You finished your TMS course. Your mood has lifted, your thinking is clearer, and for the first time in months (maybe years), you feel like yourself. Now the question settles in: how long will this last?
It’s a fair question, and it deserves a specific answer. At Nushama, we hear it from nearly every member who responds to TMS (transcranial magnetic stimulation, a non-invasive treatment that uses magnetic pulses to stimulate specific brain regions). The short answer is hopeful: for many people, the benefits last a year or longer, and there’s a lot you can do to stretch them further. Here’s what the research shows, the three paths most people follow after their course, and how we help you pick yours.
How long TMS typically lasts
Here’s the short version: for most people who feel better after TMS, the relief sticks around.
The biggest study to track this followed 205 people for a full year after their TMS course. A year later, more than 6 out of 10 people were still feeling the benefits, and about 1 in 3 were fully back to themselves (Janicak et al., 2014). A smaller earlier study showed similar holding power at the three- and six-month marks, and more recent research in 2025 continues to back this up, including with newer, shorter protocols.
Individual results vary, and there are a few patterns worth knowing:
- If TMS got you all the way back to feeling like yourself (not just a little better), the benefits tend to stick around longer.
- If your depression was less severe or less long-running when you started, you’re more likely to hold your gains.
- If you’re also managing anxiety, substance use, or trauma, relapse can happen a bit sooner, so a proactive plan matters more.
Think of these as patterns, not promises. They help you picture what to expect and plan for what comes next.
Three common paths after TMS (and how to tell which is yours)
Everyone’s path after TMS looks a little different. In practice, most people land on one of three:
Path 1: You feel better and stay better, no follow-up sessions needed
Some people finish their course, feel fully like themselves again, and stay that way for a year or more without any extra sessions. This tends to be the case if TMS brought you all the way back (not just part of the way), your depression wasn’t too severe or long-running to start with, your life isn’t in a big stressful chapter, and you’re staying connected with your regular psychiatrist or therapist.
If that sounds like you, the plan is simple: keep doing what’s already working, stay aware of how you’re feeling, and check in with your care team now and then so someone has eyes on you if things shift.
Path 2: You feel better and use light follow-up to stay that way
A lot of people benefit from occasional follow-up sessions, especially if depression has come and gone in the past. This path makes sense if TMS helped a lot but didn’t take you all the way, if you have a history of things sliding after treatment, if you’ve got a stressful stretch coming (a job change, caregiving, a season that’s always hard), or if past treatments tend to wear off over time.
Follow-up can look like a single session once a month, a small cluster of 3 to 5 sessions every few months, or a short brush-up course once a year. What’s right for you depends on your history and how your symptoms move over time.
Path 3: Things come back, and you do another full course
For some people, the benefits fade over months and the depression comes back enough to warrant a full re-course (usually 20 to 30 sessions again). The good news: people who responded the first time often respond faster the second time.
A re-course is not a failure. Depression can be a recurring condition, and going back for another round is part of the plan, not a sign TMS “didn’t work.” The big year-long study actually built re-treatment into how they followed people, because it’s a normal part of managing depression over time.
Do follow-up TMS sessions actually help?
Short answer: yes, for a lot of people.
The research points in the same direction: some kind of ongoing care after the initial course helps lower the chances of the depression coming back. In one study, people who had occasional follow-up sessions relapsed less than half as often as people who didn’t (Richieri et al., 2013). A smaller study found that once-a-month sessions delayed relapse, though the authors noted one session a month may not be enough for everyone. And more recent 2025 research continues to support follow-up TMS as a real option for people who want to stay well without relying on long-term medication.
Major clinical guidelines for depression care also recommend ongoing support after someone feels better, not just stopping when the immediate episode passes. The field is still figuring out exactly what the ideal follow-up schedule looks like, but the general message is clear: stay ahead of things rather than wait for a full relapse to start over.
Early warning signs most people miss
The most useful thing you can do after TMS is learn to notice when things are starting to slip. The early signs are usually subtle and easy to brush off, and catching them early gives you a real window to act before a full episode takes hold.
Here’s what tends to show up first, in roughly the order people notice them:
- Sleep starts shifting. Often the very first sign, showing up one or two weeks before mood drops. You might start waking up earlier, sleeping later, or feeling unrested even after a full night.
- Energy dips. You feel tired in a way you didn’t two weeks ago. Things that were easy start feeling harder.
- Thinking gets foggy. Trouble concentrating, reaching for words, or that cloudy feeling you remember from before treatment.
- Pleasure starts flattening out. Things you were enjoying again (a show, a meal, time with someone you love) start to feel muted. This is a pattern over several days, not a single off day.
- You want to pull back. Canceling plans, skipping calls, feeling the pull to be alone, even in small ways.
A simple weekly check-in you can do
Once a week, rate each of these on a 1 to 5 scale:
- How well you slept
- Your energy
- How clearly you’re thinking
- How much you’re enjoying things you usually enjoy
- How much you want to be around other people
If two or more drop by a point or more for two weeks in a row, that’s worth a call to your clinician. Don’t wait for a third week to “be sure.” The whole point is to catch things early, before a small dip becomes a full relapse.
Using Spravato or IV ketamine as a bridge if things start to slip
This is where having more than one tool really helps. If the early warning signs show up and you need another round of TMS, there’s usually a wait of a few days to a few weeks before those sessions can start. In that in-between time, something fast-acting like Spravato (a nasal spray that’s FDA-approved for depression that hasn’t responded to medication) or IV ketamine can steady your mood in days instead of weeks.
In one large study, people using Spravato alongside an antidepressant were about half as likely to relapse as those who didn’t (Daly et al., 2019), and it tends to work within days rather than weeks.
IV ketamine works in a similar way. In our experience, just one to three sessions can often steady things for a week or two while another TMS round gets scheduled. Having all three options (TMS, Spravato, IV ketamine) in the same practice means if something starts to slip, you can act right away instead of waiting. That’s part of why we built Nushama the way we did.
What a Nushama plan looks like after your course ends
At Nushama, finishing TMS is the start of a plan, not the end of one. For most members that includes:
- A check-in two to four weeks after your course ends, so we can see how the benefits are holding up and talk about what’s next.
- A simple way to track how you’re feeling week to week (like the check-in above), so small changes don’t sneak up on you.
- A follow-up plan in your back pocket. If your care team thinks you’d benefit from follow-up sessions, it’s already set up before you need it, whether that’s monthly, every few months, or a plan for another full round.
- Fast access if things start to slip. If you notice warning signs, you can reach our team quickly, and we bump members showing early signs to the front of the line.
TMS is a turning point, not the finish line
So, how long does TMS last? For a lot of people, the benefits carry well past the initial course, especially when the response is strong and there’s a plan for what comes after. The biggest long-term study we have showed that most people who responded were still doing well a full year later.
That said, TMS isn’t a cure. It’s a powerful reset, and how you take care of yourself in the 6 to 24 months afterward is a big part of what keeps that reset holding. The people who stay well tend to be the ones who keep an eye on the early signs, stay connected to their care team, and have fast access to something helpful if things shift.
If you’ve finished your TMS course and want a plan for what comes next, we’d love to talk it through with you. You can book a post-course consultation with Nushama anytime.
FAQs
How long do TMS results typically last after a full course?
For most people who respond, the benefits last at least a year. In the largest study we have (Janicak et al., 2014), about 62% of initial responders were still feeling the benefit at 12 months. How long your own response lasts depends on a few things: whether you reached full remission, your depression history, and the post-course plan you put in place.
Does TMS need to be repeated?
It depends on your individual response. Some people sustain their gains without additional sessions. Others benefit from periodic maintenance treatments or, if symptoms return fully, a re-course of 20 to 30 sessions. Re-treatment tends to work faster than the initial course.
What is maintenance TMS?
Maintenance TMS refers to scheduled follow-up sessions after an initial course, designed to sustain your response and reduce the risk of relapse. Protocols vary but may include monthly single sessions, quarterly clusters, or annual brief re-courses. Research by Philip et al. (2016) and Richieri et al. (2013) suggests maintenance sessions can meaningfully reduce the risk of relapse compared to no additional treatment.
Can ketamine or Spravato help if TMS benefits start to fade?
Yes. Rapid-acting treatments like IV ketamine or Spravato (esketamine) can stabilize mood within days, serving as a bridge while a TMS re-course is scheduled. The SUSTAIN-1 trial (Daly et al., 2019) found that esketamine plus an oral antidepressant reduced relapse risk by 51% for people in stable remission and by 70% for those in stable response. Practices that offer both TMS and ketamine-based treatments in the same place can make this transition particularly smooth.
How will I know if my TMS response is fading?
Common early signals include changes in sleep quality, reduced energy, difficulty concentrating, loss of interest in activities, and social withdrawal. Tracking these weekly can help you and your clinician catch a dip before it becomes a full relapse.
