepsy or certain metal implants in the head.

TMS in New York and New Jersey

In both New York and New Jersey, TMS treatment is widely available through hospitals and specialty clinics. Major medical centers in NYC (Mount Sinai, Columbia, NYU, etc.) have TMS services integrated into their psychiatry or neuromodulation programs. For example, ColumbiaDoctors’ Depression Program notes it “utilizes the first FDA-approved TMS device” and provides daily treatments for six weeks. Smaller clinics and telemedicine providers are also expanding access. In Westchester County, St. James TMS & Psychiatry advertises “a state-of-the-art TMS practice in New York,” offering TMS alongside medication management for depression and bipolar conditions. Likewise, other mental health centers (e.g. Integrity Mental Health and TMS Services, Greenbrook TMS, Princeton TMS, etc.) market comprehensive “TMS health services” covering assessments, treatment, and follow-up.

In New Jersey, both hospital systems and outpatient centers deliver TMS. Hackensack Meridian’s Jersey Shore Univ. Medical Center (Neptune, NJ) was the first NJ hospital to offer deep TMS for depression, with 20‑minute outpatient sessions. Bergen New Bridge Medical Center (Paramus, NJ) recently opened a Depression Center of Excellence that includes TMS alongside ECT and ketamine. Their CEO noted that TMS is an “alternative treatment for depression…shown to manage treatment-resistant depression in adults”. These programs often serve patients on commercial insurance and, as Bergen New Bridge highlighted, even Medicare/Medicaid patients through state safety-net support. In practice, patients can find New Jersey TMS therapy at dedicated centers (e.g. The TMS Center of New Jersey, Greenbrook TMS) and some psychiatric practices throughout the state.

Practical Details: Both states have multiple trained providers of “New York TMS treatment” and “tms therapy New Jersey.” Clinics typically schedule a consultation to review a patient’s history and ensure TMS is appropriate. Each TMS session involves sitting in a reclining chair while the coil is positioned; patients often feel a light tapping on the scalp, but no pain. Patients can use headphones or earplugs to muffle the clicking sound of the machine. A full course is about 20–30 sessions (five days/week) as noted. Some centers now offer accelerated protocols (e.g. theta-burst stimulation) that cut sessions to 3–10 minutes, but these are applied over similar multi-week courses.

Effectiveness is usually monitored weekly. Providers often administer depression rating scales or conduct clinical interviews to track improvement. Many clinics (like ColumbiaDoctors) note TMS results become apparent after several weeks. If a patient achieves remission or response, the team will discuss maintenance options (occasional booster sessions or transition to other therapies). If TMS does not work, clinicians consider alternatives like ECT or ketamine.

Insurance & Cost: TMS is expensive as a treatment course, but most insurers cover it for FDA-approved indications. As one provider blog notes, “Yes, most insurances cover TMS therapy for Major Depressive Disorder (MDD) and treatment-resistant depression”. New York law requires insurers to cover TMS for depression under parity rules, and many NJ plans follow suit. However, coverage usually hinges on medical necessity (e.g. multiple prior antidepressant trials). Patients should verify that the chosen TMS center is in-network and obtain prior authorization. Copays or coinsurance may apply depending on the plan. Some practices (like St. James TMS & Psychiatry) publicly list accepted insurers, which include most major carriers in NY/NJ. For uninsured or out-of-network patients, self-pay and financing options may be available.

FAQ: Common Patient Questions

What is TMS treatment used for?
TMS (transcranial magnetic stimulation) is used to treat psychiatric conditions by modulating brain circuits. It is FDA-cleared for major depression (and OCD, migraines, smoking cessation). In practice, it’s prescribed mostly for treatment-resistant depression when medications or therapy have failed. Some clinicians also use it off-label for other issues like bipolar depression, anxiety, PTSD, or chronic pain. However, for these conditions (including bipolar disorder), TMS is considered experimental until more evidence or approvals emerge.

• Does TMS really help depression?
  Yes. Numerous studies show TMS can significantly improve symptoms in depression. In those who have tried several medications without relief, about 50–60% experience meaningful improvement with TMS. Roughly a third of patients achieve full remission (depression symptoms go away). Mount Sinai and other centers report that TMS “provides new hope” for patients who didn’t respond to meds. Remember that “help” varies: some patients feel moderately better, others have dramatic results. Importantly, most TMS patients stay awake and comfortable during treatment, and side effects tend to be mild (mostly headache or scalp tingling).

• How long is TMS treatment?
  A standard TMS course is typically 4–6 weeks long. Patients usually come in 5 days a week (weekends off) for about 20–30 sessions. Each session lasts about 20–50 minutes, including setup. The stimulation itself may last only a few minutes, followed by brief monitoring. For example, ColumbiaDoctors notes their sessions “take one hour or less” and are done daily for six weeks. Some newer protocols shorten session time but extend treatment over a similar period. After the first week or two, most patients gradually notice symptom changes. Mount Sinai even provides extra “weaning” sessions at the end of treatment.

• Is TMS good for bipolar disorder?
  TMS can be used for bipolar depression in some cases, but it is off-label (not FDA-approved specifically for bipolar). Experts are actively researching its role. In 2020, the FDA gave “breakthrough” designation to a TMS device for bipolar depression, reflecting promising but preliminary evidence. Some clinicians may offer TMS to bipolar patients who have failed medications, especially in the depressive phase. It appears generally safe, but careful monitoring is needed (since any brain stimulation has a slight risk of triggering hypomania or seizures). If you have bipolar disorder, discuss TMS with your psychiatrist: it may or may not be recommended based on your history and current state.

• How successful is TMS for depression?
  Success varies by individual. As noted, about half of eligible patients improve significantly. The average patient response is encouraging, especially compared to further medication trials. However, some people have only partial relief and may need additional treatments. The success rate also depends on having realistic expectations: TMS often helps a great deal, but it may not permanently “cure” depression. Recurrences are common in mood disorders. Many clinics report that patients feel much better for many months, with the average benefit lasting over a year. If depression returns, some patients do repeat TMS courses.

What are the pros and cons of TMS therapy?
Pros: Noninvasive and well tolerated; no sedation or systemic medication. Effective for many who’ve failed meds. Minimal side effects (mostly headache, rare seizures). Outpatient treatment – patients drive home.
Cons: Time-intensive (daily visits for weeks). Insurance prerequisites (usually requires prior medication failures). Not everyone responds and benefits may fade, so some need repeat sessions. Off-label for bipolar and other uses (less evidence available).

TMS Treatment in NY/NJ: Finding Care

Patients and providers in New York and New Jersey have increasing access to TMS. Search terms like “transcranial magnetic stimulation New York” or “tms therapy New Jersey” return many clinic options.

• New York: Beyond academic centers (Mount Sinai, Columbia, NYU), there are private TMS practices. For example, St. James TMS & Psychiatry in White Plains (NY) advertises comprehensive TMS services integrated with telepsychiatry. Manhattan-based programs (such as Neurotherapeutix or NYC Psychiatric Associates) emphasize advanced TMS (e.g. MRI-guided) for depression and more. Many New York clinics highlight expertise in tms management New York, coordinating TMS with medication management.

• New Jersey: Jersey Shore University Med Center (part of Hackensack Meridian) and Bergen New Bridge Medical Center are leading hospitals offering TMS as part of their depression programs. Private centers like Greenbrook TMS (with NJ locations) and The TMS Center of Princeton provide TMS therapy and often work with insurers. In NJ, clinics often market “new jersey tms treatment” for depression. Telemedicine options may also exist for consults, though the treatment itself requires on-site attendance.

In both states, providers often include a TMS consultation, insurance check, and therapy plan. For patients, it’s important to inquire about treatment duration, expected outcomes, and insurance during the initial consultation. For example, ask: “What is TMS treatment for depression and how many sessions will I need?” Clinics will respond with evidence-based answers (e.g. 20–30 sessions over 6 weeks). Providers can coordinate with patients’ payers: as Columbia notes, “TMS treatments are typically covered by insurance” once criteria are met.

In summary, TMS is a well-established, FDA-approved option for treatment-resistant depression, and an emerging tool for bipolar depression. Both patients and providers in NY/NJ should know it involves daily outpatient sessions over several weeks, has about a 50–60% response rate in TRD, and is generally safe with few side effects. It represents a valuable addition to the mental health “tms management New York/NJ” toolkit. Clinics like St. James TMS & Psychiatry illustrate one model of integrated care, and others (e.g. Bergen New Bridge) underscore that TMS is now a standard part of mood-disorder services. As with any therapy, success depends on proper patient selection, expertise of the provider, and realistic expectations.