The History of TMS: From Faraday to FDA and Beyond

Everything you need to know about The History of TMS: From Faraday to FDA and Beyond — how it works, what it costs, and how to find a provider who actually knows what they're doing.

In 1831, Michael Faraday demonstrated that a changing magnetic field could induce an electrical current in a conductor. He was studying electromagnetic induction — not treating depression. But the principle he established is the same one that makes TMS possible.

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It took more than 150 years from Faraday’s demonstration to the first magnetic stimulation of the human motor cortex. The path from there to FDA clearance and global clinical practice is a story of neuroscience, engineering, and the gradual acceptance that the brain, like any organ, could be modulated without drugs or surgery.

What You’ll Learn

• How Anthony Barker’s 1985 breakthrough created modern TMS technology
• The serendipitous discovery that TMS affects mood
• How FDA clearance in 2008 transformed the TMS landscape
• The expansion of TMS indications from depression to OCD, migraine, and beyond
• How the Stanford Neuromodulation Therapy protocol transformed what TMS can achieve

The Early Years: Finding the Right Tool

The first attempt to stimulate the brain magnetically came from Anthony Barker at the University of Sheffield in 1985. Barker’s device delivered magnetic pulses through a coil placed on the scalp, activating the motor cortex and causing muscle contractions in the hand. It was the first modern transcranial magnetic stimulation.

The early machines were crude by today’s standards — single pulse devices that could activate the motor cortex but not sustain the patterned, repeated stimulation needed for therapeutic applications. Within years, however, researchers had built repetitive TMS (rTMS) devices capable of delivering trains of pulses.

Early research quickly established that:

• Repeated stimulation at high frequencies (5-20 Hz) increased cortical excitability
• Repeated stimulation at low frequencies (1 Hz or less) decreased cortical excitability
• The prefrontal cortex was reachable and connected to mood circuits
• The technology was safe enough for human use

The Depression Discovery

Interest in TMS as a mood treatment grew in the 1990s, as researchers observed possible mood effects of stimulation and began testing prefrontal stimulation in depression.

This led to early trials in the mid-1990s, including work by George and colleagues at the Medical University of South Carolina, reporting antidepressant effects of high-frequency TMS to the left dorsolateral prefrontal cortex. These early studies were small, and larger sham-controlled trials followed.

Over the next decade, larger trials followed. The consistency of findings — modest but significant antidepressant effects across multiple trials — built the case for FDA consideration.

FDA Clearance: The Turning Point

In 2008, the FDA cleared the first TMS device (NeuroStar) for treatment of major depressive disorder in patients who had not responded to at least one antidepressant medication. It made NeuroStar the first TMS device cleared for depression in the United States.

The evidence supporting the clearance was debated at the time, and subsequent trials and meta-analyses have since built a larger evidence base.

But the clearance mattered enormously for the field. Insurance coverage followed FDA clearance. More manufacturers entered the market. More clinicians trained in TMS. The treatment became available at scale.

Subsequent clearances from other manufacturers (Magstim, MagVenture, BrainsWay) and additional indications (OCD, migraine, smoking cessation) expanded the reach of TMS technology.

The Indications Expand

2013: BrainsWay Deep TMS cleared for major depressive disorder

2018: BrainsWay Deep TMS cleared for OCD — the first repetitive TMS clearance for a psychiatric condition other than depression

2020: BrainsWay Deep TMS cleared as an aid in short-term smoking cessation; MagVenture cleared as an adjunct for OCD (first theta burst clearances for depression came in 2018–2020)

2021: BrainsWay Deep TMS cleared for depression with comorbid anxiety symptoms

2022: Magnus Medical’s SNT cleared for treatment-resistant depression

2024: NeuroStar cleared as an adjunct for adolescents ages 15–21 with depression

The expansion of indications reflects growing evidence and increasing comfort with the technology. Each clearance required separate clinical trials, building the evidence base incrementally.

The Accelerated Protocol Era

The biggest shift in TMS practice over the past decade has been the development and validation of accelerated protocols. The Stanford Neuromodulation Therapy protocol — 10 sessions of 1,800 pulses over 5 days, using fMRI-guided targeting and accelerated delivery — reported remission in about 90% of participants in an open-label study of 22 patients (Cole et al., 2020); a later sham-controlled trial of 29 participants found a mean 52.5% reduction in depression scores with active treatment versus 11.1% with sham (Cole et al., 2022).

The accelerated approach was not new — researchers had explored multiple daily sessions for decades — but the Stanford protocol provided rigorous early efficacy data, which larger trials continue to test. The combination of better targeting, better dosing, and better scheduling transformed what TMS could achieve.

The Technology Evolves

TMS coil design has evolved substantially since Barker’s original single-coil device:

Figure-8 coils — the standard for 25 years, balancing focality and depth for cortical targets

Double-cone coils — angled wings that penetrate slightly deeper for larger or deeper cortical areas

H-coils (Deep TMS) — specialized geometry reaching subcortical structures for OCD and other indications

Multi-locus coils — emerging technology allowing dynamic targeting without physically moving the coil

Neuronavigation — MRI-guided GPS systems that track coil position relative to individual brain anatomy. Now standard at academic centers, still optional at many community clinics

The Current State

TMS is now practiced in hundreds of clinics in the United States and thousands worldwide. The evidence base includes hundreds of randomized controlled trials, multiple meta-analyses, and clinical practice guidelines from professional organizations including the American Psychiatric Association and the Clinical TMS Society.

The technology is more precise, the protocols are more effective, and the accessibility is greater than at any point in its history. The fact that many patients do not respond remains the central challenge, driving research into better targeting, better prediction, and better combination approaches.

Where TMS Is Heading

The next decade of TMS development will likely be defined by three themes:

Precision targeting. Personalized targeting based on individual brain connectivity — the AI-guided approaches discussed in our recent article — will become standard, improving response rates.

Personalized prediction. Machine learning models incorporating genetic, imaging, and clinical data will predict TMS response before treatment begins, allowing better patient selection and protocol matching.

New indications. Research is active in PTSD, bipolar disorder, schizophrenia (negative symptoms), Alzheimer’s disease (cognitive effects), autism, and addiction. Some of these indications will reach clinical trials; some will reach clearance.

The Faraday Lineage

The TMS in your clinic traces a direct technological lineage to Faraday’s demonstration of electromagnetic induction. The physics has not changed — changing magnetic fields still induce electrical currents. What has changed is 200 years of engineering, neuroscience, and clinical validation.

The treatment you might receive today is built on decades of work by hundreds of researchers who asked, one question at a time, whether this strange new technology could help the patients who had not been helped by anything else.

The answer, so far, has been yes — incrementally, imperfectly, but real.

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