Is TMS a 'Cure'? Understanding Remission vs. Response in Depression Treatment

Someone you know may have described TMS as the moment they felt like themselves again. That anecdote captures hope—and it raises a practical question: does transcranial magnetic stimulation end depression, or does it simply reduce symptoms? Clear, clinical language helps separate meaningful outcomes from hopeful shorthand.

Defining treatment success: Remission vs. Response

Treatment outcomes in depression are not binary. Clinicians typically use two related but distinct benchmarks: response and remission. Both matter, but they measure different clinical realities.

• Response commonly means a substantial reduction in symptom severity. Practically, many researchers and clinicians define response as a ≥50% improvement on standardized rating scales such as the Hamilton Depression Rating Scale (HAM-D) or the Patient Health Questionnaire (PHQ-9).
• Remission refers to a reduction of symptoms to a level below a clinical threshold—effectively the absence, or near absence, of core depressive symptoms. A HAM-D score of ≤7 or a PHQ-9 score below 5 are frequently used cutoffs in clinical research.

The difference is meaningful: a person who responds to treatment may still have lingering symptoms that impair function, while a person in remission experiences minimal symptoms and typically better daily functioning.

TMS remission rates and depression response rates: what the numbers mean

Clinical trials and real-world studies report different figures, and methodology matters. Meta-analyses often aggregate results across protocols, devices, and patient populations, producing a range rather than a single number.

• Depression response rates with repetitive transcranial magnetic stimulation (rTMS) are commonly reported in the range of roughly 40–60% across controlled trials and observational studies. Response captures substantial symptom reduction, which can translate into improved mood and functioning for many patients.
• TMS remission rates are typically lower, often reported in the range of about 25–40% depending on the population studied—particularly whether patients had treatment-resistant depression or fewer prior treatment failures.

These figures reflect averages. Individual outcomes vary based on illness history, concurrent treatments, the specific TMS protocol, and adherence to the treatment course. For patients and clinicians, interpreting these numbers requires context: a 30% remission rate in a treatment-resistant group may be clinically meaningful, whereas the same number in a less severe cohort would carry a different implication.

Why the ranges vary

• Different devices and stimulation parameters (frequency, pulse count, coil type).
• Patient selection: some trials enroll individuals with multiple medication failures; others include less refractory cases.
• Definitions: remission thresholds and timing of assessment (immediately post-treatment vs. weeks later) differ between studies.

Is TMS a 'cure'?

The word "cure" implies permanent and complete resolution. Most clinicians and researchers avoid that label for depression treatments, including TMS. Here’s a more clinically honest framing:

• TMS is an evidence-based, FDA-cleared treatment for major depressive disorder that can produce substantial symptom reduction and remission in a significant minority of patients.
• For some people, remission achieved with TMS is durable and life-changing; others will experience relapse or require maintenance strategies.

So, while advanced TMS treatments can produce remission in many cases, calling it a universal cure overstates the current evidence. Framing success in probabilistic terms aligns better with clinical reality and helps manage expectations.

Clinical examples of success metrics

Consider two hypothetical patients:

1. Patient A completes a full course of TMS, reports a 60% drop in PHQ-9 score, returns to work, but still experiences occasional low-energy days. This is a response that improves quality of life but may not meet remission thresholds.
2. Patient B achieves a PHQ-9 score below 5 and maintains that level for months after treatment. This is a remission, showing minimal residual symptoms and restored functioning.

How clinicians measure and monitor outcomes

Objective scales and patient-reported outcomes complement clinical judgment. Common tools include the HAM-D, Montgomery–Åsberg Depression Rating Scale (MADRS), and PHQ-9. Routine measurement supports shared decision-making by making progress—or lack of it—transparent.

• Clinicians often assess at baseline, mid-treatment, end-of-course, and during follow-up.
• Functional measures—work performance, social engagement, sleep, and ability to perform daily activities—help determine whether a statistical improvement translates into meaningful recovery.

Predictors of better outcomes

No single factor guarantees success, but patterns emerge in the literature and clinical practice.

• Lower overall medical and psychiatric comorbidity tends to predict better outcomes.
• Shorter duration of the current depressive episode and fewer prior treatment failures are associated with higher remission probabilities.
• Engagement with concurrent psychotherapy and lifestyle interventions often amplifies benefit.

Age, baseline severity, and the presence of certain features (e.g., psychotic symptoms) can moderate outcomes. Many experts suggest discussing these factors with a clinician to understand how they apply to an individual case.

Durability, maintenance, and managing expectations

TMS can induce remission, but some patients relapse. Management strategies aim to preserve gains.

• Maintenance options include periodic "booster" TMS sessions, continuation pharmacotherapy, and ongoing psychotherapy.
• Close follow-up in the months after treatment helps detect early signs of symptom return so interventions can be adjusted promptly.
• Functional recovery—return to work, social roles, and activities—may lag behind symptom improvement. Patience and rehabilitation-focused interventions can be necessary.

Open conversations about likely outcomes, timelines, and contingency plans reduce mismatched expectations. Clear communication at the outset sets realistic goals and improves long-term satisfaction.

Risks, tolerability, and what to ask a provider

TMS is generally well tolerated. Common side effects are transient scalp discomfort or mild headaches. Serious adverse events, such as seizures, are rare but possible; screening reduces risk.

• Ask whether the clinic uses an FDA-approved TMS system and what safety protocols are in place.
• Inquire about the clinician’s experience, the exact stimulation protocol, and how outcomes will be measured.
• Discuss contraindications—most importantly, intracranial metallic implants or devices that could be affected by magnetic fields.

Beyond symptom counts: broader markers of success

Counting points on a scale matters, but so do daily life outcomes. Many patients and clinicians prioritize regained functioning, reduced suicidal ideation, improved relationships, and restored sense of purpose.

• Functional recovery—returning to work or school, resuming social activities.
• Resilience—ability to manage stressors without significant symptom recurrence.
• Quality of life—sustained improvements in sleep, appetite, and energy.

Practical next steps for people considering TMS

Consider TMS if standard treatments (antidepressant medications and psychotherapy) produced insufficient benefit or caused intolerable side effects. A thorough evaluation by a psychiatrist or TMS-trained clinician is the usual starting point.

• Ask about local experience with TMS therapy for depression and request data on observed outcomes and follow-up protocols.
• Clarify how the care team will measure progress, manage side effects, and coordinate maintenance planning if remission is achieved.
• Remember that combining treatments—medication, psychotherapy, and lifestyle interventions—often yields the most durable results.

Questions worth bringing to an appointment

• What remission and response rates have you observed in patients similar to me?
• Which rating scales will you use, and how often will you reassess?
• What is the plan if I respond but do not reach remission, or if I relapse after treatment?

Final thoughts and practical framing

TMS is a powerful, evidence-supported option that produces meaningful symptom reduction for many people and remission for a significant minority. Calling it a cure mischaracterizes the nuanced reality: outcomes exist on a spectrum and are shaped by clinical history, treatment parameters, and ongoing care decisions.

A pragmatic approach centers on defining treatment success together with a clinician—deciding whether the immediate goal is symptom reduction, functional restoration, or sustained remission—and planning follow-up accordingly. Many experts suggest that combining TMS with other therapeutic strategies and establishing a maintenance plan increases the chance that improvement will last. Speak with a qualified provider to understand how these concepts apply to your situation and to evaluate whether TMS therapy aligns with your goals.