Use of TMS in Treatment of Depression, Discussion With Rachel Rohaidy, MD

Rachel Rohaidy, MD, discussed the clinical role and evolving landscape of transcranial magnetic stimulation (TMS) in the management of depressive disorders. Rohaidy emphasized that TMS is an FDA-approved, noninvasive neuromodulation treatment indicated for patients with major depressive disorder (MDD) who have demonstrated inadequate response or intolerance to antidepressant pharmacotherapy.¹ Although TMS is also FDA-approved for obsessive–compulsive disorder and smoking cessation, insurance coverage remains largely limited to treatment-resistant MDD.

Rohaidy explained that TMS modulates activity within the dorsolateral prefrontal cortex (DLPFC) and its connected networks, including limbic circuits that are typically underactive in depression. Repeated magnetic-pulse stimulation is thought to normalize circuit function by enhancing synaptic plasticity, improving neurotransmitter dynamics (including dopamine and glutamate release) and strengthening cognitive control networks implicated in maladaptive affective states. She notes that TMS is generally well tolerated, preserves cognitive functioning, and should be considered prior to more invasive interventions such as electroconvulsive therapy.

Emerging developments Rohaidy highlighted include accelerated treatment protocols such as the Stanford SAINT approach, which compresses multiweek treatment courses into several days and has demonstrated rapid, robust antidepressant effects in early studies.² She also underscored growing interest in personalized or neuroimaging-guided TMS, using functional MRI and EEG biomarkers to tailor treatment parameters. Additional exploratory research may involve examining TMS for substance use disorders—particularly craving modulation via DLPFC or medial prefrontal cortex stimulation—although these indications remain investigational.

Rohaidy noted she hopes to see substantial advances in neuromodulation over the next decade, positioning TMS as a central and rapidly evolving tool in psychiatric practice.

Dr Rohaidy is a double board-certified psychiatrist in adult and addiction psychiatry at Miami Neuroscience Institute.

References

1. Macmillan C. Transcranial magnetic stimulation (TMS) for depression, OCD: what to know. Yale Medicine. January 28, 2025. Accessed November 24, 2025. https://www.yalemedicine.org/news/transcranial-magnetic-stimulation-tms-what-you-need-to-know

2. Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT). Stanford Medicine. Accessed November 24, 2025. https://stanfordhealthcare.org/medical-treatments/s/stanford-accelerated-intelligent-neuromodulation-therapy.html