What Conditions Can TMS Treat?

What does TMS treat?
Note from the author, Taj Dhillon:
“So… What Exactly Can You Treat with TMS?”
If you’ve ever wondered whether Transcranial Magnetic Stimulation (TMS) is just for depression, or if it’s some kind of futuristic brain massage for anything that ails you – pull up a chair (preferably one with a head coil). This article dives into the full menu of disorders that TMS can treat – on-label, off-label, and everywhere in between. From treatment-resistant depression to OCD, smoking cessation, and even some of the off-the-record but promising new uses (like PTSD, chronic pain, and anxiety), we’re breaking down the science and the hype so you know what’s actually being treated. We’ll also touch on the crucial point that TMS clinics vary in their approaches, training, and expertise – and why it truly matters who’s driving the electromagnetic bus inside your brain. (Spoiler: scope of practice is not just a buzzword.) So whether you’re a curious patient, a fellow brain nerd, or someone who simply typed “can magnets cure my sadness?” into Google – we’re glad you’re here. Let’s demystify this magic (read: science) together.
Now that you know what TMS is, let’s dive into what it treats!

What does TMS treat?

In Canada, Transcranial Magnetic Stimulation (TMS), particularly its repetitive form (rTMS), is approved by Health Canada for the treatment of: 

  • Major Depressive Disorder (MDD), especially in cases resistant to traditional treatments. TMS has been approved for this indication since 2002. (Health Canada, 2002)
  • Obsessive-Compulsive Disorder (OCD). Certain TMS devices, such as those utilizing the H-coil design, have received approval for this use. This includes Brainsway technology, utilized at TMS Life. (BrainsWay Ltd, 2025)
  • Smoking Cessation. In 2022, Health Canada approved a specific rTMS device for short-term treatment aimed at helping individuals quit smoking.  (Canadian Medical Association Journal, 2024)

TMS is also being explored and utilized off-label in clinical settings across Canada for various other conditions, including:

When Science Says Yes (even if the label doesn’t yet) – a rundown of the term “off-label”:

You might notice that TMS is approved by Health Canada for conditions like depression and OCD, but it’s also used to treat PTSD, anxiety, and chronic pain. This is called off-label use—when a Health Canada-approved treatment is applied to conditions it hasn’t been formally approved for (Informed Health, n.d). Off-label use is common and accepted in medicine, especially in mental health, as long as it’s supported by strong clinical evidence and professional guidelines. It doesn’t mean the treatment is unsafe or unproven—just that it hasn’t yet gone through the lengthy and costly approval process for that specific condition.

We always follow the latest research, use protocols grounded in peer-reviewed studies, and personalize each treatment plan. You’ll never be treated with anything unproven or without your full understanding and consent. Think of off-label use as “not yet formally approved for this specific use, but well-studied and research-backed.”

However, off-label doesn’t mean “anything goes.” Clinicians must still practice within their scope. For example, neurological conditions are best managed by specialists in neurology, while psychiatric disorders are most appropriately addressed by mental health professionals.  

At TMS Life, we stay within our scope and specialize in the treatment of psychiatric and mental health conditions, including Major Depressive Disorder (MDD), anxious depression, anxiety, PTSD, and OCD. Patient safety, ethical practice, and evidence-based care are always at the core of what we do.  

Why is off-label use allowed?

Off-label use is permitted in Canada when a clinician determines that the potential benefits outweigh the risks. The treatment must be informed and voluntary, with clear documentation and patient consent explaining the experimental nature of the treatment if it falls under this category. (Law Business Research, 2022)

Here are some other parameters that must be taken into consideration (Health Canada, 2021; McGill Law Journal, 2014; Health Canada, 2018; Gowling WLG, 2023; Stikeman Elliott, 2023; Health Canada, 2024; University of Toronto Faculty of Law Review, 2005)

  1. Medical Expertise and Autonomy: Physicians use their professional judgment to choose the best treatment for patients, even without official approval for that condition.
  2. Scientific Evidence Exists: Often, high-quality research supports the treatment’s effectiveness for other conditions, it just hasn’t gone through the full regulatory process for those indications yet. 
  3. Approval Process is Slow: Health Canada approval is a long and expensive process. It may take years for a treatment that already works well to become officially approved for every possible use.
  4. Patient-Centered Care: Off-label use allows doctors to personalize treatment, especially when patients have already tried standard options without success.

Off-Label, On-Protocol: Where Science Meets Good Judgment

Informed Consent: Clinicians must inform patients the use is off-label and give them a chance to ask questions or decline

Ethical Guidelines: Doctors must use off-label treatments based on evidence, not speculation or profit.

Monitoring: Clinicians carefully track outcomes and adjust treatments if they do not help or cause side effects.

Example: Doctors across Canada use antidepressants like amitriptyline for chronic pain, despite no Health Canada approval, because studies and experience show they work.(CADTH, 2016)

Now, let’s hone in on some specific diagnoses that are commonly treated off-label at TMS Life that have shown treatment success with TMS.

Anxious Depression

Anxious depression is a subtype of Major Depressive Disorder (MDD) with prominent anxiety symptoms. Clinicians commonly treat anxious depression with TMS, even though Health Canada has not granted a separate indication. Depression and anxiety frequently co-occur. Studies show that approximately 60-70% of people with major depressive disorder (MDD) also experience some form of anxiety disorder during their lifetime (Health Promotion and Chronic Disease Prevention in Canada, 2017). The most common co-occurring anxiety disorders include: generalized anxiety disorder (GAD), panic disorder, and social anxiety disorder.

Why Comorbid Conditions Are Equally Important:

The high rate of comorbidity complicates diagnosis and treatment, as overlapping symptoms often occur (e.g., sleep disturbances, difficulty concentrating, fatigue). However, clinicians must recognize both conditions to plan effective treatment. Treating only one may result in incomplete recovery.

Comorbid conditions significantly impact clinical care, requiring a comprehensive treatment approach. When multiple diagnoses exist, clinicians tailor TMS to target shared or distinct neural circuits. This approach may use shared-region protocols or multiple coils to reach each condition’s brain areas.

Depression and anxiety often co-occur and involve circuits targeted by the BrainsWay H7 coil used in our clinic. The H7 coil actively stimulates the medial prefrontal cortex (mPFC) and anterior cingulate cortex (ACC). These structures regulate emotion, support cognitive control, and integrate mood with anxiety-related processes. Disrupted activity in these regions appears in depressive and anxiety disorders, especially in anxious depression.(Clear Path Psychiatry, 2025)

The BrainsWay H1 coil targets the DLPFC (dorsolateral prefrontal cortex), a region linked to depression. The H7 coil stimulates deeper areas like the mPFC and ACC as an alternative.

A protocol called iTBS (intermittent theta burst stimulation) delivers patterned magnetic bursts to modulate neural activity in target regions efficiently. This method may help relieve symptoms of anxious depression. (Brain Canada, 2024).

This approach helps address a wide range of symptoms across both conditions, giving our clients the best chance at meaningful recovery.

If Health Canada has not granted a separate indication for “anxious depression,” how do clinics worldwide use TMS to treat it, and how do they do it?

  1. Primary Diagnosis is MDD: Patients with treatment-resistant Major Depressive Disorder meeting TMS criteria qualify for treatment under Health Canada approval.
  2. Anxiety as a Specifier, Not a Barrier: Anxiety symptoms do not disqualify patients from TMS for depression. Many with MDD and anxiety improve in both areas.
  3. Clinical Judgment and Evidence-Based Practice: Clinicians use evidence and experience to support TMS for anxious depression, despite lacking formal approval. Numerous studies show left DLPFC high-frequency TMS improves depression and reduces anxiety symptoms.. (CANMAT, 2016; Health Canada, 2002)

Post-Traumatic Stress Disorder

Clinicians in Canada increasingly treat PTSD with TMS using off-label protocols based on clinical evidence, discretion, and patient demand. It is also important to consider the needs and treatment considerations of certain demographics with PTSD, like veterans.

Below is an outline of how the process of being treated for PTSD with TMS off-label works. But first, here’s some useful background information on the incidence of Post-Traumatic Stress Disorder in Canada:

According to the 2023 Survey on Mental Health and Stressful Events (SMHSE) conducted by Statistics Canada, approximately 8.4% of adults in Canada reported moderate to severe symptoms of post-traumatic stress disorder (PTSD) in the month prior to the survey. (The Daily, 2024)

Let’s also consider gender differences: 9.8% of women reported moderate to severe PTSD symptoms, while 6.9% of men reported moderate to severe PTSD symptoms. (CNS Neuroscience & Therapeutic, 2008).  Age also makes a difference: For those between 18 and 24 years old, 12.7% reported moderate to severe PTSD symptoms.  For those 65 years and older, 3% reported moderate to severe PTSD symptoms. (Statistics Canada, 2024).

Exposure to Potentially Traumatic Events (PPTEs):

The prevalence of PTSD symptoms increases with the number of different types of PPTEs experienced:

These findings highlight the significant impact of traumatic experiences on mental health and underscore the importance of accessible mental health support for those affected.

Post-traumatic stress disorder (PTSD) is notably more prevalent among Canadian veterans compared to the general population. A comprehensive study conducted by Veterans Affairs Canada, in collaboration with Statistics Canada, revealed that as of 2018, 22% of Canadian Armed Forces (CAF) members and veterans met the criteria for PTSD at some point in their lives.

As outlined above, a clinician would use peer-reviewed medical research and its results to determine whether a patient or client is a candidate for TMS treatment that shows promise in effectiveness.

In this case, here is a Canadian study that proves the effectiveness of TMS in PTSD: This randomized, double-blind, sham-controlled trial was conducted by researchers at the University of British Columbia and Vancouver General Hospital. The study aimed to evaluate the efficacy of low-frequency (1 Hz) versus high-frequency (10 Hz) rTMS over the right dorsolateral prefrontal cortex (DLPFC) in treating civilian patients with post-traumatic stress disorder (PTSD). Thirty-one participants were randomly assigned to receive 10 sessions of either 1 Hz rTMS, 10 Hz rTMS, or sham stimulation over two weeks. (ClinicalTrials.gov, n.d.)

Key Findings:

  • The 1 Hz rTMS group showed significant improvement in PTSD symptoms, as measured by the Clinician-Administered PTSD Scale (CAPS), compared to both the 10 Hz and sham groups.
  • The study suggests that low-frequency rTMS targeting the right DLPFC may be an effective treatment for PTSD.(The Canadian Journal of Psychiatry, 2020)

The BrainsWay H7 coil delivers magnetic pulses to the mPFC (medial prefrontal cortex) and ACC (anterior cingulate cortex), aiming to modulate neural activity associated with PTSD symptoms. (BrainsWay, n.d.) This approach is based on the understanding that these brain regions play a crucial role in processing traumatic memories and regulating emotional responses. (BrainsWay, 2020).

According to clinical research studies (above), protocols used to address PTSD symptoms are usually:

  • delivering a low frequency (1 Hz) treatment to the right DLPFC, targeting hyperactive fear circuitry (amygdala-prefrontal pathways
  • bilateral stimulation – some clinics combine right 1 Hz and left 10 Hz for dual modulation of both anxiety and depressive symptoms.
  • Intermittent Theta Burst Stimulation (iTBS)
  • Newer, shorter protocols targeting either right DLPFC or medial prefrontal cortex (mPFC) are also being trialed.

This is an example of start to finish of how clinicians arrive at the decision to treat a diagnosis very commonly addressed with TMS, but which is treated off-label.

Studies and clinical trials (especially in veterans) have shown significant symptom reduction in hyperarousal, intrusive thoughts, and mood.

Canadian clinics often follow protocols modeled after VA or NIH-funded research in the U.S. and adapt them to local practice. Alternatively, or in addition to TMS, symptoms of PTSD are also often treated with other treatments like medications or newer alternative therapies like ketamine. 

Now that we’ve explored which diagnoses TMS can treat, get ready for our next blog where we’ll explain how we determine the optimal dosage of electromagnetic pulses — a process called determining the motor threshold. This involves targeting the motor cortex, a region of the brain mapped to the fascinating “homunculus” — a distorted little figure that represents how different parts of your body are controlled by the brain. Using this brain map, we personalize your treatment based on your unique diagnosis and symptoms. Stay tuned for the science behind how we tailor TMS just for you!