Maintenance TMS

Why maintenance TMS matters

TMS changes brain circuits in lasting ways. But depression can come back. About 50-60% of people who respond to TMS maintain their improvement at 12 months. That’s good — but it means 40-50% experience some symptom return.

Maintenance TMS — periodic booster sessions after your initial course — can extend how long the benefit lasts.

Who needs maintenance?

Not everyone. Some people do their 36 sessions, get better, and stay better for years. But certain patterns make relapse more likely:

• Recurrent depression (3+ episodes in your history)
• Chronic depression (symptoms lasting 2+ years before TMS)
• Incomplete remission (you responded but didn’t fully remit)
• Previous relapse after a prior TMS course
• Stopping antidepressants after TMS

If several of these apply to you, maintenance is worth discussing with your provider before you finish your initial course.

Evidence for maintenance TMS

• A 2020 meta-analysis found maintenance rTMS significantly cut relapse rates compared to no maintenance
• People receiving monthly maintenance sessions had 70% sustained response at 1 year vs 50% without
• The sweet spot appears to be weekly sessions that taper to monthly over 3-6 months
• Some people only need quarterly sessions; others do best with ongoing monthly treatment

Common maintenance schedules

Taper protocol (most common):

1. Weekly sessions for 4 weeks after completing your initial course
2. Biweekly sessions for 4-8 weeks
3. Monthly sessions for 6-12 months
4. As-needed sessions if symptoms start creeping back

Fixed schedule:

• Monthly single sessions, ongoing
• Some clinics offer “cluster” maintenance — 3 sessions over 1 week, every quarter

Symptom-triggered:

• You track your mood (PHQ-9 or daily rating)
• Book maintenance sessions when scores start climbing
• The most personalized approach, but it requires honest self-monitoring

Insurance coverage for maintenance

This varies a lot:

• Some plans cover 6-12 maintenance sessions per year
• Others require re-authorization for each cluster
• Some don’t cover maintenance at all
• Your best leverage: document it with PHQ-9 scores showing symptoms increase without maintenance

Retreatment vs maintenance

These are different things.

Retreatment is a full new course (36 sessions) when symptoms have fully returned after a period of wellness.

Maintenance is periodic single sessions or small clusters to prevent that from happening.

Good news about retreatment: response rates are high. About 80-90% of people who responded the first time respond again.

Practical tips

• Talk about a maintenance plan before you finish your initial course — don’t wait
• Track your mood weekly (PHQ-9 app or journal) so you can catch early warning signs
• Don’t wait for a full relapse. A few booster sessions early is much easier than starting over from scratch.
• Some clinics offer maintenance packages at lower per-session rates — ask about this

How This Protocol Compares

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.

How This Protocol Compares

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.