Key points at a glance:
- Depression can affect more than mood. Many people also have trouble focusing, remembering things, or thinking clearly, often called “brain fog.”
- In a new study, patients with hard-to-treat Depression were able to process information faster after a full course of 30 TMS sessions. They also said that everyday tasks like planning and staying organized felt easier.
- Larger reviews of earlier research found similar improvements in thinking skills. In 7 of 9 studies of people with Depression, TMS helped with memory, focus, or other thinking skills.
- The research on TMS therapy for cognitive and mood enhancement is promising but still developing. The newest study was small, and more research is needed to show how much thinking skills improve for each person.
- At Mid City TMS, our team tailors each treatment plan to the patient and tracks changes in both mood and thinking skills during treatment.
Transcranial magnetic stimulation (TMS) has firmly established itself as a highly effective, non-invasive treatment for major depressive disorder, especially in patients who have not responded to antidepressant medications. But as the science evolves, researchers are uncovering something even more compelling:
TMS may improve not only mood, but also cognition and overall brain function.
A new study of patients with treatment-resistant Depression, presented at the Clinical TMS Society’s 2026 annual meeting, along with two recent systematic reviews, provides a deeper understanding of how TMS affects cognitive performance. These findings are particularly relevant for patients with Depression, where symptoms often extend beyond mood to include memory problems, poor concentration, and “brain fog.” These cognitive symptoms of Depression can affect work, relationships, and daily life.
Below, we break down this research on TMS therapy for cognitive and mood enhancement in greater detail and explain what it means for patients considering TMS at Mid City TMS.
New Research on TMS Therapy for Cognitive and Mood Enhancement in Treatment-Resistant Depression
Depression is associated with measurable deficits in processing speed, memory, and executive functioning. While 30 sessions of TMS to the dorsolateral prefrontal cortex (DLPFC) is the standard treatment course for treatment-resistant MDD, the study’s authors note that no known studies had examined cognitive changes after a full 30-session course.
In this study, researchers at Ball State University measured processing speed, working memory, and executive functioning in 15 patients with treatment-resistant MDD before and after 30 sessions of TMS. Participants received high-frequency repetitive TMS (rTMS) to the left DLPFC, followed by intermittent theta-burst stimulation (iTBS) to the right DLPFC, and five participants also received additional iTBS to the left DLPFC. Cognitive performance was evaluated with a battery of standardized neuropsychological tests.
After the full course, results were:
- Processing speed: significant improvement (p = .006)
- Self-reported executive functioning: significant improvement (p = .008)
- Working memory: no significant change (p = .19)
- Task-based executive functioning: no significant change after correcting for multiple comparisons (p = .04, against a corrected threshold of .0125)
The authors describe the improvement in processing speed as consistent with non-depressed individuals. The executive functioning results are more mixed: patients reported improvements in their day-to-day executive functioning, but those gains did not appear on task-based tests, a gap the authors identify as a priority for further research. Explore this question in more depth in our post on TMS and executive functioning.
These results are preliminary. The study was small, had no sham (placebo) comparison group, used a combined protocol that differs from a standard single-target course, and has been published as a conference abstract rather than a full peer-reviewed paper.
Supporting Study 1: Meta-Analysis of TMS Effects on Cognitive Function
The first supporting study, a 2023 paper in Frontiers in Neurology, is a systematic review and meta-analysis evaluating the effects of rTMS on cognitive performance across 25 randomized controlled trials.
Study Design and Scope
- Included 25 trials from 21 studies, involving 806 patients with:
- Mild cognitive impairment (MCI)
- Alzheimer’s disease
- Compared active TMS vs. sham (placebo) stimulation
- Assessed global cognitive function using standardized tests such as the Mini-Mental State Examination (MMSE), Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), and Montreal Cognitive Assessment (MoCA)
Key Quantitative Findings
Significant Improvement in Global Cognition
The meta-analysis found that active TMS produced statistically significant improvements in global cognitive scores compared to sham treatment (standardized mean difference 0.91 in the short term and at follow-up), and the improvement persisted at four-week follow-up. The authors note relatively small sample sizes and substantial variability between studies.
This suggests that TMS may produce measurable changes in overall cognitive function.
Stimulation Frequency Matters
Subgroup analyses suggested that moderate frequencies of 5 and 10 Hz were more effective than low-frequency (1 Hz) or higher-frequency (20 Hz) stimulation, and that patients with mild to moderate impairment responded better than those with severe impairment. The authors note that these subgroup findings need confirmation in further trials.
Targeting the Dorsolateral Prefrontal Cortex (DLPFC)
Stimulation of the left DLPFC, the same region used in Depression treatment, produced significant cognitive gains, with the largest effect among the DLPFC approaches studied. This area plays a central role in:
- Executive control
- Working memory
- Emotional regulation
This is highly relevant to Depression, where dysfunction in these same networks contributes to:
- Poor concentration
- Impaired decision-making
- Reduced cognitive flexibility
The overlap between cognitive and mood networks helps explain why TMS may improve both domains simultaneously. For a closer look at how TMS affects brain networks and neuroplasticity, see our post on how TMS treatment works.
Supporting Study 2: A Broader Review of TMS, Cognition, and Safety
The second study, a 2024 systematic review and meta-analysis in International Psychogeriatrics, takes a broader perspective, examining 143 studies (including 94 randomized controlled trials) involving about 5,800 participants. These included people with MCI, Alzheimer’s disease, other dementias, and nondementia conditions with cognitive impairment, including MDD.
Findings in Major Depressive Disorder
Of particular relevance to Mid City TMS patients, the review included nine randomized controlled trials of TMS in patients with MDD. Seven of the nine reported improved cognition, while two did not. Most of the review’s open-label studies also involved patients with MDD, and nearly all reported cognitive benefits; only two, both using bilateral DLPFC stimulation, found no improvement.
These improvements may not be merely secondary to mood changes. Several MDD studies noted cognitive benefits independent of improvement in Depression, and patients whose depressive symptoms improved with TMS sustained their cognitive gains. At the same time, the authors caution that because left DLPFC stimulation has known antidepressant effects, many studies cannot separate direct cognitive effects from improvements that follow better mood.
Findings in Cognitive Impairment and Dementia
- A meta-analysis of 25 sham-controlled trials in MCI and Alzheimer’s disease found large effects on all three standard measures of global cognition: the MMSE, the MoCA, and the ADAS-Cog.
- Of 34 sham-controlled trials in Alzheimer’s disease, 31 (91%) showed significant cognitive improvement.
- Memory and executive function: individual studies also reported improvements in specific domains such as memory, working memory, and executive function, although too few studies measured these domains for them to be pooled.
- The authors note that the average MMSE gains were smaller than the threshold usually considered clinically significant, that overall study quality was modest, and that protocols and outcome measures varied widely between studies.
What This Means for Patients with Depression
Although the two reviews include broader populations, the anchor study focused on treatment-resistant MDD, and the 2024 review includes nine randomized trials in MDD. Together they point to several practical takeaways about TMS therapy for cognitive and mood enhancement.
TMS Targets Brain Circuit Dysfunction
Depression is increasingly understood as a disorder of:
- Impaired connectivity
- Reduced neuroplasticity
- Dysregulated brain networks
TMS directly targets these circuits, rather than acting broadly on neurotransmitter levels throughout the body.
Cognitive Symptoms May Be Treatable
Many patients assume that:
- “Brain fog”
- Poor concentration
- Memory problems
are unavoidable parts of Depression. This research suggests otherwise: TMS may improve some of these symptoms, particularly processing speed. This is critical because many patients with Depression continue to struggle with functioning even after mood symptoms improve.
Full Treatment Course Matters
The new study measured cognitive changes after a full 30-session course, the standard for treatment-resistant MDD. This highlights the importance of:
- Completing the recommended number of sessions
- Maintaining consistency
- Following evidence-based protocols
The 2024 review also notes that most cognitive studies used 10 to 20 sessions, fewer than the 30-session protocol cleared by the FDA for MDD, which also uses higher intensity and more pulses per session. At Mid City TMS, treatment plans are designed to maximize these benefits.
Personalized Treatment Is Essential
Both reviews found that results varied based on:
- Stimulation parameters
- Target location
- Individual patient characteristics
The 2024 review’s authors call for more individualized approaches, noting that TMS protocols may eventually be guided by each patient’s symptoms and cognitive profile. This underscores the importance of individualized care.
Why TMS Is Different from Medications
Unlike antidepressants, which act broadly across the brain and body, TMS:
- Targets specific neural circuits
- Supports neuroplasticity
- May improve both mood and cognition
- Has minimal systemic side effects
This makes it particularly valuable for patients who:
- Have not responded to medications
- Experience cognitive side effects from drugs
- Want a non-pharmacologic treatment option
TMS at Mid City TMS
At Mid City TMS, we incorporate the latest scientific insights into every aspect of care. Our Medical Director, Bryan Bruno, MD, is an original member of the Clinical TMS Society, where the new study was presented, and we offer TMS therapy for cognitive and mood enhancement as part of a comprehensive Depression treatment plan.
Our approach includes:
- Targeting the dorsolateral prefrontal cortex using evidence-based protocols
- Monitoring both mood and cognitive symptoms
- Adjusting treatment parameters based on response
- Providing individualized, patient-centered care
We understand that Depression affects the whole brain, and the whole person.
Final Thoughts on TMS Therapy for Cognitive and Mood Enhancement
This research on TMS therapy for cognitive and mood enhancement provides encouraging evidence that TMS may be more than a treatment for mood symptoms, with potential benefits for cognitive function as well.
Key takeaways:
- TMS significantly improves global cognition, memory, and executive function
- Effects are strongest with higher frequency and adequate treatment duration
- TMS works by enhancing neuroplasticity and network connectivity
- Cognitive and emotional improvements are closely linked
- Functional recovery extends beyond symptom relief
For patients struggling with Depression, especially those experiencing cognitive symptoms, TMS offers a unique and scientifically grounded path to recovery. Learn how Mid City TMS can help. Contact us today online or call us at 212-517-1867 to make an appointment.
Sources
- Miller, S., Pierson, E., Segal, S., Finch, H., Bolin, J., Weber, C., Spies-Upton, S., & Youngblood, K. TMS effects on neuropsychological functioning in patients with treatment-resistant major depressive disorder. Transcranial Magnetic Stimulation. 2026;7. https://doi.org/10.1016/j.transm.2026.100235
- Yan, Y., Tian, M., Wang, T., Wang, X., Wang, Y., & Shi, J. Transcranial magnetic stimulation effects on cognitive enhancement in mild cognitive impairment and Alzheimer’s disease: A systematic review and meta-analysis. Frontiers in Neurology. 2023;14:1209205. https://doi.org/10.3389/fneur.2023.1209205
- Pagali, S. R., Kumar, R., LeMahieu, A. M., Basso, M. R., Boeve, B. F., Croarkin, P. E., Geske, J. R., Hassett, L. C., Huston, J. III, Kung, S., Lundstrom, B. N., Petersen, R. C., St. Louis, E. K., Welker, K. M., Worrell, G. A., Pascual-Leone, A., & Lapid, M. I. Efficacy and safety of transcranial magnetic stimulation on cognition in mild cognitive impairment, Alzheimer disease, Alzheimer’s disease related dementias, and other cognitive disorders: A systematic review and meta-analysis. International Psychogeriatrics. 2024;36(10):880–928. https://doi.org/10.1017/S1041610224000085