Everything you need to know about TMS Maintenance Therapy: How Long Do Results Last? — how it works, what it costs, and how to find a provider who actually knows what they're doing.
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One of the most common questions TMS patients ask after completing their initial treatment course is: How long will this last? It’s a reasonable concern. After all, few people invest six weeks of daily appointments hoping for a brief reprieve. Long-term follow-up data suggests that many people who respond to TMS maintain much of the benefit, although some relapse.
What You’ll Learn
- What long-term follow-up studies show about how long TMS benefits last
- Why benefits can fade for some people
- Maintenance protocol options from monthly boosters to flexible as-needed approaches
- Who benefits most from ongoing maintenance TMS
- Practical considerations for insurance coverage and time commitment
Understanding TMS Durability: What the Research Shows
The best-known durability data comes from a multisite naturalistic follow-up (Dunner et al., Journal of Clinical Psychiatry, 2014). It followed 257 patients who completed an acute TMS course for 12 months. Of 120 patients who responded or remitted by the end of acute treatment, about 62.5% continued to meet response criteria throughout follow-up, and many of the others relapsed. About 36% of patients received additional TMS during the year (abstract).
These results are encouraging but come from an observational study without a control group, in which additional TMS and other treatments were allowed. Individual outcomes vary.
The Science of Why TMS Fades
Depression is a recurrent condition, and relapse after any successful treatment is common. Researchers do not fully understand why benefits fade for some people. Maintenance approaches, such as occasional TMS sessions, continued medication, or psychotherapy, are used to reduce the risk of relapse.
Maintenance Protocol Options
Monthly Booster Sessions
Some clinics offer periodic “booster” TMS sessions after the initial treatment course. Schedules vary widely, and no single protocol has been established. Examples include:
- A short cluster of sessions after the acute course
- One session per month for several months
- One session every few months for longer-term maintenance
Evidence for maintenance TMS is limited. Reviews describe small, mostly non-randomized studies, and the role of maintenance TMS has not been firmly established (systematic review).
Flexible “As-Needed” Approach
Not every patient needs the same maintenance intensity. Some clinics now offer an “open-door” model where patients complete a brief mood assessment (PHQ-9 or similar) every 4–6 weeks, and trigger a booster session only if scores begin climbing toward baseline. This reduces treatment burden while preserving outcomes.
Combined Maintenance
Patients who combine TMS with ongoing psychotherapy or a low-dose maintenance medication often fare best. Psychotherapy and medication are commonly used to help sustain recovery, while continuing an antidepressant may help reduce relapse risk.
Who Should Consider Maintenance TMS?
Clinicians may be more likely to consider maintenance for patients who have experienced:
- Multiple failed medication trials before TMS
- Severe, recurrent depression with 3+ episodes
- A history of relapse within 6 months of prior treatments
For patients whose first depressive episode was successfully treated with TMS and who have strong social support and coping skills, maintenance may be less important, but this is a decision for you and your clinician.
Practical Considerations
Insurance coverage for maintenance TMS varies. Medicare LCD L33398 states that maintenance therapy is not currently supported by clinical trial evidence and is not considered reasonable and necessary (LCD), though retreatment after relapse may be covered in some cases. Commercial policies vary and many do not cover maintenance sessions. Check your plan before scheduling.
Time commitment for a monthly booster session is typically a shorter appointment, often under an hour including check-in, compared to the 6-week daily commitment of the acute phase.
Side effects during maintenance are generally similar to those during the acute course, such as scalp discomfort or headache.
The Bottom Line
Many people keep their improvement for a year or longer, but relapse is possible. Work with your TMS provider to design a maintenance plan that matches your risk profile, lifestyle, and recovery goals.
Frequently Asked Questions
How long do TMS results last without maintenance?
In a 12-month follow-up study of 257 patients (Dunner et al., Journal of Clinical Psychiatry, 2014), about 62% of patients who had responded to acute TMS still met response criteria a year later, and about 36% received additional TMS during that time. Individual outcomes vary.
What happens to TMS effects over time?
Depression is a recurrent condition, and relapse after any successful treatment is common. Why benefits fade for some people is not fully understood. Maintenance approaches, including occasional TMS sessions, medication, or psychotherapy, are used to reduce relapse risk, but evidence for maintenance TMS is limited.
Does Medicare cover TMS maintenance therapy?
Medicare LCD L33398 states that maintenance therapy is not currently supported by clinical trial evidence and is not considered reasonable and necessary, though retreatment after relapse may be covered in some circumstances. Commercial policies vary, and many do not cover maintenance sessions. Check your plan before scheduling.
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