Everything you need to know about Deep TMS vs. Standard TMS: Which Technology Is Right for You? — how it works, what it costs, and how to find a provider who actually knows what they're doing.
The TMS Patient Buyer's Guide
Everything to know before your first consult — questions to ask, what to expect, and how to compare providers.
Walk into five different TMS clinics and you may encounter three different coil technologies, two different stimulation frequencies, and a range of protocols with names that sound like they belong in a graduate neuroscience course. Understanding the technology differences matters because the coil design determines which brain structures get stimulated and how deeply.
The two broad categories are standard TMS (using figure-8 or circular coils) and deep TMS (using H-coils designed to reach subcortical structures). Here is what the distinction actually means for your treatment.
Standard TMS: The Figure-8 Coil
Standard TMS coils — most commonly figure-8 shaped — create a focused magnetic field concentrated at the intersection of the two wings. The magnetic field strength drops off rapidly with distance, meaning the stimulation is most intense at the cortical surface directly beneath the coil.
This is actually ideal for targeting the dorsolateral prefrontal cortex (DLPFC), which is where most standard TMS protocols aim. The DLPFC sits on the surface of the brain, and its location relative to the motor cortex (used to calibrate intensity) is well-established.
Figure-8 coils produce a focal point roughly 1-2 centimeters in diameter. This precision is an advantage when you have a well-defined cortical target and want to minimize stimulation of surrounding tissue. The technology is mature and well-studied, and figure-8 coil systems are FDA-cleared for depression (and, for some devices, OCD).
The trade-off is depth. The magnetic field diminishes quickly, making it difficult to consistently stimulate structures more than 2-3 centimeters below the cortical surface. If subcortical targets are needed, you need either more sessions, higher doses, or a different coil design.
Deep TMS: The H-Coil Approach
Deep TMS technology, commercialized by BrainsWay, uses a specialized coil geometry called the H-coil. The design intentionally shapes the magnetic field to penetrate more deeply while maintaining reasonable focality — reaching 3-4 centimeters below the cortical surface, and in some configurations even deeper.
The trade-off is focality. Deep TMS coils necessarily stimulate a larger volume of brain tissue than figure-8 coils. For some applications, this is desirable — reaching the anterior cingulate cortex, insular cortex, or medial prefrontal cortex may require the deeper penetration. For others, it means stimulating brain regions you did not intend to target.
BrainsWay’s Deep TMS system received FDA clearance for depression in 2013, OCD in 2018, and as an aid in short-term smoking cessation in 2020, and it has also been cleared for depression with comorbid anxiety symptoms. The OCD protocol targets the medial prefrontal cortex and anterior cingulate cortex — structures that standard TMS coils cannot reliably reach.
Clinical Outcomes: Does Deep TMS Work Better?
Head-to-head comparisons between deep TMS and standard TMS are surprisingly rare, which makes definitive claims about superiority difficult.
For depression, both technologies have positive controlled trials. In BrainsWay’s pivotal sham-controlled trial, 38.4% of patients responded and 32.6% reached remission at week 5, versus 21.4% and 14.6% with sham (Levkovitz et al., 2015). Differences in trial design make direct comparison with standard TMS trials unreliable.
For OCD, the targets (medial prefrontal and anterior cingulate cortex) are deeper than a standard coil typically reaches, which is the rationale for the H-coil. In the pivotal sham-controlled trial, response rates were 38.1% with active deep TMS versus 11.1% with sham at the end of treatment, and 45.2% versus 17.8% at one-month follow-up (Carmi et al., 2019).
For other conditions where deeper structures are implicated, evidence is more limited. BrainsWay has FDA clearance as an aid in short-term smoking cessation; uses for PTSD and chronic pain are off-label.
Which Should You Choose?
The answer depends on your specific condition, treatment history, and what your clinician recommends. Some broad guidance:
Choose standard TMS (figure-8) if:
- You are treating depression or anxiety, where the DLPFC is the established target
- Your clinic offers standard TMS and has strong outcomes data
- Cost is a factor — standard TMS is more widely available and often less expensive per session
- You want a theta-burst or accelerated protocol; ask which protocols each clinic’s device is cleared and set up for
Choose deep TMS (H-coil) if:
- You have OCD — deep TMS has specific FDA clearance for this indication
- You have treatment-resistant depression and have not responded to multiple standard TMS courses
- Your clinician believes subcortical targeting would benefit your specific case
- You are treating smoking addiction — BrainsWay has FDA clearance specifically for this
- Your clinic has deep TMS available with experienced operators
The Operator Variable Matters More Than the Coil
Coil technology is only one factor. Operator experience, accurate targeting, and adherence to the protocol also matter, although there is little head-to-head research quantifying how much each contributes.
This means the question “should I get deep TMS or standard TMS” should really be “which clinic has the most experienced TMS team with the best outcomes for my condition.” The coil technology is a secondary consideration.
Before choosing a clinic, ask specifically: how many TMS patients have they treated, what are their response and remission rates, do they use neuronavigation for targeting, and what experience do they have with your specific condition.
Emerging Technologies
Coil engineering is an active area, and several manufacturers are developing coils that try to balance depth and focality.
The other notable development is multi-coil arrays — systems using multiple coils simultaneously to shape the magnetic field more precisely than any single coil can achieve. Several academic centers are exploring this approach, though commercial availability remains limited.
Making the Decision
Technology choice in TMS is not a simple matter of “better” or “worse.” Different coil designs reflect different trade-offs between depth, focality, and target accessibility. The right choice depends on your condition, your treatment history, and — most importantly — the expertise of the clinical team offering the treatment.
Start with the condition. If you have OCD, deep TMS is specifically designed for your case. If you have depression and have not responded to standard TMS, deep TMS represents a reasonable next step. For most other indications, standard TMS remains the well-established first-line TMS approach.
Then find the best team, not the best coil.
Related reading
- TMS for Multiple Sclerosis: Addressing Fatigue, Depression, and Cognitive Impairment
- What TMS Actually Feels Like: A Session-by-Session Guide
- How to Prepare for Your First TMS Session
- Preparing for Your First TMS Session: A Practical Walkthrough
- TMS for Treatment-Resistant Depression: What Patients Need to Know
