TMS Therapy for Treatment-Resistant Depression: Your Most Frequently Asked Questions Answered by Hagan Health in Louisville

May 8, 2026

TMS Therapy for Treatment-Resistant Depression: Your Most Frequently Asked Questions Answered by Hagan Health in Louisville

When traditional antidepressants and talk therapy have not provided the relief you need, it can feel discouraging. Many individuals living with treatment-resistant depression (TRD) begin searching for alternative options and eventually find themselves asking: what is Transcranial Magnetic Stimulation (TMS) therapy, and could it help me? At Hagan Health in Louisville, KY, our team receives this question regularly, and we understand how important it is to have clear, reliable answers before pursuing any new treatment.

This FAQ-style guide is designed to address the most common questions patients and their loved ones have about TMS for treatment-resistant depression. Whether you are just beginning your research or are actively considering treatment, the information below can help you make a more informed decision in consultation with a qualified provider.

What Is TMS Therapy and How Does It Work?

Transcranial Magnetic Stimulation, commonly referred to as TMS, is a non-invasive brain stimulation treatment that has been cleared by the FDA for treatment-resistant depression. It uses focused magnetic pulses – similar in strength to those produced during an MRI – to stimulate specific regions of the brain associated with mood regulation, particularly the prefrontal cortex.

Why Is It Considered Non-Invasive?

TMS is classified as non-invasive because it does not require surgery, anesthesia, or sedation. Unlike some other brain stimulation therapies, TMS does not involve any incisions or implanted devices. The magnetic pulses are delivered through a coil placed against the scalp, and patients remain fully awake and alert throughout each session. Because the treatment is also non-systemic, it does not circulate medication through the bloodstream, which means patients typically avoid the systemic side effects commonly associated with antidepressant medications.

What Happens in the Brain During TMS?

The magnetic pulses generated during a TMS session pass through the skull and stimulate nerve cells in the targeted brain region. In patients with depression, activity in the prefrontal cortex is often reduced. TMS aims to increase neural activity in these underactive areas, which may help restore healthier patterns of brain function over time. The cumulative effect of repeated sessions is believed to contribute to gradual improvements in mood and depressive symptoms for many patients.

Who Is a Good Candidate for TMS Therapy?

TMS is specifically indicated for adults with treatment-resistant depression, which is generally defined as major depressive disorder (MDD) that has not responded adequately to at least one or more trials of antidepressant medication. At Hagan Health, we work closely with each patient to determine whether TMS may be an appropriate option based on their individual clinical history.

What Qualifies as Treatment-Resistant Depression?

Treatment-resistant depression is not a formal clinical diagnosis on its own, but it is a widely recognized term used to describe cases where standard first-line treatments – typically antidepressant medications and psychotherapy – have failed to produce sufficient improvement. According to estimates published in 2026, approximately one-third of individuals with major depressive disorder do not achieve adequate relief from initial medication trials. For these individuals, TMS may represent a meaningful next step in their treatment journey.

Are There People Who Should Not Receive TMS?

While TMS is considered safe for most adults, there are certain contraindications. Individuals who have metallic implants in or near the head – such as aneurysm clips, cochlear implants, or metal plates – may not be candidates for TMS. Patients with a history of seizures or epilepsy should also discuss their situation thoroughly with a provider before proceeding. During a consultation at Hagan Health, our clinical team conducts a comprehensive screening to ensure that TMS is both safe and appropriate for each individual.

What Should I Expect During a TMS Treatment Session?

For patients in the Louisville area who are considering TMS, understanding what a typical session looks like can help ease any uncertainty. Below are answers to some of the most frequently asked questions about the treatment experience.

How Long Does Each Session Last?

A standard TMS session typically lasts between 20 and 40 minutes, depending on the specific protocol used. Some newer TMS protocols may vary slightly in duration. Because no anesthesia or sedation is required, patients can drive themselves to and from appointments and resume normal daily activities immediately after each session.

How Many Sessions Are Needed?

A full course of TMS therapy generally involves sessions five days per week over a period of four to six weeks, followed by a tapering phase. The total number of sessions can vary depending on the patient’s response and clinical needs. Your provider at Hagan Health will develop a treatment plan tailored to your specific situation.

What Does TMS Feel Like?

During treatment, patients sit in a comfortable chair while the TMS coil is positioned against the scalp. Most patients describe the sensation as a tapping or clicking feeling on the head. Some individuals may experience mild discomfort during the first few sessions, but this typically decreases as the brain adjusts to the stimulation. Patients are able to read, listen to music, or simply relax during their sessions.

Is TMS Therapy Safe? What Are the Potential Side Effects?

Safety is understandably one of the top concerns for anyone exploring what TMS therapy involves. The good news is that TMS has a well-established safety profile and has been studied extensively in clinical trials and real-world practice.

Common Side Effects

The most commonly reported side effects of TMS include:

  • Mild to moderate scalp discomfort or tenderness at the treatment site
  • Headache during or shortly after the session
  • Lightheadedness
  • Tingling or twitching of facial muscles during stimulation

These side effects are generally mild and tend to diminish over the course of treatment. Most patients find them manageable and do not discontinue therapy as a result.

Serious Side Effects

Serious adverse events associated with TMS are rare. The most significant risk is seizure, but the incidence is extremely low – estimated at less than 0.1% of patients. Hagan Health follows strict safety protocols and screening procedures to minimize risk for every patient who undergoes treatment at our Louisville clinic.

How Does TMS Compare to Medication Side Effects?

One of the reasons many patients seek out TMS is to avoid or reduce the systemic side effects often associated with antidepressant medications, such as weight gain, sexual dysfunction, fatigue, and gastrointestinal issues. Because TMS targets the brain directly without entering the bloodstream, it does not typically produce these types of side effects. This is an important distinction for patients who have struggled to tolerate multiple medications.

How Effective Is TMS for Treatment-Resistant Depression?

When patients ask what is TMS therapy capable of achieving, effectiveness is naturally at the center of that question. While individual results vary and no treatment can guarantee outcomes, the clinical evidence supporting TMS for treatment-resistant depression is substantial and continues to grow in 2026.

Clinical studies have shown that many patients experience a meaningful reduction in depressive symptoms following a full course of TMS, with a significant percentage achieving remission. Response rates in clinical trials have generally ranged from approximately 50% to 60%, with remission rates around 30% to 35%. These figures are particularly notable given that TMS patients have, by definition, already failed to respond to other treatments.

It is important to set realistic expectations. Some patients may notice gradual improvement during the treatment course, while others may not experience changes until after completing the full series of sessions. Hagan Health encourages open communication with your treatment team throughout the process so that progress can be monitored and adjustments made if needed.

Is TMS Therapy Covered by Insurance?

Cost and coverage are among the most practical questions patients have when learning about TMS. At Hagan Health, TMS therapy is often covered by insurance for patients with treatment-resistant depression, particularly after documented medication failures. We currently accept several major insurance providers for TMS, including:

  • Aetna
  • Cigna
  • TRICARE
  • Medicare
  • Anthem
  • Beacon/Carelon

Because every insurance plan is different, we recommend contacting Hagan Health directly to verify your specific coverage and discuss your options. Our team is available to help you navigate the process and understand what your plan may offer.

Why Choose Hagan Health for TMS in Louisville?

Hagan Health is dedicated to providing evidence-based, compassionate care for individuals in the Louisville community who are living with treatment-resistant depression. Our clinic utilizes advanced TMS technology designed to stimulate broader and deeper brain structures, which may enhance therapeutic outcomes for some patients.

Located at 4010 Dupont Circle, Suite 202, in Louisville, KY, our practice is committed to creating a supportive and professional environment for every patient. From your initial consultation through your final session, our clinical team works closely with you to ensure your experience is as comfortable and effective as possible.

Taking the Next Step Toward Relief

If you or someone you care about has been living with depression that has not responded to standard treatments, understanding what TMS therapy is and how it may help is an important first step. TMS offers a non-invasive, non-systemic alternative that has helped many patients achieve meaningful improvement in their quality of life.

At Hagan Health, we are here to answer your questions and help you determine whether TMS may be right for you. We encourage anyone in the Louisville area who is curious about this treatment to reach out and schedule a consultation. Speaking with a qualified provider is the best way to get personalized guidance based on your unique clinical history and treatment goals. Contact Hagan Health today to learn more and begin exploring your options for treatment-resistant depression.

smoking

Smoking Addiction

BrainsWay Deep TMS is a noninvasive, FDA-cleared, outpatient brain stimulation procedure with proven clinical results to help patients to quit smoking.  Known as the addiction coil, the H4 coil was specifically designed for targeting the deep areas of the brain involved in addictions.

A large study in 14 centers examined adults who had been long-term heavy smokers, all having failed prior quit attempts using medication, therapy, or other methods. Of those that completed Deep TMS treatment, 28% achieved four consecutive weeks without smoking, most of them not smoking for at least three months after treatment.  Among all participants in the study, the average number of cigarettes smoked per week over the course of treatment was reduced by 75%.  

TMS has none of the side effects commonly found in medication to treat smoking cessation. TMS is well-tolerated with years of safety data supporting Deep TMS. Patients may initially experience minor headaches or pain at the site of treatment which typically subside after the first few sessions. There is no preparation, no anesthesia, and patients are able to resume daily activities immediately after each treatment session. Treatments are done in our office. Each treatment session lasts 25-30 minutes. They are done daily on weekdays for 3 weeks followed by a weekly session for another 3 weeks.

BrainsWay Deep TMS offers a fresh approach that may help to quit smoking using cutting-edge neuroscience. Clinically proven and well-tolerated, Deep TMS is the first non-invasive technology that is FDA-cleared to treat smoking addiction.

addiction

OCD

Deep TMS has recently be approved by the FDA for treatment of obsessive-compulsive disorder (OCD).  OCD traditionally has been treated primarily with exposure psychotherapy, and while it is also treated with medication such as fluvoxamine, OCD does not respond well to medication management.  Medication improves symtpoms greater than 30% in only 50% of patients, and half of OCD patients stop taking their medication due to side effects.  And while exposure therapy might improve OCD, as many as 80% of patients continue to have symptoms after psychotherapy, according to some studies.

BrainsWay Deep TMS is a noninvasive, FDA-cleared, outpatient brain stimulation procedure with proven clinical results for improving the symptoms of OCD.  The technology stimulates the brain using its patented H-coil, known as the H7 coil, resulting in a deep and broad penetration of the magnetic field into areas of the brain that are affected in OCD. Deep TMS is safe and well-tolerated, has a very low rate of side effects, and does not require anesthesia.  

Research has proven a higher level of improvement using Deep TMS.  Almost 68% of OCD patients were able to reduce symptoms by more than 30%, and 87% of those who responded saw sustained improvement for at least a year.

depression

Depression

Major depression was the diagnosis first approved for treatment with TMS, and it is still the most commonly treated condition. Most patients are treated with TMS after failures of medications and psychotherapy, as insurance companies will pay for TMS treatment only after medication failures.  However, TMS treats depression much better than medication, and some would argue that TMS should be the first treatment instead of the last.  

When patients have not improved with medication, they are considered to be “treatment-resistant”. And in treatment-resistant depression, TMS treatment results in significant improvement, defined as more than a 50% reduction in symptoms, in more than 80% of patients.  And more than 60% of patients achieve remission.  That is a very high and a very impressive number of people who are happy for the first time in many years after TMS treatment.

TMS treatments for depression are done in a series of 36 treatments.  Patients have a 20-minute treatment 5 days a week for six weeks followed by 6 more treatments in a tapering schedule over three more weeks. No preparation is needed, and there is no recovery time.  After each treatment, patients are able to leave and go about their day.  Except for a rare seizure, which occurs in 1 of 1000 patients, TMS has only minor side effects of mild headache or scalp soreness in the first few days. 

It is said that after successful TMS treatment, that there is a 50% chance of relapse of depression within the first year.  However, at Hagan Health we consider that statistic to be too high, and our relapse rate is lower.  While treatments are done by certified and experienced treaters, Dr. Hagan is closely involved in determining the location and strengths of settings to provide the most accurate treatment.  In addition, Dr. Hagan meets with patients every week or two before and during treatment, and periodically after treatment, in order to insure the best possible results.  Depression varies from patient to patient, and it is important to get the know the patient and the thoughts, feelings, and circumstances that might lead to relapse.  Using cognitive therapy techniques, patients are taught to be aware of triggers and to be prepared with the cognitive tools used to reduce the chances of relapsing. 

TMS for Anxious Depression

Recently TMS has been cleared by the FDA for treatment of Anxious Depression.  This condition is one in which anxious distress is a major part of the clinical picture while depression remains the predominant diagnosis.  Anxiety which is treated along with depression is also significantly improved, while TMS is not currently considered appropriate for the treatment of anxiety without depression.

Dr. Hagan Bio

So the lesson Al taught me was about my lack of happiness related to feelings of inadequacy. Even though I had become a brain surgeon, I did not have a healthy self-regard. Al explained to me that my father, in his drive to succeed and to push me to succeed, would never let me savor a victory, that whenever I achieved something important, he would ask, . “How could you have done it better?” Or “what is next?”. He was setting the bar at perfection, such that nothing less than perfection was going to be good enough. Al said, “Nobody is perfect”, and that I would be much happier deciding what degree of imperfection I was going to settle for. When one sets the bar at perfection, then every effort falls short of perfection and is therefore a relative failure, it becomes yet more evidence of one’s belief that he is fundamentally flawed and inadequate. He said that we are all always doing our best, and that is not fair for my father or for me myself to tell myself that I am not good enough. It was the single most important piece of wisdom that I would learn for the next several decades, and I have told this story many times to those who, like me, grew up to have similar issues.

After seeing Al for a year, another year or two went by. One day at church I was listening to a talk from a psychotherapist who had grown up in a family in which his mother was an alcoholic and his father was a workaholic. His story sounded so much like mine that I decided to see him professionally to “learn more about this garbage in my head”. I saw Paul for two years.

A few years later, life had become quite stressful. I was married with three small children, practicing neurosurgery full time and doing some farming on the side. It was at this time that I started seeing my third therapist, the one that I would see for most of the next 10 years. Keith was a psychiatrist, an MD like me, who did only psychotherapy. A few months after starting my therapy with Keith, I realized that I liked what he did better than what I did. The process of therapy is that of developing an increasing awareness of how one got to be the way he or she is, starting with childhood issues. Specifically, this type of therapy is called “psychodynamic psychotherapy”.

Dr_Hagan
Terry

Three years into my experience with Keith, I made the final decision that I would rather be a psychiatrist, because I came to love the process of developing insight into one’s own psychology. As I closed my neurosurgery practice and completed a residency in psychiatry, I was so grateful the entire time for the opportunity to turn myself into a psychiatrist. “Who gets to do that?!” Years later a patient was looking at the books on my bookshelf and asked, “So you were a neurosurgeon; did you like it?” I had been asked many times why I decided to give up neurosurgery to become a psychiatrist, but no one had ever asked if I liked neurosurgery. The answer had to be that no, I did not. I did not like who I was. But I have loved psychiatry from the very beginning, and I really appreciate the contribution it has had in my own personal development.

But because of my heavy early experience in psychotherapy, I also became proficient and experienced in both psychodynamic psychotherapy and in cognitive behavioral therapy (CBT). And I attended the Cincinnati Psychoanalytic Institute for a year to take my psychotherapy skills to a higher level.

During the 17 years that I have been practicing psychiatry, I have continued to grow. The most gratifying experiences I have had have been when I have settled into a psychotherapy relationship with a patient, while there have been many, others with whom I have combined psychiatry with psychodynamic therapy, practicing psychodynamic psychiatry.

Terry
Dr. Hagan Bio

During these same years, I have also been on several mission trips, which have given me perspectives that I would never have learned otherwise. The concepts of loving your neighbor, giving of your time and resources, being kind and gentle and gracious, have come to define me.

I have always been at the head of my own practice, managing my own business. I have experience with other businesses as well, such as being a successful alpaca breeder for 10 years. “They do not teach business in medical school.” In a growing psychiatry practice, running the business is something you learn from necessity.