If you’ve been living with depression for a long time, you may already know how frustrating it can be to try treatment after treatment without getting the relief you hoped for. Medications help many people, but not everyone. Therapy is important, but sometimes it isn’t enough on its own.
That’s why more people are asking about TMS, or transcranial magnetic stimulation, a noninvasive treatment that works directly on the brain. TMS has been FDA approved for depression since 2008 and is supported by years of clinical research. What many people do not realize, however, is that how TMS is delivered can matter just as much as whether you try it.
This is something Dr. Joshua Kuluva, a board certified neurologist and psychiatrist, often discusses with patients who are exploring TMS as an option. His work focuses on treating complex brain based conditions and helping patients understand how advances in neuroscience translate into practical treatment decisions.
Why Depression Can Be So Hard to Treat
Depression is not a personal failure or a lack of effort. It is a medical condition that involves measurable changes in the brain.
Research shows that certain areas involved in mood, motivation, and decision making do not function in the same way in people experiencing depression. One key region is the prefrontal cortex, which plays an important role in emotional regulation and stress response. When this network is not functioning optimally, symptoms can persist even when someone is actively seeking help.
Understanding depression as a condition involving specific brain circuits has helped shift how clinicians think about treatment. Instead of viewing depression as a single uniform disorder, it is increasingly recognized as involving patterns of brain activity that may benefit from targeted intervention.
How TMS Works in Simple Terms
TMS uses magnetic pulses to stimulate a specific area of the brain linked to mood regulation. It does not involve surgery or anesthesia, and patients remain awake during treatment sessions.
Most TMS protocols follow a standardized method that has been used safely and effectively for many years. In conventional practices, the doctor identifies a treatment location on the scalp using established measurements and delivers stimulation there during each session. For many people, this approach leads to meaningful improvement in symptoms.
At the same time, brains are not identical. At Piedmont Neuroscience Center, rather than using scalp based measurements, they use a personalized MRI to find the individualized dorsolateral prefrontal cortex.
Why Precision Matters
Everyone’s brain anatomy varies slightly. The exact location of mood related brain (dorsolateral prefrontal cortex) regions can differ from person to person. Over time, researchers have learned that small differences in targeting may influence how the brain responds to stimulation.
The key insight from this research is not that TMS is unreliable, but that precision matters. As clinicians better understand how to engage mood regulating circuits, treatment approaches continue to evolve. This growing emphasis on precision reflects a broader shift in psychiatry toward treatments that are increasingly individualized and informed by neuroscience.¹
What New Research Is Teaching Us
More recent research suggests that refining how stimulation is targeted may improve outcomes in certain cases. In research settings, advanced imaging and connectivity studies have helped identify more precise ways to engage relevant brain circuits. While some of these approaches remain primarily within academic and research environments, they have influenced how clinicians think about treatment delivery more broadly.
Rather than focusing on whether a treatment works in a general sense, attention has increasingly turned toward how it is applied and how individual brain differences may shape response. This shift reflects a deeper understanding of depression as a condition rooted in brain networks rather than isolated symptoms.
What This Means for Patients Considering TMS
For individuals considering TMS, it can be helpful to understand that it is a well studied, noninvasive option for depression that works by stimulating brain areas involved in mood regulation. As research continues to refine delivery techniques, clinicians are better able to think carefully about how and when TMS may fit into an overall treatment plan.
Dr. Kuluva’s approach emphasizes education and individualized assessment. At Piedmont Neuroscience Center, TMS is not viewed as a standalone solution, but as part of a broader, brain based framework for understanding depression. Care decisions are guided by medical evaluation, clinical judgment, and thoughtful discussion of risks, benefits, and expectations.
The Bigger Picture
Depression is not only about brain chemistry. It involves communication between brain regions and the functioning of complex neural networks. TMS represents one way of engaging those networks directly and noninvasively.
Learning how TMS works and how it can be delivered with increasing precision can be both informative and reassuring. It reflects a growing understanding of depression as a brain based condition and highlights the importance of thoughtful, targeted care.
For individuals exploring options beyond medication alone, consultation with a clinician who understands both the neurological and psychiatric dimensions of depression can provide clarity. At Piedmont Neuroscience Center, conversations about TMS begin with careful evaluation and a shared discussion about whether this treatment aligns with each person’s goals and medical history. That measured, individualized approach is often where meaningful progress begins.
References
¹ Kuluva J, Warner D. Navigated TMS depression therapy. In: Krieg SM, Picht T, eds. Navigated Transcranial Magnetic Stimulation in Neurosurgery. 2nd ed. Springer; 2025