What Makes a Good TMS Candidate? Self-Assessment Guide



The ideal TMS candidate is someone with depression, anxiety, or OCD who hasn't found adequate relief from medication or therapy—or who wants to avoid medication altogether. TMS works best for people who are motivated, medically stable, and don't have certain contraindications like metal implants in the head or a history of seizures. If you've been told you're "treatment-resistant," you may actually be an excellent candidate—TMS response rates in this population range from 50-70% with traditional protocols, and up to 88% with accelerated approaches like our KIND One-Day Protocol.

The Real Question Behind "Am I a Candidate?"

When someone asks me if they're a good candidate for TMS, they're usually asking something deeper: "Is there still hope for me?"

Maybe you've tried three, five, eight medications. Maybe each one came with side effects that felt worse than the depression itself. Maybe you've been in therapy for years and still feel stuck. Maybe you've started to believe that feeling this way is just... who you are now.

I want you to know something: the fact that medications haven't worked doesn't mean you're broken. It doesn't mean your depression is "too severe" or "too complicated." It often means you just haven't found the right tool yet.

TMS works through a completely different mechanism than medication. It targets brain circuits directly rather than flooding your system with chemicals. So a history of medication failure isn't a strike against you—in many ways, it's the reason TMS might be exactly what you need.

Ideal Candidates for TMS

You may be an excellent candidate for TMS if:

You have depression that hasn't responded to medication. This is the classic profile. If you've tried two or more antidepressants without achieving remission—or if you achieved partial improvement but are still struggling—TMS offers a different approach that targets the problem at its source.

You can't tolerate medication side effects. Weight gain, sexual dysfunction, emotional blunting, fatigue—these side effects drive many patients away from medications even when they're somewhat helpful. TMS has none of these systemic side effects.

You want to avoid medication entirely. Some people don't want to take psychiatric medications for personal, philosophical, or practical reasons. TMS offers a non-pharmacological alternative.

You have OCD that hasn't responded to therapy and/or medication. TMS was FDA-cleared for OCD in 2018. For patients who've tried ERP therapy and SSRIs without adequate relief, TMS targets the brain circuits involved in obsessive-compulsive patterns.

You have depression with significant anxiety. Many patients have both depression and anxiety—what we call "anxious depression." TMS was FDA-cleared for anxious depression in 2020, and in clinical practice, we often see improvement in both conditions.

You're pregnant or planning to become pregnant. This is a population I'm especially passionate about. Depression during pregnancy is serious, but many medications aren't safe for the developing baby. TMS doesn't cross the placental barrier and is considered safe during pregnancy.

You're an older adult concerned about cognitive effects. Unlike ECT, TMS has no memory side effects. For elderly patients who need treatment for depression but can't tolerate medication side effects or ECT-related memory impairment, TMS is often the best option.

You're a teen who hasn't responded to first-line treatments. Emerging research supports TMS for adolescents with treatment-resistant depression. For parents concerned about long-term medication effects on a developing brain, TMS offers an alternative.

You're on multiple medications for other conditions. Because TMS doesn't involve adding another medication, there are no drug interactions to worry about. For patients already managing complex medication regimens, this is a major advantage.

An Informal Self-Assessment

Consider how many of the following apply to you:

Your Depression/Anxiety History:

- I've been diagnosed with depression, anxiety, or OCD by a healthcare provider

- My symptoms have been present for months or years, not just a few weeks

- My symptoms significantly impact my daily life, relationships, or work

- I've tried at least one antidepressant without adequate improvement

- I've experienced troublesome side effects from psychiatric medications

- I've tried therapy but still struggle with symptoms

Your Treatment Goals:

- I want a treatment that doesn't require daily medication

- I prefer to avoid systemic side effects like weight gain or sexual dysfunction

- I want treatment that won't affect my cognitive clarity

- I'm willing to commit to a treatment protocol (whether daily sessions for weeks or an accelerated approach)

- I'm motivated to feel better and ready to take action

Your Medical Situation:

- I don't have metal implants in or near my head (cochlear implants, aneurysm clips, deep brain stimulators)

- I don't have a history of seizures or epilepsy

- I'm not currently experiencing active psychosis

- I'm generally medically stable

Scoring (Informal):

If you checked most items in the first two sections and none of the contraindications in the medical section, you're likely a good candidate for evaluation.

If you're unsure about any medical factors, that's exactly what a consultation is for—we can review your specific situation and determine candidacy together.

Who Should NOT Have TMS

TMS is remarkably safe, but it's not appropriate for everyone. Here are the main contraindications:

Absolute Contraindications:

Metal implants in or near the head. This includes:

- Cochlear implants

- Deep brain stimulators

- Aneurysm clips or coils

- Metallic implants in the skull

- Bullet fragments or shrapnel near the head

Dental work is generally fine. Fillings, crowns, braces, retainers, and dental implants don't interfere with TMS and aren't a safety concern.

History of seizures. If you've had seizures from any cause—epilepsy, head trauma, medication-induced, or otherwise—TMS is typically not recommended. The magnetic pulses can potentially trigger seizures in susceptible individuals.

Active epilepsy. Patients with a current diagnosis of epilepsy or seizure disorder are not candidates for TMS.

Relative Considerations (Evaluated Case by Case):

Certain cardiac devices. Pacemakers and other implanted cardiac devices need to be evaluated individually. Some newer devices may be compatible with TMS; others aren't.

History of traumatic brain injury. Depending on severity and any resulting structural changes, TBI may or may not preclude TMS.

Certain neurological conditions. Some conditions affecting the brain may require additional evaluation.

Active substance abuse. While TMS can help with addiction, active intoxication or withdrawal can affect treatment safety and efficacy.

What About "Treatment-Resistant" Depression?

Let me address this label directly, because I think it creates unnecessary hopelessness.

"Treatment-resistant depression" typically means you haven't responded to two or more adequate trials of antidepressant medications. It's a clinical definition used for insurance purposes and research classification.

But here's what it actually means: the tools you've tried so far haven't worked. That's it.

It doesn't mean your depression is incurable. It doesn't mean you're a "difficult case." It doesn't mean there's something uniquely wrong with your brain.

In fact, patients with treatment-resistant depression often respond beautifully to TMS—precisely because TMS works through a different mechanism than medication.

The STAR*D trial showed that only 37% of patients achieve remission with the first antidepressant. With each subsequent medication trial, the odds get worse. By the fourth attempt, remission rates drop below 7%.

But TMS response rates in treatment-resistant patients? 50-70% with traditional protocols. Up to 88% with accelerated approaches in our published research.

So if you've been labeled "treatment-resistant," don't lose hope. You may actually be an ideal candidate for TMS.

Special Populations: Where TMS Really Shines

Pregnant Women

Depression during pregnancy affects 10-20% of women and carries real risks for both mother and baby. But many antidepressants cross the placenta, and their effects on fetal development remain concerning.

TMS is localized to the brain. It doesn't circulate systemically. It doesn't cross the placental barrier. For pregnant women with depression, TMS offers a way to get treatment without exposing the baby to medication.

Older Adults

Elderly patients often can't tolerate antidepressant side effects—falls from dizziness, cognitive effects, drug interactions with their other medications. And while ECT can be effective, the memory side effects are particularly concerning in this population.

TMS has no cognitive side effects. No systemic side effects. No drug interactions. For older adults who need depression treatment, it's often the safest effective option available.

Teenagers and Young Adults

Parents understandably worry about putting their children on psychiatric medications—especially long-term. The developing brain is different from the adult brain, and we don't fully understand how years of antidepressant exposure might affect it.

Emerging research supports TMS for adolescents with treatment-resistant depression. While more studies are needed, TMS offers families an alternative when medication hasn't worked or isn't desired.

Patients on Multiple Medications

If you're already taking medications for diabetes, blood pressure, thyroid issues, and who knows what else, adding another medication means more potential interactions, more side effects, more complexity.

TMS doesn't interact with your other medications. It's a separate treatment modality that doesn't add to your pill burden.

Beyond Depression: Other Conditions TMS Can Help

While depression is the most common reason people seek TMS, it's FDA-cleared for several conditions:

OCD (FDA-cleared 2018) — TMS targets the anterior cingulate cortex and related circuits involved in obsessive-compulsive patterns.

Anxious Depression (FDA-cleared 2020) — Depression accompanied by significant anxiety often responds well to TMS.

Smoking Cessation (FDA-cleared 2020) — TMS can reduce cravings by modulating reward circuits.

Research is also exploring TMS for:

- PTSD

- ADHD

- Chronic pain and fibromyalgia

- Autism spectrum disorder (for specific symptoms)

- Cognitive decline

- Migraines

If you have one of these conditions and haven't found relief from other treatments, it's worth discussing TMS as a potential option.

Questions to Consider Before Your Consultation

To make the most of your consultation, think through these questions ahead of time:

About your condition:

- How long have you been struggling with depression, anxiety, or OCD?

- What symptoms affect you most significantly?

- How do your symptoms impact your daily life, work, and relationships?

About your treatment history:

- What medications have you tried, and what happened with each?

- Have you tried therapy? What type, and for how long?

- What side effects have you experienced from treatments?

About your goals:

- What does "feeling better" look like to you?

- Are you hoping to reduce or eliminate medication?

- What's most important to you in a treatment—speed, convenience, durability?

About logistics:

- Can you commit to daily appointments for several weeks (traditional TMS)?

- Or would an accelerated protocol (like our KIND One-Day Protocol) better fit your life?

- What are your insurance and budget considerations?

The Bottom Line

If you're reading this, you're probably wondering whether TMS might finally be the thing that helps.

Here's what I can tell you: TMS has helped people who had completely given up hope. People who had tried everything. People who had been told—directly or indirectly—that they would just have to learn to live with their depression.

That doesn't mean TMS works for everyone. Nothing does. But the response rates are strong, the safety profile is excellent, and the mechanism is entirely different from what you've probably tried before.

If you're medically appropriate and genuinely motivated to feel better, TMS might be exactly what you've been looking for.

The only way to know for certain is to have a proper evaluation.

Ready to Find Out If You're a Candidate?

At Kind Minds, our complimentary consultation is designed to answer this question definitively. We'll review your history, discuss your goals, and give you an honest assessment of whether TMS is likely to help your specific situation.

No pressure. No sales tactics. Just clear information to help you make the right decision.

Schedule Your Complimentary Consultation →

*Medical Disclaimer: This self-assessment is for informational purposes only and does not constitute medical advice. Only a qualified healthcare provider can determine TMS candidacy after a thorough evaluation. Individual results vary.*

About the Author

Dr. Georgine Nanos, MD, MPH, is a board-certified physician and founder of Kind Minds in Encinitas, California. She has evaluated thousands of patients for TMS candidacy and helped hundreds find the right treatment path—whether that's TMS, a different approach, or a combination of modalities. Her published research on the KIND One-Day TMS Protocol documents some of the strongest real-world outcomes ever reported.