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.

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, well-studied, and FDA-cleared for multiple indications including depression, OCD, and migraine.

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, developed by researchers at the University of Durham and 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 bipolar depression in 2024. The OCD clearance was notable because it specifically 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 show response rates in the 50-60% range in treatment-resistant populations. The BrainsWay depression trials showed roughly 37% remission at 16 weeks, comparable to standard TMS outcomes.

For OCD, deep TMS has an advantage by necessity — the target structures are not reliably accessible with standard coils. Studies have shown roughly 40-45% response rates for OCD symptoms with deep TMS, a meaningful improvement over what standard TMS can offer for that condition.

The picture is similar for other conditions where subcortical structures are implicated, including addiction (particularly smoking cessation, where BrainsWay has FDA clearance), PTSD, and chronic pain.

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 the option for theta-burst or accelerated protocols, which are better established on standard platforms

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

Here is what research consistently shows: the expertise of the TMS operator and the accuracy of targeting matter more for outcomes than the specific coil technology used. A skilled clinician using a standard figure-8 coil with neuronavigation will generally outperform a less experienced operator using a deep TMS system without imaging guidance.

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

Two newer technologies deserve mention. Magstim’s figure-8 DTx coil and MagVenture’s CoolTouch coil are designed to offer deeper penetration than standard figure-8 coils while maintaining better focality than H-coils — essentially trying to split the difference. Early data suggests they may offer an intermediate option for clinicians who want to reach slightly deeper structures without the larger stimulation volume of deep TMS.

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.