Deep TMS (H-Coil) Protocol

What is deep TMS?

Deep TMS (dTMS) uses a specialized H-shaped coil inside a padded helmet to reach deeper and wider brain regions than standard figure-8 coil TMS. Developed by BrainsWay, it’s the main alternative to standard rTMS — and it holds FDA clearances that no other TMS device has.

How H-coils work

Standard figure-8 coils focus stimulation on a small area — about 2cm deep and 1cm wide. The H-coil creates a broader field pattern, reaching roughly 4cm deep and stimulating a larger volume of brain tissue. Different H-coil designs (H1, H7, etc.) are shaped to target different brain regions.

Broader reach. Deeper penetration. That’s the pitch.

FDA-cleared indications

Deep TMS has the broadest FDA clearance of any TMS device:

That OCD clearance matters. Deep TMS is the only FDA-cleared TMS option for OCD. Same for smoking cessation.

Protocol details

For depression:

• H1 coil targeting left DLPFC
• 18-20 minute sessions
• 36 sessions over 6-9 weeks
• 120% motor threshold intensity

For OCD:

• H7 coil targeting anterior cingulate and medial PFC
• 20-minute sessions
• Provocation paradigm — brief symptom exposure right before stimulation
• 29 sessions over 6 weeks

For smoking cessation:

• H4 coil targeting bilateral insula and PFC
• 18-minute sessions
• Combined with smoking cue exposure
• 18 sessions over 6 weeks

Deep TMS vs standard rTMS for depression

For depression specifically, both achieve comparable response rates (50-60%). Deep TMS may have an edge for:

• People who didn’t respond to standard rTMS (deeper targets could be the difference)
• OCD (it’s the only FDA-cleared TMS option)
• Smoking cessation (again, the only FDA-cleared TMS option)
• Conditions involving deeper brain structures — insula, medial PFC, anterior cingulate

The treatment experience

• You sit in a treatment chair
• A padded helmet goes over your head (the H-coil is inside)
• You’ll feel a broader tapping/pulsing sensation than with a figure-8 coil — it covers more scalp area
• Sessions run 18-20 minutes
• Some people find the helmet less comfortable at first compared to a handheld coil. Most adjust after a few sessions.

Finding a deep TMS provider

BrainsWay systems are available at hundreds of clinics across the US. When searching, ask specifically for “deep TMS” or “BrainsWay.” Insurance covers deep TMS the same way it covers standard TMS.

Finding a Provider

Not every TMS clinic offers every protocol. When searching, ask specifically which protocols they support and which devices they use. Our clinic directory helps you find experienced providers in your area. For protocol-specific questions, the treating psychiatrist should be able to explain why they recommend one approach over another for your situation.

Frequently Asked Questions

What makes deep TMS different from standard rTMS?

Deep TMS uses an H-shaped coil (BrainsWay) that penetrates deeper and covers a broader brain volume than standard figure-8 coils. Standard rTMS reaches about 2cm deep; H-coils reach approximately 4cm, activating deeper structures like the medial PFC and anterior cingulate. This broader stimulation pattern is what enables deep TMS to hold exclusive FDA clearances for OCD and smoking cessation.

Is deep TMS more effective than standard TMS for depression?

Both achieve comparable response rates for depression (50-60%). Deep TMS may offer an advantage for people who didn’t respond to standard rTMS — the deeper reaching stimulation may activate targets that the figure-8 coil misses. For OCD and smoking cessation, deep TMS is the only FDA-cleared TMS option, making it the clear choice for those specific indications.

Does deep TMS cost more than standard TMS?

Not usually. Deep TMS billing codes are the same as standard TMS (90867, 90868, 90869), and most insurers cover it equivalently. The H-coil helmet procedure is similar in duration to standard TMS sessions (18-20 minutes). Some clinics may charge slightly more for the device itself, but insurance coverage generally applies the same way.

What does the deep TMS treatment experience feel like?

The H-coil helmet produces a broader, more diffuse tapping sensation than a standard figure-8 coil — you’ll feel it over a wider area of your scalp. Some people find the helmet less familiar initially compared to a handheld coil, but most adjust comfortably within a few sessions. The treatment itself is still well-tolerated, and no anesthesia or sedation is needed.

Does deep TMS require special training for the provider?

Yes. BrainsWay systems require specific training and certification, and not every TMS clinic has a BrainsWay device. When searching for a provider, ask specifically whether they offer deep TMS or BrainsWay treatments. The clinic directory includes provider device information where available.