Depth. That’s the key distinction. Standard rTMS uses a figure-8 coil that focuses on a small cortical area about 2cm deep. Deep TMS (dTMS) uses an H-coil inside a helmet that stimulates wider and deeper brain regions — roughly 4cm deep. Same principle, different reach.
What You’ll Learn
- How H-coil and figure-8 coil designs differ
- FDA clearance comparison
- Efficacy for depression and OCD
- Session experience differences
- Cost comparison
Technology
Standard rTMS (figure-8 coil):
- Devices: NeuroStar, MagVenture, Magstim, Nexstim
- Focused stimulation of a specific cortical spot
- Primarily targets the left DLPFC for depression
- Precise, but limited to the outer cortex
Deep TMS (H-coil):
- Device: BrainsWay (primary manufacturer)
- Broader stimulation pattern reaching deeper structures
- Can target the insula, medial PFC, and anterior cingulate cortex
- Helmet-based design with various H-coil configurations for different conditions
FDA Clearances
| Condition | Standard rTMS | Deep TMS |
|---|---|---|
| Depression | 2008 | 2013 |
| OCD | No | 2018 |
| Smoking cessation | No | 2020 |
| Anxious depression | 2021 (NeuroStar) | No |
Deep TMS covers more conditions. Standard rTMS has been treating depression longer.
Efficacy for Depression
Head-to-head comparisons are limited, but here’s what the data shows:
- Response rates: Both hit 50-60%
- Remission rates: Both land at 30-35%
- Deep TMS may work slightly faster in some studies
- Standard rTMS has more published long-term follow-up data
For depression specifically? They perform about the same.
Where Deep TMS Pulls Ahead
OCD: Deep TMS is the only FDA-cleared TMS option for OCD. The H-coil targets the anterior cingulate cortex and medial PFC — deeper structures wired into OCD circuitry that figure-8 coils simply can’t reach as effectively.
Smoking cessation: Deep TMS targeting the insula received FDA clearance. Standard rTMS can’t reach the insula as efficiently.
Multiple conditions: If you have depression plus OCD, or depression plus an addiction component, deep TMS’s broader reach could be a real advantage.
Session Comparison
| Factor | Standard rTMS | Deep TMS |
|---|---|---|
| Session time | 19-37 minutes | 20 minutes |
| Positioning | Coil held against head | Helmet worn |
| Comfort | Focused tapping sensation | Broader sensation |
| Sessions per course | 36 (typical) | 20-36 (varies by condition) |
Cost
Similar for you. Insurance covers both the same way:
- $200-$400 per session
- $6,000-$12,000 per course
- Coverage depends on your diagnosis, not the device type
Most people don’t choose the technology — they choose a provider. A skilled clinician with either device will likely get good results. If you happen to have access to both, talk to your psychiatrist about which technology better fits your specific symptoms.
Search for TMS providers or explore other device comparisons.
Key Takeaways
- Deep TMS uses H-coils to reach subcortical structures; standard rTMS uses figure-8 coils
- Depression outcomes are comparable between the two approaches
- Deep TMS is the only TMS device with FDA clearance for OCD
- Standard rTMS is more widely available at US clinics
- Both are covered by insurance similarly
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