Depression after military service can feel different from ordinary sadness. You may be carrying combat memories, grief, chronic pain, sleep disruption, traumatic brain injury, survivor’s guilt, or the exhausting effects of staying constantly alert. When depression and post-traumatic stress disorder (PTSD) occur together, standard treatment may not provide enough relief.
If several antidepressants or therapy approaches have not helped, transcranial magnetic stimulation (TMS) may offer another path. TMS is a non-invasive, outpatient treatment that uses magnetic pulses to influence brain circuits involved in mood regulation. It does not require anesthesia, surgery, or a daily pill.
At Light-tunnel Behavioral Health Services Inc. in New Haven, Connecticut, TMS is considered as part of a personalized psychiatric treatment plan. Dr. Omolola Aragbada, PMHNP, is one of the psychiatric providers in the practice, where care may also include medication management, therapy, psychiatric evaluation, and interventional psychiatry.
Why Depression Can Become Treatment-Resistant in Veterans
Veterans experience substantial rates of depression, PTSD, anxiety, sleep problems, substance-use concerns, and chronic pain. These conditions can reinforce one another. For example, insomnia may increase emotional reactivity, while depression may reduce motivation to attend therapy or maintain social connections.
Treatment-resistant depression does not mean that you are beyond help. It usually means that your symptoms have not improved adequately after one or more appropriate treatment trials. The brain can become like a network of communication routes with a traffic signal stuck on red: medication may improve some signals, but the broader circuit may remain inefficient.
Antidepressants can be helpful, but they are not effective for everyone. You may also experience:
- Sexual side effects, nausea, weight changes, or fatigue
- Emotional blunting or reduced motivation
- Sleep disruption
- Interactions with other medications
- The burden of remembering a daily pill
- Delays while trying multiple medications to find the right fit
TMS takes a different approach. Rather than circulating throughout your body, magnetic stimulation is directed toward specific cortical regions, commonly the left dorsolateral prefrontal cortex for depression. Repeated stimulation may influence cortical excitability, synaptic plasticity, neurotransmitter activity, and communication between prefrontal and limbic networks.
How TMS Differs From Medication and ECT
TMS is often described as a drug-free treatment option, although some patients continue medication during TMS when clinically appropriate. It is also different from electroconvulsive therapy (ECT).
| Treatment | How it works | Typical advantages | Important considerations |
|---|---|---|---|
| Antidepressants | Change signaling through systemic medication exposure | Convenient; useful for many people; may treat multiple symptoms | Daily dosing; systemic side effects; may require several trials; response can be incomplete |
| TMS | Uses repeated magnetic pulses to stimulate targeted brain circuits | Non-invasive; no anesthesia or sedation; no routine systemic medication effects; generally no ECT-like memory effects; return to daily activities is usually possible | Requires frequent appointments; scalp discomfort or headache can occur; response is not guaranteed |
| ECT | Uses a medically controlled electrical stimulus under anesthesia to produce a therapeutic seizure | Often highly effective and may work rapidly in severe or urgent depression | Requires anesthesia and recovery time; temporary confusion and memory problems can occur; more invasive than TMS |
TMS is not a replacement for ECT in every situation. ECT may be considered when depression is severe, psychotic, immediately dangerous, or requires a rapid response. Your psychiatric provider should help you compare the options based on symptom severity, suicide risk, medical history, prior treatment response, and your preferences.
What the Research Shows
In a landmark multisite randomized controlled trial, O’Reardon et al. (2007) found that active figure-8-coil rTMS produced greater antidepressant benefit than sham treatment in adults with medication-resistant depression. This study helped establish conventional rTMS as an evidence-based option for treatment-resistant depression.
A later randomized controlled trial of Deep TMS using a BrainsWay H-coil found higher response and remission rates with active treatment than sham treatment. In the per-protocol analysis, response was 38.4% with Deep TMS versus 21.4% with sham, while remission was 32.6% versus 14.6% (Levkovitz et al., 2015).
Veteran-specific research is encouraging but requires careful interpretation. In a large VA randomized clinical trial of 164 veterans with treatment-resistant depression, Grammer et al. (2018) did not find a statistically significant difference between active rTMS and sham on the primary depression outcome. Both groups improved substantially, possibly reflecting the effects of intensive clinical contact, expectation, and concurrent care.
That result does not mean TMS cannot help veterans. It means that outcomes in veteran populations may be influenced by complex factors, including comorbid PTSD, traumatic brain injury, chronic pain, sleep disturbance, and multiple simultaneous treatments. A large naturalistic VA cohort reported clinically meaningful improvement in depression and PTSD symptoms among veterans receiving prefrontal TMS (Madore et al., 2022).
Where Does PTSD Fit In?
TMS is FDA-cleared for major depressive disorder, not as a universal stand-alone treatment for PTSD. Research on PTSD is developing, including studies of TMS combined with trauma-focused therapy. Some veterans experience improvement in both depression and PTSD symptoms, but TMS for PTSD alone may not be covered by the VA under current policy.
For that reason, TMS should usually be discussed as one part of a broader plan that may include Cognitive Processing Therapy, Prolonged Exposure, medication management, sleep treatment, and support for substance-use concerns.
Deep TMS, Figure-8 rTMS, and Theta-Burst Stimulation
Different TMS systems and protocols are not interchangeable. BrainsWay Deep TMS is one of the most researched TMS systems and uses an H-coil helmet designed to stimulate a broader and somewhat deeper volume of prefrontal tissue.
| Approach | Coil or pattern | General characteristics | Approximate session time |
|---|---|---|---|
| Traditional figure-8 rTMS | Focal figure-8 coil | More targeted, superficial cortical stimulation; commonly used for left prefrontal depression protocols | Often 20–40 minutes, depending on settings |
| BrainsWay Deep TMS | H-coil | Broader stimulation pattern designed to reach deeper prefrontal networks; supported by major depression RCT evidence | Often about 20 minutes, plus setup |
| Theta-burst stimulation (TBS) | Rapid patterned bursts | Uses bursts of stimulation to shorten treatment time; protocol and device determine duration | Some protocols last approximately 3 minutes; others are longer |
The exact duration depends on the system, target, motor threshold, and prescribed protocol. A typical acute course is five sessions per week for four to six weeks. Some TMS systems require sessions of approximately 20–40 minutes, while certain theta-burst protocols may last as little as three minutes.
Access for Veterans in New Haven
Veterans may be able to receive TMS through:
| Payment pathway | How it may work | What to confirm |
|---|---|---|
| VA treatment | TMS may be available at a VA medical center following evaluation and referral | Whether your VA facility offers TMS and whether you meet clinical criteria |
| VA Community Care | Under the MISSION Act, community treatment may be authorized when VA access or availability standards are met | Referral, contracted-provider status, and written prior authorization before beginning |
| Commercial insurance or Medicare | Many plans cover TMS for treatment-resistant depression when medical-necessity criteria are met | Diagnosis, prior medication trials, deductible, copay, and prior authorization |
| Self-pay | You can pay directly without waiting for an insurance authorization decision | Transparent pricing, payment options, scheduling, and whether a superbill is available |
VA policy generally supports TMS for qualifying major depressive disorder and OCD, with documentation of diagnosis, severity, and treatment resistance. Coverage rules can change, and PTSD alone may not qualify as a covered primary indication. Do not begin community TMS assuming the VA will reimburse you; obtain authorization first.
How Self-Pay Clients Benefit at Light-tunnel Behavioral Health Services Inc.
Self-pay can be useful when you are uninsured, out-of-network, facing a high deductible, or trying to avoid a lengthy prior-authorization process. At Light-tunnel Behavioral Health Services Inc., self-pay clients can ask about:
- Transparent pricing before beginning care
- No insurance prior-authorization wait
- Flexible scheduling around work, family, and transportation
- The same personalized psychiatric evaluation and treatment planning
- Sliding-scale availability or payment options when applicable
- Superbills for potential out-of-network reimbursement
You can also review the practice’s insurance information, TMS therapy resources, or contact Light-tunnel Behavioral Health Services Inc. to discuss eligibility.
What to Do and What to Avoid Before Starting TMS
Do
- Bring a complete list of medications, supplements, and substances.
- Report any seizure, fainting episode, head injury, stroke, neurological disorder, or traumatic brain injury.
- Tell your clinician about metal fragments, aneurysm clips, cochlear implants, neurostimulators, or other implants near your head or neck.
- Discuss bipolar disorder, mania, psychosis, suicidal thoughts, and substance or alcohol use.
- Attend sessions consistently; repeated stimulation is central to the treatment model.
- Use hearing protection as directed.
- Report persistent headache, scalp pain, unusual mood elevation, confusion, or other concerning symptoms.
- Continue therapy and medication exactly as prescribed unless your clinician changes the plan.
Avoid
- Stopping antidepressants or mood stabilizers without medical guidance.
- Hiding alcohol use, withdrawal risk, or recreational drug use.
- Assuming a faster protocol is automatically better.
- Treating TMS as a substitute for emergency care.
- Beginning treatment before the clinician completes implant and seizure-risk screening.
Safety Screening
Certain metallic or electronic implants near the head may make TMS unsafe because magnetic fields can move, heat, or interfere with devices. A seizure history is a significant precaution requiring individualized risk-benefit review; it is not automatically disqualifying in every case. Your clinician will also consider medications or conditions that may lower the seizure threshold.
Medical Disclaimer and Crisis Resources
This article is for education and does not diagnose you or recommend a specific TMS device, protocol, medication, or treatment schedule. TMS must be prescribed and administered by qualified professionals after a complete psychiatric, neurological, and medical evaluation. Possible side effects include headache, scalp discomfort, facial twitching, lightheadedness, hearing-related concerns, and, rarely, seizure. TMS is not appropriate for everyone.
If you may hurt yourself, cannot stay safe, or are experiencing an urgent psychiatric crisis:
- Call or text 988 for the Suicide & Crisis Lifeline.
- Veterans can call 988, then press 1 to reach the Veterans Crisis Line.
- Call 911 or go to the nearest emergency department if there is immediate danger.
Continue the Series
Read the next post: TMS Therapy for Depression: How It Works and Why New Haven Patients Are Turning to It in 2026
References
O’Reardon, J. P., Solvason, H. B., Janicak, P. G., et al. (2007). Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: A multisite randomized controlled trial. Biological Psychiatry, 62(11), 1208–1216. https://doi.org/10.1016/j.biopsych.2007.01.018
Levkovitz, Y., Isserles, M., Padberg, F., et al. (2015). Efficacy and safety of deep transcranial magnetic stimulation for major depression: A prospective multicenter randomized controlled trial. World Psychiatry, 14(1), 64–73. https://doi.org/10.1002/wps.20199
Grammer, G. G., Marci, C. D., Adebimpe, A., et al. (2018). Effect of repetitive transcranial magnetic stimulation on treatment-resistant major depression in US veterans: A randomized clinical trial. JAMA Psychiatry, 75(9), 884–893. https://pmc.ncbi.nlm.nih.gov/articles/PMC6142912/
Madore, M. R., Kozel, F. A., Williams, L. M., et al. (2022). Prefrontal transcranial magnetic stimulation for depression in US military veterans: A naturalistic cohort study in the Veterans Health Administration. Journal of Affective Disorders, 297, 671–678. https://doi.org/10.1016/j.jad.2021.10.025
U.S. Department of Veterans Affairs. Transcranial Magnetic Stimulation: Clinical Determination and Indication. https://www.va.gov/COMMUNITYCARE/docs/providers/CDI/IVC-CDI-00026.pdf