Why Some Patients Need Multiple TMS Courses

Ashley Keays • March 30, 2026

Transcranial magnetic stimulation (TMS) is a proven, FDA-approved treatment for conditions like treatment-resistant depression and OCD - and for many patients, a single course of TMS delivers meaningful, lasting relief. But for others, the journey looks a little different. Some patients benefit from a second course of TMS, periodic booster sessions, or an ongoing maintenance plan to sustain their results over time.


If you've completed TMS and are wondering what comes next - or if your clinician has mentioned the possibility of additional treatment - this guide will help you understand why repeat courses happen, how decisions about further treatment are made, and what maintenance TMS can look like in practice.



What Is a TMS Course, and How Does It Typically Work?


A standard course of TMS at Creative Wellness typically involves daily sessions, five days a week, over four to six weeks. Each session lasts approximately 20 minutes. During treatment, magnetic pulses are precisely delivered to areas of the brain associated with mood regulation, gradually encouraging healthier neural activity.


Many patients begin noticing improvements within the first few weeks, and results often continue to develop after the course concludes. For a significant proportion of patients, this initial course produces sustained symptom relief - sometimes for a year or more.


However, TMS is not a one-size-fits-all treatment. The brain is complex, mental health conditions vary enormously between individuals, and factors like the severity of symptoms, prior treatment history, and the presence of other conditions all influence how someone responds to TMS.




Why Some Patients Benefit From More Than One Course



The need for additional TMS treatment doesn't mean the first course failed - in most cases, it means the opposite. Here are the most common reasons a patient might return for further TMS:


1. Symptom Recurrence Over Time


Conditions like treatment-resistant depression are chronic for many people. Even when TMS produces an excellent initial response, symptoms can return over time - particularly during periods of heightened stress, major life changes, or seasonal shifts. This is not unique to TMS; it reflects the nature of the underlying condition.


In these cases, a repeat course of TMS can effectively re-establish the neural changes that reduced symptoms in the first place. Research suggests that patients who have responded well to TMS previously are likely to respond well again.


2. Partial Response to the Initial Course


Some patients experience meaningful improvement during their first TMS course but don't achieve full remission. This partial response is still clinically significant - and it often means the brain is showing signs of neuroplasticity that a second course can build upon.


In these situations, a clinician may recommend adjusting the treatment protocol — including targeting different brain regions, modifying the frequency or intensity of pulses, or extending the overall course length — to optimize outcomes.


3. Complex or Comorbid Conditions


Patients managing multiple mental health conditions - such as depression alongside PTSD, OCD, or anxiety - often have more complex treatment needs. TMS may need to be applied across different brain regions or protocols to address overlapping symptoms, which can mean a longer or more phased treatment journey.


4. Medication Changes or Life Stressors


Significant changes to a medication regimen, a major health event, or a sustained period of stress can sometimes destabilize progress. TMS can play a stabilizing role during these periods, either through a short booster series or a more structured maintenance plan.

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How Clinicians Decide Whether Additional TMS Is Appropriate


The decision to recommend further TMS is never made arbitrarily. At Creative Wellness, our clinicians take a thorough, individualized approach to evaluating whether additional treatment is in your best interest.


Key factors considered include:


  • Degree of symptom response: How much did your symptoms improve, and how well have those improvements held over time?


  • Duration of remission: How long did your improvement last before symptoms began to return?


  • Current symptom severity: Are symptoms mildly creeping back, or is there a significant relapse requiring prompt intervention?



  • Patient goals and preferences: What are you hoping to achieve, and what level of commitment is realistic for your schedule and lifestyle?


This evaluation is a collaborative process. Your clinician will never push additional treatment for its own sake - the goal is always to ensure that any recommended course of action is grounded in your clinical picture and personal circumstances.




Understanding Maintenance TMS


Maintenance TMS refers to a less intensive, ongoing schedule of TMS sessions designed to preserve the gains made during a full treatment course. Rather than five sessions per week, maintenance might look like one session per week, fortnightly, or monthly - tailored to what keeps your symptoms at bay.


Think of it similarly to how some patients with chronic depression continue low-dose medication even when feeling well - not because they're unwell, but because sustained support helps prevent a return of symptoms.


Maintenance TMS is particularly worth considering for patients who:


  • Have a history of recurrent depressive episodes
  • Responded very well to TMS but have experienced symptom recurrence after previous courses
  • Prefer to reduce or avoid long-term medication reliance
  • Have a lifestyle or occupational profile that makes sustained well-being particularly important


Your clinician will work with you to design a maintenance schedule that fits your life - and will reassess regularly to make sure it's still the right approach.

Interested in learning more?


Schedule a consultation to see if TMS could be right for you.

Visit our contact page or call 253-900-1605 to speak with our team.

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What the Research Says About Repeat TMS


The evidence base for repeat and maintenance TMS is growing. Studies consistently show that patients who respond to an initial TMS course and then receive a repeat course following relapse show similar - and in some cases better - outcomes than their first course. This aligns with what we understand about neuroplasticity: the brain's capacity for change doesn't simply 'switch off' after the first round of treatment.


Maintenance protocols are also increasingly well-supported, with evidence suggesting that patients on structured maintenance programs experience fewer relapses and longer periods of wellness compared to those who stop TMS entirely after a single course.



TMS as Part of a Broader Care Plan


At Creative Wellness, we believe in a whole-person approach to mental health. TMS - whether it's a first course, a repeat course, or maintenance sessions - is rarely the only tool in play. Our clinicians regularly coordinate TMS care alongside:


  • Medication management: Carefully monitored psychiatric medication can complement TMS and help stabilize outcomes between courses.


  • Counseling and therapy: Evidence-based therapies like CBT build coping skills and emotional resilience that support and sustain TMS outcomes.



This integrated approach means that your TMS clinician isn't working in isolation - they're part of a team that considers the full picture of your mental health.




What to Expect If You're Considering a Second Course


If you've completed TMS and are noticing symptoms returning, or if you feel like you gained some benefit but not quite enough, the first step is to speak with your clinician. There's no pressure to commit to anything immediately - the conversation itself is informative and valuable.


A follow-up evaluation will typically involve:


  • Reviewing your symptom history since completing TMS
  • Assessing your current symptom severity using validated clinical tools
  • Reviewing any changes to your medication or other treatments
  • Discussing your schedule, insurance, and practical considerations
  • Talking through what a new course or maintenance plan would look like specifically for you


For patients who have completed a TMS course, the process is often quicker to navigate - your clinician already has a strong understanding of how your brain responds to treatment.

  • Does needing a second course of TMS mean the first one didn’t work?

    Not at all. In most cases, the need for a repeat course actually reflects a strong previous response — the brain responded well to TMS, and a second course is simply reinforcing those changes. Conditions like treatment-resistant depression are often chronic, and returning for additional treatment is a normal, evidence-based part of long-term care for many patients.


  • How often would I need to come in for maintenance TMS sessions?

    Maintenance schedules vary from patient to patient and are built around what works for you. Some patients come in once a week, others fortnightly or monthly. Your clinician will assess your symptom history and response over time and adjust the schedule accordingly - the goal is the lightest touch that keeps you well.

  • Will my insurance cover a second course of TMS?

    Coverage for repeat TMS courses depends on your individual insurance plan and the clinical documentation supporting the need for further treatment. Many insurers do cover additional courses where there is clear clinical justification. Our team at Creative Wellness has extensive experience navigating insurance approvals and will work with you to understand your options and prepare the necessary documentation.


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