Deep TMS vs. Traditional rTMS: Comparing Types of TMS Therapy for Depression in New Haven

If depression has continued despite medication, therapy, or both, you may feel as though your brain is stuck in the same painful pattern. That experience is not a personal failure. Treatment-resistant depression can involve changes in neural networks that regulate mood, motivation, attention, sleep, and emotional flexibility.

Transcranial Magnetic Stimulation (TMS) offers a noninvasive way to influence those networks. But “TMS” is not one single technology. The coil design and stimulation pattern can affect where the magnetic field reaches, how long a session lasts, which conditions the device is cleared to treat, and what your treatment schedule looks like.

This guide compares:

• Deep TMS using an H-coil, including the BrainsWay H1 coil
• Traditional rTMS using a figure-8 coil
• Theta burst stimulation (TBS), a shorter rTMS protocol

At Light-tunnel Behavioral Health Services Inc. in New Haven, your psychiatric team can help determine whether TMS belongs in a broader, personalized treatment plan. Dr. Omolola Aragbada, PMHNP, is one of the psychiatric providers who supports individualized behavioral and psychiatric care.

Quick comparison: Deep TMS vs. traditional rTMS

This table is a starting point, not a prescription. No coil is automatically “better” for every person.

How the coil designs differ

Traditional figure-8 rTMS: focused stimulation

A figure-8 coil contains two connected loops. When positioned over the scalp, it creates a relatively concentrated magnetic field. For depression, high-frequency stimulation is commonly directed toward the left dorsolateral prefrontal cortex (DLPFC), a region involved in attention, planning, motivation, and emotional regulation.

A helpful analogy is a spotlight: figure-8 rTMS is designed to concentrate energy over a relatively specific cortical area. Modeling and experimental studies often estimate effective stimulation at approximately 1.5–2 centimeters below the cortical surface, although the exact field depends on coil design, intensity, head anatomy, and positioning.

Traditional rTMS has a substantial evidence base. In a multicenter randomized controlled trial, active left-prefrontal rTMS produced greater antidepressant benefit than sham treatment in adults with treatment-resistant depression (O’Reardon et al., 2007).

Deep TMS with an H-coil: broader network stimulation

Deep TMS uses an H-coil system placed within a cushioned helmet. The coil elements are arranged to create a broader field that is designed to reach deeper cortical networks than conventional figure-8 systems.

The word “deep” does not mean that magnetic pulses travel uncontrollably into the brain. It refers to the design and distribution of the induced electrical field. Estimates of depth vary across studies and systems, and greater depth generally involves a tradeoff with focality. In other words, a broader field may reach more of a network but be less pinpointed than a figure-8 coil.

BrainsWay is one of the most researched TMS systems, with its company reporting use across more than 60 clinical trials worldwide. More importantly, the H1 coil has been evaluated in a large, multicenter, randomized, sham-controlled trial. In that study, active Deep TMS produced higher response and remission rates than sham treatment after the acute treatment phase (Levkovitz et al., 2015).

Is Deep TMS more effective than traditional rTMS?

The honest answer is: the evidence does not prove that one approach is universally superior.

A direct randomized clinical trial compared H1-coil Deep TMS, figure-8 rTMS, and medication treatment in adults with major depressive disorder. Both TMS groups improved more than medication treatment alone. The H1-coil group showed a higher response rate and greater symptom reduction in some analyses, but the formal head-to-head remission comparison was not definitive (Filipčić et al., 2019).

That distinction matters. A promising result is not the same as a universal rule. Outcomes can depend on:

• Depression severity and duration
• Previous medication trials
• Co-occurring anxiety, OCD, or other conditions
• Sleep, substance use, and medical factors
• Coil positioning and stimulation parameters
• Consistency with treatment visits
• Individual neurobiology

Your symptoms may feel overwhelming right now, but they are not necessarily permanent. TMS works gradually for many patients, and the absence of improvement after a few sessions does not always predict the final outcome.

Which patients may be better suited to each option?

Deep TMS may be considered when:

• You have treatment-resistant major depressive disorder and want to discuss a broader stimulation field.
• Your provider is considering a system with additional FDA-cleared indications, such as OCD or short-term smoking cessation, when clinically appropriate.
• You have difficulty responding to previous treatments and want to review both standard and interventional options.
• A helmet-style device feels more comfortable or practical for you than a handheld figure-8 coil.

BrainsWay’s H1 coil is cleared for depressive episodes in adults with MDD who did not achieve satisfactory improvement from previous antidepressant treatment in the current episode. FDA clearance is device-specific, so a clinic should explain exactly which system and protocol are being offered.

Traditional figure-8 rTMS may be considered when:

• Your care team prefers a more focal stimulation approach.
• You are seeking a well-established conventional left-prefrontal protocol.
• The clinic’s available system uses figure-8 coils and is appropriate for your clinical history.
• A theta burst protocol may help reduce time spent in the treatment chair.

This does not mean that one technology is “stronger.” It means the treatment plan should match your diagnosis, history, preferences, safety screening, and practical needs.

What about theta burst stimulation?

Theta burst stimulation (TBS) is a patterned form of rTMS. Instead of delivering pulses in the traditional high-frequency pattern, it delivers brief bursts that imitate certain rhythmic patterns of brain activity.

The most commonly discussed depression protocol is intermittent theta burst stimulation (iTBS). In the THREE-D randomized non-inferiority trial, approximately three minutes of iTBS was found to be non-inferior to approximately 37 minutes of standard 10-Hz rTMS for reducing depressive symptoms (Blumberger et al., 2018).

This is why some TMS sessions can last as little as three minutes. However:

• A three-minute session is not the same as a three-minute treatment course.
• You may still need frequent visits over several weeks.
• Not every device offers the same TBS protocol.
• Your provider must confirm whether the protocol is appropriate and available.

Session length, treatment course, and side effects

TMS sessions often last about 20–40 minutes, depending on the device, coil, pulse pattern, and treatment settings. Standard BrainsWay H1 depression sessions have commonly used approximately 20-minute protocols, while traditional 10-Hz figure-8 rTMS may take approximately 37–40 minutes. Some TBS protocols are much shorter.

A typical acute course involves:

• Five sessions per week
• Four to six weeks of treatment
• Approximately 20–30 sessions
• Possible tapering or continuation sessions based on response

Common side effects include:

• Scalp discomfort or tenderness
• Headache
• Facial muscle twitching
• Jaw or neck discomfort
• Temporary lightheadedness or fatigue

A seizure is a rare but serious potential risk. TMS safety screening is especially important if you have a seizure history, significant sleep deprivation, certain neurological conditions, or metal or implanted electronic devices near the head. Always tell your provider about medications, supplements, implants, and recent health changes.

Self-pay TMS care in New Haven

If you are a self-pay client, you can still benefit from a structured evaluation rather than trying to choose a TMS technology on your own. At Light-tunnel Behavioral Health Services Inc., self-pay patients can ask about:

• Psychiatric evaluation and treatment planning
• Whether TMS treatment is available for their diagnosis and clinical history
• The specific coil and protocol being offered
• Session fees and expected course costs
• Scheduling options and payment expectations
• Medication management and therapy that may complement interventional care

Self-pay care may be helpful when insurance authorization is unavailable, coverage is limited, or you prefer to discuss treatment privately before making a decision. Contact the New Haven practice directly for current availability, pricing, and clinical eligibility.

Learn more about psychiatric evaluation services, medication management, and behavioral health services.

What to do before choosing a TMS system

Do:

• Ask which device, coil, and protocol will be used.
• Ask whether the recommendation is based on your diagnosis and treatment history.
• Confirm the expected session length and total number of visits.
• Discuss metal implants, seizure history, medications, and bipolar symptoms.
• Ask how progress will be measured.
• Tell your provider if discomfort is more than mild or if symptoms worsen.

Avoid:

• Assuming “Deep” automatically means more effective.
• Choosing a device based only on marketing claims.
• Stopping medication without prescriber guidance.
• Missing appointments without discussing a revised schedule.
• Treating TMS as a replacement for emergency psychiatric care.

At Light-tunnel Behavioral Health Services Inc., Dr. Omolola Aragbada, PMHNP, and the psychiatric care team can help you compare options within a compassionate, individualized plan.

Medical safety disclaimer and crisis resources

This article is educational and does not replace an evaluation by a qualified healthcare professional. TMS is a medical treatment, and eligibility, device selection, stimulation settings, risks, and expected outcomes must be determined individually. FDA clearances vary by device, coil, diagnosis, age group, and protocol.

If you are in immediate danger, experiencing psychosis or mania, or thinking about harming yourself:

• Call or text 988 to reach the Suicide & Crisis Lifeline.
• Call 911 or go to the nearest emergency department.
• Contact a trusted person and avoid being alone until help arrives.

References

1. O’Reardon JP, Solvason HB, Janicak PG, et al. Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biological Psychiatry. 2007;62(11):1208–1216. PubMed | DOI

2. Levkovitz Y, Isserles M, Padberg F, et al. Efficacy and safety of deep transcranial magnetic stimulation for major depression: a prospective multicenter randomized controlled trial. World Psychiatry. 2015;14(1):64–73. PubMed | Full text | DOI

3. Filipčić I, Šimunović Filipčić I, Milovac Ž, et al. Efficacy of repetitive transcranial magnetic stimulation using a figure-8-coil or an H1-coil in treatment of major depressive disorder: a randomized clinical trial. Journal of Psychiatric Research. 2019;114:113–119. PubMed | DOI

4. Blumberger DM, Vila-Rodriguez F, Thorpe KE, et al. Effectiveness of theta burst versus high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D): a randomised non-inferiority trial. The Lancet. 2018;391(10131):1683–1692. DOI

5. BrainsWay. Our TMS Treatments and FDA-cleared indications.

6. U.S. Food and Drug Administration. FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder.

Continue the Series

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