Transcranial magnetic stimulation (TMS) has become one of the most important advances in Depression treatment over the past two decades. For patients with treatment-resistant Depression, TMS offers a non-medication, noninvasive option that can provide meaningful symptom relief when antidepressants alone have not worked.
As TMS technology has developed, several forms of treatment have entered the market, and the deep TMS vs. rTMS question is one of the most common patients ask when comparing options. Repetitive transcranial magnetic stimulation (rTMS) and deep transcranial magnetic stimulation (deep TMS or dTMS) are the two most widely used approaches. Patients researching treatment are often told that deep TMS reaches deeper brain structures and may therefore be more powerful or effective. Current scientific evidence does not clearly support the idea that deep TMS is superior to standard rTMS for Depression treatment.
Understanding rTMS and Deep TMS
Repetitive transcranial magnetic stimulation uses rapidly changing magnetic fields to stimulate specific brain circuits involved in mood regulation. In Depression treatment, stimulation is typically directed at the dorsolateral prefrontal cortex, a brain region associated with emotional regulation and cognitive control. Traditional rTMS uses a figure-8 shaped coil positioned over a targeted area of the scalp, allowing relatively focused stimulation of superficial cortical regions. rTMS has been studied extensively in Major Depressive Disorder over many years and has received FDA clearance for treatment-resistant Depression, OCD, smoking cessation, migraines, and several other conditions.
Deep TMS uses a different coil, commonly called an H-coil, designed to stimulate a broader and somewhat deeper volume of brain tissue. Supporters of deep TMS often point to its ability to reach deeper brain structures, but the assumption that deeper stimulation automatically produces better antidepressant effects has not been proven in clinical trials. Depression is not caused by dysfunction in a single deep brain structure. It involves abnormalities across distributed brain networks, which is part of why conventional rTMS, without directly stimulating deeper structures, has remained effective for so many patients.
Deep TMS vs. rTMS: What Does the Research Actually Show?
The central question for patients is straightforward: does deep TMS work better than standard rTMS? At present, the answer appears to be no. A systematic review and meta-analysis comparing high-frequency rTMS using figure-8 coils with deep TMS using H-coils found that antidepressant outcomes were generally comparable between the two approaches, and researchers concluded that the existing data did not demonstrate a clear advantage for deep TMS.
More recent reviews reach similar conclusions. A 2025 comparison of the two approaches noted significant evidence gaps and limitations in the available studies, and the authors called for more rigorous head-to-head trials before any claims of superiority can be justified. That review identified only three direct comparative studies between standard figure-8 coil rTMS and deep TMS using the H1 coil, which shows how limited the head-to-head evidence remains. Deep TMS is often marketed as though it represents a major advancement over standard rTMS, but the scientific literature does not currently support that claim. Standard rTMS, by contrast, has a far larger evidence base, having been studied in thousands of patients across numerous randomized controlled trials, giving it considerably more extensive long-term safety and efficacy data than deep TMS systems currently have.
Why Patient Comfort Matters
Tolerability is another meaningful difference between the two approaches. Because deep TMS stimulates a larger and deeper volume of tissue, many patients report that treatment feels more intense. The H-coil system used in deep TMS often produces more widespread scalp muscle activation and facial discomfort compared to the more focused stimulation of a figure-8 coil.
Patient reports and clinical experience frequently suggest that deep TMS sessions can be harder to tolerate, with headaches, scalp pain, jaw discomfort, and other unpleasant sensations occurring more often than with rTMS. The 2025 review found that deep TMS tended to produce more treatment-related discomfort overall. In one comparative study, headache rates were higher with the H1 deep TMS coil, at 29%, compared with 20% for standard figure-8 rTMS. Muscle twitching, jaw pain, and spasms occurred in 12% of deep TMS patients, at notably higher rates than with standard rTMS, and pain at the treatment site was also more common with deep TMS. By contrast, most patients receiving standard rTMS describe the sensation as tapping on the scalp that becomes easier to tolerate as treatment continues.
Safety and Seizure Risk In Deep TMS vs rTMS
Seizure is one of the rare but important risks associated with all forms of TMS. Fortunately, seizures during properly administered TMS are extremely uncommon, and when clinical safety guidelines are followed, both rTMS and deep TMS are generally considered safe. Because deep TMS stimulates a broader volume of brain tissue, however, some clinicians and researchers have raised concerns that it could carry a somewhat higher seizure risk, since the larger stimulation field and greater neural recruitment may contribute to increased excitatory effects. While absolute seizure rates remain low for both approaches, there is no clear evidence of superior antidepressant outcomes with deep TMS that would justify accepting additional discomfort or potentially increased risk.
Why Precision Matters More Than Depth
A common misconception about deep TMS is the idea that more stimulation is automatically better. In neuroscience, this is not necessarily true. Brain stimulation is highly complex, and precise targeting often matters more than stimulating a larger area. Excessively broad stimulation may reduce specificity and increase unwanted side effects. Traditional figure-8 coil rTMS allows clinicians to target brain regions with more precision, and many experts believe that careful, individualized treatment planning matters more than simply increasing stimulation depth. Patients working through treatment options, including those considering what to expect with treatment-resistant Depression, are often better served by this kind of targeted approach than by marketing claims about depth alone.
Why Mid City TMS Uses rTMS
At Mid City TMS, we provide standard repetitive TMS treatment using figure-8 coil technology rather than deep TMS systems. This decision is based on the scientific literature, patient comfort, and safety data. We offer rTMS because it is:
- Supported by extensive scientific evidence
- FDA-cleared for treatment-resistant Depression
- Well tolerated by most patients
- Backed by long-term safety data
- Effective without requiring broader or deeper stimulation
- Associated with lower treatment discomfort for many patients
We do not offer deep TMS, because current evidence does not demonstrate superior effectiveness compared with standard rTMS, while deep TMS may involve greater discomfort and potentially higher seizure risk.
Deep TMS vs rTMS In Practice
In the deep TMS vs. rTMS comparison, the available evidence does not show that deep TMS consistently outperforms standard rTMS in Depression treatment outcomes. Several reviews have specifically called for better comparative studies before superiority claims can be justified, and patients considering TMS are better served by focusing on evidence quality, clinician expertise, treatment safety, and overall experience rather than marketing terminology.
At Mid City TMS, our commitment is to provide compassionate, scientifically grounded care using approaches supported by the best available evidence. Learn how Mid City TMS can help, or contact us today to schedule a consultation.
Sources
- Paganin, W., & Contini, L. M. (2025). Comparison of therapeutic efficacy in depression between repetitive TMS and deep TMS. Journal of neural transmission (Vienna, Austria : 1996), 132(8), 1113–1124. https://doi.org/10.1007/s00702-025-02944-w
- Cheng, J. L., Tan, C., Liu, H. Y., Han, D. M., & Liu, Z. C. (2023). Past, present, and future of deep transcranial magnetic stimulation: A review in psychiatric and neurological disorders. World journal of psychiatry, 13(9), 607–619. https://doi.org/10.5498/wjp.v13.i9.607