Find relief from trauma and get back to living life.

When experiencing a real or perceived life-threatening situation, the brain will shift into ‘reptilian brain,’ prioritizing pure instinct and survival. It enters into the fight or flight mode and activates basic brain structures that keep the brain in a heightened sense of awareness and safety.

Once the threat has passed, the brain will typically down-regulate itself and return to its everyday default mode. Depending on the severity and repetitiveness of the stressful trauma, however, and the genetic predisposition of the individual, this may not occur effectively. Similar to circuits that become stuck and dysfunctional in clinical depression, certain pathways become fixed in a fight or flight response in PTSD.

We all have different reactions to stressful and traumatic events and anyone can develop PTSD depending on the circumstances. Increased risk factors include:

Research has shown the brain actually changes biologically following traumatic experiences. Three significant brain areas become ‘dysregulated’ in PTSD:

Unsurprisingly, a combination of any of the above symptoms can severely interfere with everyday activities resulting in:

Furthermore, PTSD often occurs or causes parallel mental health issues such as:

Similar to other psychiatric conditions such as Major Depressive Disorder, the mainstay of treatment for PTSD involves medications and specific types of therapy.  Therapy typically involves common approaches such as CBT (cognitive behavioral therapy) or more targeted therapy such as EMDR (eye movement desensitization and reprocessing), CPT (cognitive processing therapy), or exposure therapy. As is the case with Major Depression, however, PTSD treatment can often be resistant to these approaches. A recent meta-analysis showed that less than half of patients receiving trauma focused therapy achieved a meaningful response to treatment, some two-thirds of patients failed to achieve remission, and one-third dropped out of treatment. And the effect size for medications was even less than for therapy.²

TMS offers a unique approach and compelling results in the treatment of PTSD.  Numerous studies have shown TMS to be an effective treatment option for PTSD when medications and therapy have not worked. Different protocols have been utilized in an attempt to treat the core symptoms of PTSD, but most, similar to depression treatment, also target an area of the brain called the dorsolateral prefrontal cortex. This area on the surface of the brain is involved in regulating deeper brain structures and can affect key areas of the brain that are involved in PTSD symptoms such as the amygdala and hippocampus. What do the studies show? 

Research has been going on for quite some time with TMS treatment for PTSD. A meta-analysis from 2014 summarized that TMS treatment for PTSD was effective and that the effect size was similar to TMS treatment for Major Depression.³ Studies reviewed included RCTs (randomized controlled studies) - the gold standard for research - and utilized validated rating scales for PTSD such as the PCL-5 (PTSD checklist) and the CAPS-5 (clinician administered PTSD scale). Some of the studies utilized as few as 10 treatments in two weeks and were found to be beneficial, but more sessions and more pulses per session tended to show greater improvement in symptoms.

More recent meta-analyses reviewing TMS treatment for PTSD have found similar and even more robust findings.⁴⁵⁶ RCTs have consistently shown at least one-third of patients with improvement on PTSD rating scales and others have been closer to one-half of patients experiencing significant response. Longer term response data is more limited, but points to at least 2-3 months of sustained response following treatment and a more recent paper has found benefit with TMS up to 1 year post treatment.⁷

In 2021, the VA implemented a nationwide study to evaluate clinical outcomes in veterans being treated with TMS.⁸ While the primary inclusion criteria for this study was Major Depression, around 68% of the patients in this study also suffered from comorbid PTSD, and both Major Depression and PTSD responses were measured. Of the 340 veterans with comorbid PTSD, 65.3% showed response and 46.1% no longer met threshold criteria after receiving an adequate dose of TMS.

Read more: TMS success rate →

Another study, which examined TMS as a monotherapy for PTSD and compared a 1 Hz protocol to a 10 Hz protocol, also found clinically significant improvements in PTSD symptoms after 30 TMS treatments.⁹ This study utilized multiple rating scales to evaluate response and remission results, and they found that around 29-46% of patients experienced response and 21-33% experienced remission (depending on rating scale). In addition to these findings, they also saw that both the 1 Hz and 10 Hz groups showed similar improvements in both PTSD and depressive symptoms, and these improvements were sustained at a 3 month follow up. 

As listed above, a number of studies have shown very good results with TMS. It is not currently FDA approved for the treatment of PTSD, but often utilized off-label as PTSD can frequently be treatment resistant. As noted, other psychiatric conditions also commonly co-occur with PTSD. Major Depression occurs in some half of all PTSD sufferers. In light of this, additional treatment protocols that target PTSD more specifically can often be added into TMS being utilized to treat Major Depression at the same time. Interestingly with TMS for PTSD, a right-sided treatment target (as opposed to left-sided used in Major Depression) often provides benefit. An inhibitory vs excitatory protocol can also be tried based on response to treatment and based on specific symptoms of PTSD that are present.

Read more: TMS for sleep disorders & insomnia→

Currently, repetitive Transcranial Magnetic Stimulation-rTMS, can be considered for patients with PTSD who have not responded to or tolerated standard treatments such as:

It also can be a good add-on treatment option for those already receiving TMS for Major Depression. Inspire TMS Denver does not charge additional fees for add-on treatments. And our out-of-pocket rates for those seeking care outside insurance coverage are competitive. Read more: TMS therapy cost  →

TMS has an excellent track record for treatment-resistant disorders such as PTSD.

TMS therapy remains a relatively new therapy only receiving FDA approval for Treatment Resistant Major Depression in 2008. However, thousands of publications and studies have taken place over the last decade-plus since then, exploring it’s benefit for other conditions such as PTSD.

As with TMS therapy for Major Depression, TMS therapy for PTSD follows a similar course - 5 sessions per week for 6 weeks with a 3-week taper following. Individual treatment plans may vary, however. Similarly, response times vary with TMS.  Some patients experience relief from symptoms in just one to two weeks, while others take four to six weeks and may require modifications to treatment parameters and/or additional treatment sessions. More questions about TMS Therapy for PTSD or other content on this page? Please contact us here to see about a free phone consultation.